Hypertension

Front 1

Hypertension increases risk for:
ocular effects
(5)

Back 1

Hypertensive retinopathy
Retinal macro-aneurysm
Optic neuropathy
Retinal vein and artery occlusion
Retinal artery emboli

Front 2

Hypertension may increase risk for:
2

Back 2

Diabetic retinopathy
Age related macular degeneration

Front 3

HTN
____most common cause of preventable deaths in US

Back 3

2nd

Front 4

What is the normal systolic?

Back 4

120<

Front 5

what is the normal diastolic?

Back 5

80<

Front 6

pre-htn values?

Back 6

systolic 120-139
diastolic 80-89

Front 7

HTN
stage 1
stage 2

Back 7

systolic: 140-159
stage 2 > 160
Diastolic
90-99
stage 2 > 100

Front 8

Risk of CVD ____ for each increment of ____ mmHg above 115/75 mm Hg

Back 8

doubles
20/10

Front 9

In individuals _____, systolic bp > _________ traditionally considered more important risk factor for CVD than diastolic bp

Back 9

>50 yo
140 mmHg

Front 10

Risk of stroke is ___X greater with BP > 160 mm Hg

Back 10

4

Front 11

10 - 15% deaths attributed to HTN are from

Back 11

CVAs

Front 12

Peripheral resistance - influenced by _____ ______ in small arterioles

Back 12

tunica media

Front 13

________system: ↑ vasoconstriction

Back 13

symathetic

Front 14

Blood volume: _______ system ↑ release of renin by kidneys

Back 14

sympathetic

Front 15

secondary HTN
3

Back 15

Impaired natriuresis
Baroreceptor resetting
Abnormalities in renin-angiotensin-aldosterone system

Front 16

Secondary HTN

Back 16

Renal disease
Endocrinologic causes
Sleep apnea and sleep deprivation
Medications

Front 17

Secondary HTN
Medications
6

Back 17

Oral contraceptives
Steroids and nonsteroidal anti-inflammatory drugs (Not ASA)
Cold remedies and appetite suppressants
Tricyclic antidepressants
Cyclosporine

Front 18

goals of lowering BP
If diabetic or renal disease with proteinuria,

Back 18

Reduce to < 140/90 mm Hg
Reduce to < 130/80

Front 19

If you reduce BP -
Decreased stroke incidence by _____
Decreased myocardial infarction incidence _____
Decreased heart failure incidence by _____

Back 19

Decreased stroke incidence by
35 – 40%
Decreased myocardial infarction incidence 20 – 25%
Decreased heart failure incidence by > 50%

Front 20

Antihypertensive
drugs

Back 20

Diuretics
Beta-blockers
ACE inhibitors
Angiotensin II antagonists
Calcium channel blockers
Renin inhibitors

Front 21

Antihypertensive drugs usually work =

Back 21

Most of these medications work by one of two mechanisms or their combination

Front 22

common diuretics

Back 22

Thiazide
Loop
Potassium-sparing

Front 23

how do Thiazide work?
how long?

Back 23

Decrease reabsorption of Na+ in kidney (short term)
Increased vasodilation (long term)
1- 3 weeks for maximum effect

Front 24

adverse affects of thiazide diuretics

Back 24

Potassium depletion
Increased arrhythmias
Hyperuricemia
Volume depletion
Hypercalcemia
Hyperglycemia

Front 25

Loop diuretics

Back 25

Inhibit re-absorption of ions in kidney
Most efficacious of all diuretics
Bumetanide more potent than furosemide

Front 26

Time course -Loop Diuretics

Back 26

Rapid onset allows them to be used in emergent situations
Also have short duration

Front 27

Loop Diuretics - Adverse effects

Back 27

Ototoxicity which can be permanent
Hyperuricemia (Furosemide)
Acute hypovolemia
Severe and rapid loss of blood volume
Can cause hypotension, shock, cardiac arrhythmias
Potassium depletion

Front 28

K sparing diuretics
mechanism of action

Back 28

Inhibit Na+ reabsorption and K+ secretion
Spironolactone binds with receptor sites used by aldosterone
Prevent aldosterone from binding and working

Front 29

K sparing SE

Back 29

May induce gynecomastia in males and menstrual irregularity in females
Best given for short course treatment

Front 30

ß-adrenergic blockers
most effective

Back 30

Most effective in
Young patients
Caucasian patients

Front 31

ß-adrenergic blockers
most effective in

Back 31

Most effective in
Young patients
Caucasian patients

Front 32

ß-adrenergic blockers
mechanism

Back 32

Primary activity is to decrease cardiac output
Decrease sympathetic outflow to decrease renin release

Front 33

ß-adrenergic blockers
max course

Back 33

several weeks

Front 34

ß-adrenergic blockers

Back 34

CNS side effects
Bronchoconstriction (non-selective)
Bradycardia
Alterations in lipid metabolism
Sexual dysfunction
Peripheral vasoconstriction (non-selective)
Disturbances in glucose metabolism (non-selective)
Fatigue and depression

Front 35

ß-adrenergic blockers
contraindications

Back 35

Sinus bradycardia
Asthma
Greater than 1st degree heart block
Peripheral vascular disease (non-selective)
Diabetics using insulin (non-selective)

Front 36

ace inhibitor
mechanisms

Back 36

Mechanism of action
Block conversion of angiotensin I to angiotensin II, and thus reduces vasoconstriction and peripheral resistance
Also decreases formation of aldosterone which reduces retention of sodium and water
Prevent inactivation of bradykinin
Bradykinin causes vasodilation

Front 37

ace inhibitor
se

Back 37

Adverse effects
Dry cough
Rashes
Fever
Altered taste
Hyperkalemia

Front 38

ace inhibitor
contraindicator

Back 38

preg

Front 39

Angiotensin-converting enzyme (ACE) inhibitors
often DOC in ?

Back 39

Often drug of first choice in DM

Front 40

ace inhibitor
useful in pts with ?
some concerns ~

Back 40

Useful in patients with chronic heart failure
Of limited use in Black population
First dose usually administered in MD’s office with close observation
Angioedema and syncope

Front 41

Angiotensin II antagonists (ARBs)
Mechanism of action

Back 41

Works later in angiotensin pathway by inhibiting receptor binding of angiotensin II and blocking aldosterone secretion
Produces vasodilation and reduces peripheral resistance
No effect on bradykinins

Front 42

Angiotensin II antagonists (ARBs)
Adverse effects

Back 42

Adverse effects
Less dry cough

Front 43

Angiotensin II antagonists (ARBs)
Contradindiations

Back 43

Contraindications
Not in pregnancy (fetotoxic)

Front 44

Angiotensin II antagonists

Back 44

Losartan (1st available as generic 2010)
Valsartan
Olmesartan medoxomil (specifically approved for patients from 6 – 16 yo)
Eprosartan
Irbesartan

Front 45

Calcium channel blockers
Adverse effects

Back 45

Constipation
Dizziness
HA
Fatigue

Front 46

Calcium channel blockers
Contraindications

Back 46

Verapamil not used for patients with heart failure
Topical β-blockers: can increase risk of hypotension, bradycardia and AV block

Front 47

Calcium channel blockers

Back 47

Benzothiazepines
Diphenylalkylamines
Dihydropyridines

Front 48

Renin inhibitors

Back 48

Aliskiren

Front 49

Alpha Blockers-how do they work?

Back 49

Alpha-1 blockers lower blood pressure by relaxation of smooth muscle in arteries and large veins

Front 50

Alpha Blockers

Back 50

Increased risk of major cardiovascular disease events in patients treated with these medications has caused them to fall out of favor

Front 51

CNS drugs
Clonidine

Back 51

Acts centrally to inhibit sympathetic vasomotor centers
Useful in treating HTN with kidney disease because it does not depend on renal activity
Available generic as a patch