L7 - Hypertension

Question 1

What is hypertension defined as?

Answer 1

consistent diastolic reading over 90mmHg (or 140mmHg systolic)

Question 2

Why is controlling BP important?

Answer 2

high blood pressure causes damage to important organs and is a major risk factor for cardiovascular disease

Question 3

What are the causes of hypertension?

Answer 3

• primary essential hypertension: cause cannot be identified
• secondary hypertension: identifiable cause (majority renal origin)

Question 4

What is the relationship between hypertension and oral health? Why?

Answer 4

• 1/3 patients with gum disease develop hypertension
• because poor oral hygiene = plaque formation
• plaque enters bloodstream
• builds up in vessels
• restricts blood flow = increased BP

Question 5

What are the 4 different aims of treatment in treating hypertension?

Answer 5

• reduce HR and CO
• produce vasodilation
• reduce blood volume
• RAAS modulators

Question 6

What is the green script?

Answer 6

• instruction to improve lifestyle prior to commencing drug treatment options for hypertension
• includes: regular exercise, reduce weight, salt restriction, smoking

Question 7

What are thiazides used for?

Answer 7

first line treatment for mild to moderate hypertension

Question 8

How do thiazides work?

Answer 8

• block the Na/Cl transporter in the distal tubule

- blood volume decreases and urine volume increases to maintain Na+ concentrations

Question 9

What are the adverse effects of thiazides?

Answer 9

• hypotension (dizziness)

- loss of electrolytes such as K+ (due to ATPase activity to compensate Na+ loss)

Question 10

What is an example of a thiazide?

Answer 10

chlorothiazide

Question 11

How do diuretics work?

Answer 11

• act on kidney
• increase sodium excretion in urine (therefore water too)
• reduced blood volume = reduced BP

Question 12

What are RAAS drugs used for?

Answer 12

second line treatment for hypertension

Question 13

What are the RAAS drugs?

Answer 13

• ACE inhibitors

- ARBs

Question 14

What are the ATII receptors?

Answer 14

• AT1 produces the pathological effects = increased BP (vasoconstriction + Na+ retention)
• AT2 produces the beneficial effects = decreased BP (vasodilation due to NO + Na+ excretion)

Question 15

What is an example of an ACE inhibitor?

Answer 15

cilazapril

Question 16

How do ACE inhibitors work?

Answer 16

• inhibit ACE enzyme to prevent ATII formation and decrease aldosterone release
• reduced AT1 receptor activation = reduced BP but also no beneficial AT2 effects
• decreased sympathetic activity = vasodilation and Na excretion to reduce BP

Question 17

What are the adverse effects of ACE inhibitors?

Answer 17

• cough
• angioedema
• hypotension
• rash

Question 18

How does ACE inhibitor cause a cough?

Answer 18

• ACE involved in bradykinin breakdown
• ACE inhibitor leads to bradykinin accumulation = cough
• bradykinin also causes vasodilation = decrease BP

Question 19

What is an example of ARBs?

Answer 19

losartan

Question 20

How do ARBs work?

Answer 20

• antagonist for AT1 receptors = still get beneficial AT2 effects
• causes vasodilation
  prevents vasoconstriction + reduced sympathetic activity

Question 21

What are the adverse effects of ARBs?

Answer 21

• well tolerated (no cough due to bradykinin accumulation)

- hypotension related side effects