Systemic Arterial Hypertension

Question 1

Treatment options for systemic arterial hypertension

Answer 1

Life style changes
Diuretics
B-blockers
ACE I inhibitors
Ca Channel blockers

Need to target primary cause too

Question 2

Life style changes

Answer 2

Not used in veterinary medicine

Question 3

Diuretics

Answer 3

Only used in emergency settings
E.g. Furosemide when in CHF

Decreases fluid retention
Increase renal Na and water excretion

Lead to volume depletion

Question 4

How do B blockers work?

Answer 4

Act on B adrenergic receptors
Reduce heart rate and contractility

Lead to reduced CO

Question 5

Examples of B Blockers

Answer 5

Atenolol (B1 selective)
Propranolol (non selective)

Question 6

Which medication is useful in hypertensive hyperthyroid cats?

Answer 6

B Blockers because the reduce HR and contractility

Question 7

What are ACE inhibitors?

Answer 7

Prevent angiotensin converting enzyme from producing angiotensin II

Block RAAS system

Leads to venous and arterial dilation

Also indirectly prevents ADH and aldosterone secretion

Question 8

What is ACE?

Answer 8

Angiotensin converting enzyme

Converts angiotension I to angiotensin II

Question 9

What does angiotensin II do?

Answer 9

Causes vasoconstriction
Reduces GFR - fluid retention
Causes ADH secretion
Causes aldosterone secretion

Question 10

What do ACE I Venous dilators

Answer 10

Decrease preload (EDV)

Question 11

What do ACE I Arterial dilators

Answer 11

Decrease afterload (ESV)
Increase cardiac output
Reduce valve leakage

Also increase oxygen supply to heart

Question 12

What is benazepril?

Answer 12

ACE Inhibitor

Question 13

When to not use propranolol?

Answer 13

Asthmatic cats - causes bronchoconstriction

Question 14

When are ACE inhibitors most useful?

Answer 14

Pathologies with elevated renin
Renal failure
Cushings
Diabetes

First choice in dogs
First choice in patients with protein uria

Question 15

First choice of treatment in dogs

Answer 15

Benazepril (ACE Inhibitor)
Often in combination with Ca Blocker (amlodipine)

Question 16

First choice of treatment in cats

Answer 16

Amlodipine

Question 17

First choice of treatment with proteinuria

Answer 17

Benazepril

Question 18

First choice of treatment in hyperthyrioid cats

Answer 18

Atenolol (B blocker)

Question 19

What do Ca Channel blockers do?

Answer 19

Inhibit influx of calcium into the cell
Results in vasodilation because smooth muscle can’t contract

Leads to decreased systemic resistance

Rapid onset

Question 20

Examples of Ca Channel blockers

Answer 20

Amlodipine - best in cats

Question 21

What is telmisartan?

Answer 21

Angiotensin II receptor blocker

Prevents vasoconstriction
Increases GFR
Prevents ADH secretion
Prevents aldosterone secretion

Question 22

When is telmisartan used?

Answer 22

In hypertensive cats with chronic kidney disease

To reduce proteinuria

Question 23

What re the therapeutic goals of hypertension treatment?

Answer 23

Reduce blood pressure
Reduce EOD risk
Decrease proteinuria
Alleviate clinical signs
Prevent further deterioration of organ function

OFTEN DON’T TARGET CAUSE