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31 Cards in this Set
- Front
- Back
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Blood Pressure Classification
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Normal: <120 and <80
Prehypertension: 120-138 or 80-89 Hypertension: >140/90 Stage 1 Hypertension: 140-159 or 90-99 Stage 2 Hypertension: > or = to 160 or > or = to 100 |
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Identifiable Causes of Secondary Hypertension
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Sleep Apnea
Drug induced or related causes Chronic Kidney Disease Primary Aldosteronism Renovascular Disease Chronic Steroid Therapy and Cushing's Syndrome Pheochromocytoma Coarctation of the aorta Thyroid or Parathyroid Disease |
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Hypertension: Target Organ Damage
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Heart: left ventricular hypertrophy; coronary artery disease; myocardial infarcts; heart failure
Brain: stroke or transient ischemic attacks Chronic kidney disease, kidney failure Retinopathy |
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Contributing Factors to Hypertension
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Obesity
Stress Lack of Exercise Diet (excess dietary salt) Alcohol intake Cigarette smoking |
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Lifestyle Modifications
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Reduce weight to normal BMI (<25kg/m^2): 5-20mmHg/10kg loss
DASH eating plan: 8-14 mmHg Dietary sodium reduction: 2-8 mmHg Increase physical activity: 4-9 mmHg Reduce alcohol consumption: 2-4 mmHg |
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DASH Diet
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Dietary Approaches to Stop Hypertension:
- Emphasizes: fruits, veggies, low fat dairy foods, and reduced sodium intake - Includes: whole grains, poultry, fish, nuts - Reduced amounts of red meat, sugar, total and saturated fat, and cholesterol |
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Mean Arterial Pressure (MAP)
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MAP= CO x PVR
CO= HR x SV |
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Antihypertensive Drugs Classification
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Diuretics
Agents affecting adrenergic function (sympatholytics) Vasodilators Agents affecting Renin Angiotensin System (RAS) |
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Diuretics
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Used as initial therapy alone or in combination with drugs from other groups
General Side Effects: renin secretion due to volume and Na depletion |
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Diuretic Groups
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Thiazides: CHLOROTHIAZIDE and HYDROCHOROTHIAZIDE--first choice
Loop Diuretics: FUROSEMIDE (Lasix), Bumetanide, Ethacrynic acid Potassium Sparing Diuretics: SPIRONOLACTONE, TRIAMTERENE, AMILORIDE |
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Sympatholytics--Agents that Affect Adrenergic Function
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Agents that prevent adrenergic transmission (RESPERINE, guanethedine, guanadrel)
Selective alpha-1 adrenergic receptor blockers (PRAZOSIN, terazosin, doxazosin) Beta-adrenergic blocking agents (PROPRANOLOL and others) Agents that act on the CNS (METHYLDOPA, CLONIDINE, guanabenz, guanfacine) |
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RESPERINE: Agents that prevent adrenergic transmission
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Mech. of Action: Depletes neurotransmitters (NE, DA, 5HT) in the storage vesicle of the central and peripheral nerve endings
Main Effects: depress SNS function CENTRALLY and PERIPHERALLY--> decreased HR, contractility and PVR Side Effects: DEPRESSION, insomnia, nightmares, ulcers, diarrhea, abdominal cramping, nasal stuffiness, ORTHOSTATIC HYPOTENSION, dry mouth, impotence Pharmacokinetics: onset is slow and full effect is seen in weeks Use: infrequently |
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GUANETHEDINE (ISMELIN): Agents that prevent adrenergic transmission
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Mech. of Action: Depletes the nerve ending of NE in the PERIPHERY
Main Effects: decrease in PVR and decrease in HR--> decrease in BP Side Effects: ORTHOSTATIC HYPOTENSION, Na+ and water retention; others similar to resperine except the CNS effects Pharmacokinetics: Poorly absorbed from the GI; onset is slow (1-2 weeks); metabolites excreted in urine Use: NOT USED ANYMORE B/C OF SEVERE SIDE EFFECTS |
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PRAZOSIN, Terazosin, Doxazosin: Selective alpha-1 adrenergic receptor blockers
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They favorably influence plasma lipid profile, and do not interfere with glucose metabolism
Mech. of Action: block alpha-1 receptors in vasculature Main Effects: decreased PVR --> decrease BP Side Effects: 1ST DOSE PHENOMENON, fluid retention, dizziness, headache Pharmacokinetics: T1/2= 4.5, 12, 20, respectively Use: used in stage 1 and 2 HTN in combination with a diuretic and a beta blocker |
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Beta-adrenergic blocking agents
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Proposed Mechanisms:
- Block cardiac beta-1 receptors--> lower CO - Block renal beta-1 receptors --> lower renin--> lower Angiotensin--> lower TPR |
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Non-selective Beta-adrenergic Blocking Agents
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PROPRANOLOL
Timolol (hydrophylic) Pindolol Penbutolol Cartelol LABETALOL (alpha and beta) Carvedilol (alpha and beta) Carteolol |
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Beta-1 Selective Beta-adrenergic Blocking Agents (in low dose)
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METOPROLOL
Acebutolol Atenolol (hydrophylic) Betaxolol Bisoprolol **Diabetes and Asthma |
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Intrinsic (ISA) Beta Blockers
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Pindolol
Acebutolol Penbutolol Cartelol Labetalol (alpha and beta) **Reynaud's |
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PROPRANOLOL (non-selective beta blocker)
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Mech. of Action: Block cardiac beta-1 receptors--> lower CO; Block renal beta-1 receptors--> lower renin--> lower angio--> lower PVR
Main Effects: decrease HR and PVR (reduce BP) Side Effects: BRADYCARDIA, depression, BETA-2 RECEPTOR BLOCKADE IN AIRWAYS, glucose and lipid metabolism, vasoconstriction in extremities Pharmacokinetics: GI, 30-50% metabolized in the FIRST PASS IN LIVER; T1/2 3-5hrs, slow release propranolol is available; can cross BBB--so can cause depression Use: used in stage 1 and 2 HTN alone or in combination with a diuretic and/or vasodilator Drug Interactions: verapamil, diltiazem, digitalis (caution AV block) |
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LABETALOL
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A combined beta-1, beta-2 (non-selective) and alpha-1 blocker
Beta blocking action is more prominent Also has some ISA property Can be given IV for hypertensive emergencies |
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Alpha-methyldopa, Clonidine (agents that act on the CNS)
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Favorable effect: lower PRA
Mech. of Action: alpha-me-dopa is metabolized to alpha-me-NE, an alpha-2 agonist that suppresses SNS output from the CNS; Clonidine is an alpha-2 agonist itself Main Effects: decreases PVR and HR Side Effects: SEDATION, drowsiness, dry mouth, impotence, bradycardia, withdrawal syndrome (REBOUND HTN) Pharmacokinetics: oral, parenteral, transdermal Use: Stage 1 and 2 HTN |
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Vasodilator Drugs
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Common Side Effects: fall in BP--> reflex tachycardia; also, a fall in BP--> renin--> Angio
--> aldo--> Na/H2O retention |
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Classes of Vasodilator Drugs
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Calcium entry blockers (Nifedipine and others)
Potassium channel openers (minoxidil, diazoxide IV) Direct acting vasodilators (hydralazine, Na-nitroprusside IV) |
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Calcium Entry Blockers
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Mechanism: inhibit Ca entry through L-type voltage gated channels
Phenylalkylamines: VERAPAMIL Benzothiazepines: DILTIAZEM Dihydropyridines: NIFEDIPINE |
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NIFEDIPINE
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Mech. of Action: selective blockade of VASCULAR Ca channels
Main Effect: Vasodilatation--> lower PVR--> lower BP Side Effects: headache, flushing, nausea, dizziness, ANKLE EDEMA, REFLEX TACHYCARDIA with short-acting version (no reflex tachycardia with verapamil and diltiazem) Use: hypertension (more effective in African Americans) and angina; not useful as an antiarrhythmic drug |
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VERAPAMIL and DILTIAZEM
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Mech. of Action: blockade of Ca channels in the vasculature, heart muscle, and the AV node
Main Effects: Vasodilatation--> lower PVR--> lower BP Side Effects: similar to nifedipine except that they do not cause reflex tachycardia Drug Interactions: caution for AV block wih beta blockers, and digitalis Use: Hypertension, angina, arrhythmias |
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MINOXIDIL and DIAZOXIDE (IV): Potassium Channel Openers
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Mech. of Action: open K-channels of vascular smooth muscle cells--> K-efflux--> hyperpolarization--> vasodilatation
Main Effect: vasodilation--> lower PVR--> lower BP Side Effects: - Mioxidil--REFLEX TACHYCARDIA, NA and FLUID RETENTION (hirsutism-Rogaine) - Diazoxide--hyperuricemia, hyperglycemia--used in hypoglycemia Use: Diazoxide IV in hypertensive emergencies |
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Na-nitroprusside (IV): Direct Acting Vasodilators
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Mech. of Action: metabolite is nitric oxide (NO); NO is a rapid acting venous and arteriolar vasodilator
Main Effect: vasodilation--> lower PVR--> lower BP Side Effects: REFLEX TACHYCARDIA, severe hypotension, possible cyanide poisoning Pharmacokinetics: rapid-acting, IV drip, short plasma half-life Use: Hypertensive EMERGENCIES |
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Agents that Affect RAS (renin angiotensin system)
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ACE Inhibitors: CAPTOPRIL, Enalapril, Lisinopril
Angiotensin II Receptor Blockers (ARB): LOSARTAN, Valsartan, Irbesartan |
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CAPTOPRIL, Enalapril, Lisinopril: ACE Inhibitors
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No adverse effects on plasma lipids, glucose, sexual function; drug of choice in diabetes-related early stage proteinuria; CONTRAINDICATED in pregnancy; not as effective in African Americans
Mech. of Action: inhibit ACE --> low circulating Ang. II--> decreased PVR--> decreased BP Side Effects: skin rash, taste, COUGH, HYPERKALEMIA Pharmacokinetics: T1/2= 3, 11, 12, respectively Use: used in stage 1 and 2 HTN; also for CONGESTIVE HEART FAILURE |
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LOSARTAN, Valsartan, Irbesartan: Angiotensin II Receptor Blockers (ARB)
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Mech. of Action: SELECTIVELY block Ang II AT-1 receptor--> decrease PVR--> decrease BP
Side Effects: NO cough, very few, similar to ACE inhibitors |
