treatment of hypertension Flashcards
(55 cards)
hypertension?
persistent elevation of BP in the systemic arterial circulation to a level higher than expected for age, sex, race and of the individual.
lifestyle interventions for treatment of hypertension?
stage 1 hypertension is usually managed through lifestyle interventions alone
- exercise
- smoking cessation
- dietary modification
(limit alcohol and caffeine intake)
why are the different types of therapeutic agents?
- ACE inhibitors
- angiotensin 2 receptor blockers (ARBs)
- diuretics (decrease water retention)
- calcium channel blocker
- B1 adrenergic receptor blockers
what is the difference in step 1 therapeutic intervention between:
1- those with diabetes and <55 yrs old
2- >55 yrs old, Afro-caribean descent?
1- give ACE inhibitor
2- give CCB
step 1 medical management of hypertension?
ACE inhibitor (ramipril) or CCB (candesartan or nifedipine) depending on the group you are treating.
step 2 medical management of hypertension?
- if max dose of step 1 has failed or not tolerated:
= combine CCB and ACE
if CCB are not tolerated in step 2 what should you give?
thiazide diuretic
step 3 medical management of hypertension?
add thiazide diuretic
step 4 medical management of hypertension?
this is now RESISTANT HYPERTENSION:
- all medications and add a further diuretic or B1 blocker
- seek specialist advise
in step 4, what further diuretic are you going to use?
low dose spironolactone
only do this if blood patssium is <4.5mmol/L
patients with hypertension should be monitored for what?
patients should be monitored for end organ damage
what is given for CV risk management in patients with hypertension?
statins for primary prevention is 10-year CV is >20%
what are the blood pressure targets for:
1- <80 yrs
2- 80 yrs
3- diabetics
1- <80 years: clinic BP <140/90 mmHg (or <135/85 AMPM/HBPM)
2- 80 years: clinic BP <150/90 mmHg (or <145/85 AMPM/HBPM)
3- Diabetics: clinic BP <130/80 mmHg
where is blood filtered?
glomerulus of the kidney
where does reabsorption of ions take place
reabsorption of solutes, ions and water will take place along the length of the tubule
what does the movement of Na do in the kidney?
it creates an osmotic gradient for H20 to follow
where in the kidney is bulk reabsorption uncontrolled?
the proximal convoluted tubule
1- what does angiotensin 2 bind to?
2- what are its effects on:
- vascular smooth muscle
- hypothalamus
- renal tubules of the kidney
1- AT1 receptors
2- increased smooth muscle constriction, increasing TPR
- on the hypothalamus:
increased release of vasopressin (ADH), reabsorption of H20 in kidneys, increased ECV - renal tubules of kidneys:
increased secretion of aldosterone from adrenal glands, Na reabsorption in the kidney, increased ECV
angiotensin 2 effect in the proximal convoluted tubule?
it stimulates Na reabsorption, particularly here.
what effect does angiotensin 2 stimulating aldosterone release?
it will further stimulate Na reabsorption in the cortical collecting duct.
1- ACE inhibitor example?
2- mechanism of action?
1- ramipril
2- inhibitor of ACE=
= no angiotensin 2
- decreased vasoconstriction = decreased TPR
- decreased water retention = decreased ECV
- decreased Na retention = decreased ECV
DECREASED BP
what other system is ACE involved in?
what is the function of this system?
the kinin-kallikren system
- this will cleave kininogen into bradykinin
- this is a vasodilator
what does ACE do to bradykinin?
it breaks in down into an active metabolite
what does bradykinin do?
- it binds to B2 receptors
- vasodilation
- PGI2 production
- NO production
