Flashcards in Pharm 5 Cardio pt1 Deck (24)
Why hypertension is bad in younger ppl:
: its effects last a long time. Avoiding sequelae (such as CHF) is a big goal of treating hypertension
How does hypertension prevalence compare by gender and age?
A higher percentage of men than women have high BP until age 45.
From ages 45 to 54, the proportions of men and women with high BP are similar.
In the older age groups, more women than men have high BP, with prevalences reaching about 84% among women aged 75 or older and 70% in men in the same age category.
The JNC guidelines were developed in response to:
the implementation of the National High Blood Pressure Educational Program in 1972 to raise awareness of the prevalence of and need for treatment standards for patients with hypertension.
JNC7 has >__ drugs for Hypertension
Hypertension-related Comorbidities (3)
Of people with BP >140/90 mm Hg:
69% with first MI
77% with first stroke
74% with heart failure
Precedes heart failure in 91% of cases
Associated with a 2- to 3-times higher risk for heart failure
The Prospective Studies Collaboration
found that the risk for vascular death for each decade of age was the same down to a usual systolic BP of at least __ mm Hg and a usual diastolic BP of at least __ mm Hg.
Below those levels there was little evidence of an association.
Meta-analysis of 17 trials revealed that a reduction of __mm Hg in DBP reduced:
stroke mortality 40%
coronary heart disease mortality 16%
5-6 mm Hg
Even minimal reductions in BP have dramatic improvements overall.
Rationale of hypertension prevention
Primary prevention stops the costly cycle of managing hypertension and its complications
What defines *Resistant Hypertension?
someone who is on triple drug therapy at optimal doses, 1 of those 3 drugs is a diuretic, and their bp is still not controlled.
3 types of hypertension control therapies
Monotherapy 50 - 60% of patients
Two-drug therapy 80 - 85%
Triple-drug therapy 90 - 95% (older patients)
Major Classes of Antihypertensive Agents (7)
Diuretics (make you pee)
Beta-adrenergic receptor blockers (-blocker)
Alpha-adrenergic receptor blockers (-blocker
Calcium channel blockers (calcium antagonists or CCBs)
Angiotensin-converting enzyme inhibitors (ACE-inhibitor)
Angiotensin II receptors blockers (ARBs)
DRIs (a direct renin inhibitors, one drug in this class)
Many antihypertensive agents can be combined, name 3 classes that usually are NOT combined.
ACE, ARB, DRIs usually are not combined.
Definition of Hypertension.
Can be caused by (5)
Elevation of arterial blood pressure above 140/90 mm Hg
Can be caused by:
An underlying disease process (secondary hypertension): Exogenous substances (caffeine, cocaine, etc.), Renal artery stenosis, Hyperaldosteronism, Pheochromocytoma.
Idiopathic process (primary or essential hypertension)
Stages of Hypertension
Stage 1: 140-159/90-99
Stage 2: 160-179/100-109
Stage 3: >179/>109
Are stats on Hypertension surrogate data or outcomes data? What does that mean?
these patients are outcomes data. You can’t tell if a specific patient with BP 200/100 will have problems, just that the population with that BP has had problems.
Surrogate data is something physical we can measure.
3 most important risk factors that increase mortality associated with htn.
What's the next most important after that?
Age > 60
Gender: men, postmenopausal women
(things you can't change)
Nest most important: smoking
3 ways of lowering blood pressure
Reduce cardiac output (ß-blockers, Ca2+ channel blockers)
Reduce plasma volume (diuretics)
Reduce peripheral vascular resistance (vasodilators)
What Provides revised guidelines for management of hypertension?
JNC VII Recommendations (3), depending on BP
Anyone 120/80: lifestyle modifications, get a htnsive drug with a COMPELLING INDICATION (comorbidities that are treated with antihypertensive drugs: Diabetes, Renal Disease, CAD, Angina, CHF)
>140/90: Lifestyle modifications, drugs even without a compelling indication
**What is a 'compelling indication' to put someone on a hypertensive drug? And what drugs would you do (4)
Diabetes mellitus: ACE-inhibitor, ARB if intolerant of ACE-I
Heart failure: ACE-inhibitor, diuretics
Isolated systolic hypertension (elderly): Long-acting dihydropyridine calcium channel antagonists (CCBs)
Myocardial infarctions: beta-blockers, ACE-inhibitor
only the systolic # is raised, diastolic is still normal.
Monotherapy for Hypertension (5 types)
Ca2+ channel blockers
ACE inhibitors, ATII antagonists and DRIs
What's the problem with alpha-blockers?
**Putting them on alpha blockers can make ppl very dizzy, and have syncopal episodes for first few days on the drug. They’ll get out of bed at 3am, have a syncopal episode and break their hip.
Tell them how to carefully get up to prevent this from happening.