Flashcards in Antihypertensives Deck (80)
What are normal blood pressure values?
What is prehypertension?
What are hypertensive blood values?
T/F Hypertension can include only high values on systolic and diastolic pressures.
FALSE; if you have systolic or diastolic high, then it is considered hypertension.
What are some "classes" that differ in BP values?
- Gender (post-menopausal women have higher BP than men, pre-menopausal women have lower BP than men)
- Race (AA have higher BP than white counterparts)
- Age (elderly individuals have higher BP than younger counterparts)
What percentage of patients get adequate treatment in HTN?
What is essential to diagnose HTN?
What diseases or drugs contribute to Secondary HTN? (6)
(1) Renal disease
(2) Endocrine disease
(3) Hyperthyroidism (increased CO)
(4) Narrowing of aorta (coarctation)
(5) Toxemia of pregnancy
(6) Oral contraceptives (2-3x more than the others- especially in obese and older women)
What are the factors for Essential HTN? (5)
(1) Alterations in cardiovascular control
(2) Humoral factors: R-A-A, catecholamines
(3) Genetic factors (30%)
(4) Life-style: SALT, diet, weight, working conditions
(5) Psychogenic factors (STRESS)
What are the multi-target complications of HTN? (5)
(1) Brain: Hemorrhage, stroke
(2) Eye: Retinopathy
(3) Vasculature: Peripheral vascular disease (atherosclerosis)
(4) Kidney: renal failure (nephrosclerosis)
(5) Heart: heart disease
In the presence of this disease, all complications of HTN become worse in what situation?
What are the increased work loads on the heart during HTN?
(1) L.V. hypertrophy (enlargement)
(2) Ischemic Heart disease --> M.I.
(3) Heart Failure (10-20% of all deaths)
What are the 4 anatomic sites of blood pressure control?
(1) Resistance- arterioles
(2) Capacitance- venules
(3) Pump Output- heart
(4) Volume- KIDNEYS
What are the 2 BP control mechanism in HTN patients?
(2) Renal blood volume- pressure control systems
What happens to these BP control mechanisms in HTN patients?
The baroreceptors and renal blood volume systems are at a higher value (therefore, HTN remains)
What is the short-term BP mechanism?
Baroreflexes (moment-to-moment adjustments)
What is the long-term BP mechanism?
Kidneys (intravascular blood volume)
How many classes of drugs are there to treat HTN?
What are the major sites of action of Antihypertensive drugs?
(1) SNS (CNS also)
(2) Renal loop
(3) Vascular smooth muscle
What are some aspects of non-pharmalogical therapy of HTN? (8)
(1) Low sodium chloride diet
(2) Weight reduction
(4) Cessation of smoking
(5) Decrease in excessive alcohol consumption
(6) Psychological methods (e.g. relaxation)
(7) Dietary increase in polyunsaturated fat intake
(8) Dietary increase in fruits, vegetables
What are the Non-selective and Beta-1 selective Beta-Blockers?
(1) Propranol: Nonselective
(2) Metoprolol: B-1 selective
What are the responses to Beta-blockers (Propranolol, Metoprolol)? Which one is predominant?
**(1) Decrease contractility, HR, CO, BP**
(2) Decrease renin release, prevents ANG-II formation, decrease BP
What are the precautions for Beta-blockers?
(1) Heart failure
(2) Diabetes- interferes with glucose metabolism
What are the adverse effects of Beta-blockers?
(1) Fatigue, disturbing dreams, nausea
(2) GI discomfort
(4) Occasional impotence
What Beta-blocker are the asthmatics prescribed? Why?
Metoprolol; because the non-selective beta-blockers will antagonise B-2 as well and cause bronchial constriction
What are the Thiazide Diuretics?
What does Hydrochlorothiazide do?
(1) Inhibits Na transport by depleting Na stores (decreases the constrictor response)
(2) Decreases blood volume, CO, BP
(3) Chronic use: decrease PR, BP
What are the adverse effects of Hydrochlorothiazide?
(3) Increase LDL cholesterol
What happens when you use Hydrochlorothiazide over 6-8 weeks?
The CO goes back to normal, yet you have a decrease in peripheral resistance that in turn keep the decrease in BP