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16 Cards in this Set
- Front
- Back
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Define Hypertension
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persistent increased systemic arterial pressure
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"Normal" range for BP?
Mild hypertension range? Moderate hypertension range? Severe hypertension range? |
Normal: 120/80
Mild: 140-150/90-100 Moderate: 160-170/100-110 Severe:>180/>110 |
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What is aetiology and risk factors associated with Hypertension?
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Primary (essential) HT
Smoking Obesity Diet (High Salt Exercise (lack of Genetics (unidentified components) Alcohol (J curve) Stress Secondary: Renal (Diabetes), Endocrine (Cushing's syndrome), Drugs (NSAIDS), Adrenal (Phaeochromocytoma) |
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Describe the signs and symptoms of Hypertension
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Signs: Presence of risk factors
Diagnostic BP Retinopathy Symptoms: Dyspnoea Visual changes Headache |
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Describe the cardiac changes in Hypertension
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Cardiac changes:
-Media:Lumen increases -Baroreceptors local and central adjust to new higher BP -Decreased density of vessels -Large vessel changes, less elastic and hardened, loss of arterial compliance -LV hypertrophy |
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Describe renal changes in Hypertension
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Renal
Change in renal vasculature leads to a decrease in Renal perfusion, GFR and decreased Na and Water excretion Activation of RAS |
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Describe the consequence of persistent Hypertension
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Atherosclerosis
Myocardial Infarction Stroke Heart failure Renal Failure Retinopathy |
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List the 4 main treatment types of Hypertension
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1) Block of sympathetic Nervous system - dec CO, VC
2) Kidney Action - reduce Blood Volume 3)Hormones - inhibit RAS system 4)Vasodilation of peripheral arterioles |
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Beta Blockers (Propanolol, Atenolol)
Outline the following: Mode of action Effects Side Effects |
MOA: Competitive reversible antagonist of B1
EFFECTS: Dec. CO, HR, SV, renin release, symp tone SIDE EFFECTS: Exacerbate Asthma, Exercise intolerance, hypoglycaemia, vivid dreams |
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Alpha blockers (Phentolamine, Doxazosin)
Outline the following: Mode of action Effects Side Effects |
MOA: Competitive reversible antagonist of A1
EFFECT: Dec. symp tone on arterioles, peripheral resistance SIDE EFFECTS: Reflex tachycardia, postural hypotension (loss of symp venoconstriction) |
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ACE inhibitors (Captopril, Enalopril)
Outline the following: Mode of action Effects Side Effects |
MOA: Blocks the action Angiotensin Converting Enzyme on vascular endothelial cells, which means Ang II is not produced
EFFECT: Dec TPR, Dec BV (loss of Aldosterone production so less Na and Water reabsorbed) SIDE EFFECTS: Cough (ACE breaks down bradykinin in lungs), sudden drop of BP on first dose |
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Ang II R blockers (Candesartan, Losartan)
Outline the following: Mode of action Effects Side Effects |
MOA: AT1 block as it mediates vasoconstriction and Ang II directed Aldosterone release
EFFECT: Dec. TPR and BV SIDE EFFECTS: Good profile, expensive |
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Diuretics (Thiazides)
Outline the following: Mode of action Effects Side Effects |
MOA: Reduce renal absorption of Na and water, with possible vasodilation
EFFECT: Dec. TPR and BV Side Effect: Decrease K+> arrythmias |
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Calcium Channel blockers (Diltiazem, Verapamil)
Outline the following: Mode of action Effects Side Effects |
MOA: Block of L-type voltage gated Ca2+ ion channels
by 1) open channel block and 2) allosteric modulation (preventing channel opening) EFFECT: Dec TPR (block of ca2+ entry in SMCs reduce vasoconstriction) Dec CO (Block of Ca2+ reduces HR and SV) SIDE EFFECTS: Constipation, negative dysrhytmias (decreased chronotropic and dromotropic effect) |
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What does NICE have to say on Hypertension drugs?
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We'll see
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Describe Postural hypotension
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When seated or laying down
Gravity induced blood pooling in lower extremities Compromises venous return Dec. CO and Dec. BP Insufficient blood perfusion to upper extremities |
