Patho & Pharmo 2 Hypertension Wk 1
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What is the normal range of blood pressure?
What is an elevated BP?
How many adults suffer from High BP?
1 in 4
Why is High BP known as the silent disease?
It is known by this description due to the fact you don't know you have it until something goes wrong.
When can a change in lifestyle be a form of medication?
Grade 1 -2
Describe the difference between dystolic and systolic?
- Dystolic is when the heart is at rest so between beats.
- Systolic is a measure of pressure whilst the heart is beating.
What other name is primary hypertension known as?
Which classification of Hypertension has the most number of reported cases?
Primary 90% & Secondary 10%
What is normal BP regulation?
Cardiac Output (CO) x Peripheral Resistance
Explain the neural control in BP?
Nueral control is fast acting and short in duration. It involves the baro receptors and the autonomic nervous system which regulate CO and vasoconstriction.
Explain Hormonal control in BP?
Hormonal action takes time and is normally long in duration. Renin is secreted from the kidneys converted to Angiotensin in the liver when this is converted to Angiotensin2 this has a vasoconstriction effect on the lungs. Therefore reducing O2 delivery in the blood that goes to the heart making it beat faster. Aldosterone is released which increases the retention of Sodium and water increasing blood volume and CO. Catecholamines which cause vasoconstriction.
Name the 4 mechanisms of primary hypertension?
- Increased Blood Volume
- Increased activity of the Sympathetic Nervous System
- Increased Renin Angiosterone System
- Increased Renal Sodium (Na+) retention
Name some of the risk factors for grade 1hypertension?
- Family history - Multiple genes may be a precusor to stress but no common genes.
- Age - Dystolic BP increases up to 50 then decreases from 60yrs onwards. Systolic increases throughout life.
- Dietary - Salt intake
- Obesity - Central adiposity associated with hypertension and also insulin resistance. Excess fat influences S.N.S & R.A.A.S
- Alcohol intake - Greater than 3 standard drinks a day increases risk of hypertension.
- Low dietary (K+) Potassium.
What are the CM of Primary Hypertension?
- Sign and symptoms are not produced in the early stage. If untreated then possible
- Increased cardiac workload = Heart failure
- Retinal haemorrhages
- Renal arteriol sclersois = Increased renin secretion.
- All individuals are different
Name some effective lifestyle changes for Grade 1 Hypertension?
- Reduce weight
- Reduce Sodium intake
- Increase Exercise to at least 30 mins per day
- Reduce Alcohol to 2 standard drinks per day for M and 1 for F
Name a common cause of secondary Hypertension?
- Renal disorders - If acute or chronic renal failure can disrupt urine output and BV regulation.
- Reno-vascular - Is when AS occurs in the renal artery reducing BF. Therefore the kidney responds by activating the renin-angiotensin system.
What are the possible hormonal disruptions in secondary grade 2 hypertension?
- Adreno-cortical hormones - Involing neoplasims that increase aldersterone or gluco-corticoids (Cushing's syndrome)Increased Sodium and H2o retention increases BP.
- Adrenaline/Nor-adrenaline - High production of secretions from tumors equal vasoconstriction effects BP.
What is Aortic Coarctation?
This is narrowing of the aorta near its exit from the heart which in turn may activate the Renin-agiostensin system due to reduced renal BF. This defect may be evident in noenate when associated with patent ductus arteriosis. In adult form it is not associated to PDA.
Can oral contraceptives create hypertension?
Yes. The combination pill can increase angiostensin and aldosterone levels. BP should be monitored. if >35yrs and has other cardiovascular risk factors.
Is hypertension common during pregnancy?
- Yes. If BP is 140/90 then there are a few pregnancy related hypertension.
- Preeclampsia - if > 20wks gestation symptoms are edema and protein in urine.
- Gestational - 1st pregnancy up to 12 wks post-partum. No protein in the urine.
What is Pulmonary Hypertension?
- When the pulmonary arterioles constrict if the alveli they supply are poorly ventalated and display Hypoxia.
- In (COPD) Chromic Obstructive Pulmonary Disorder restrictive disease and high altitude exposure due to the decreased function of the hypoxic lung.
- Left heart failure due to blood congestion in the pulmonary venous drainage into the left atrium is impaired.
What is Orthostatic Hypertension?
This is when an individual goes from lying down to sitting or standing quickly causing blood flow to pool in the feet. reduced BF from the brain equals vertigo causing falls.
Name the four main anti-hypertensives?
- A - Angiotensin converting enzymes inhibitors
- B - Beta Blockers
- C - Calcium channel antagonists
- D - Diuretics
Name 2 meds that are ARA. Describe the action of the angiotensin receptor antagonists?
- Irbesartan & Losartan
- Block Angiotensin2; Less likely to cause hyperkalaemia (High Potassium levels) than ACEI drugs. Therapuetic effect is long acting normally 4-6wks
What do alpha blockers do to a Hypertensive patient?
- Alpha1 antagonist causes vasodilation, which reduces the preload and afterload therefore improving efficency.
- Prazosin & Phentolamine are typical names often choosen in a crisis as they are fast acting.They are active on the arterioles and venules. Side effects Postural Hypertension, fatigue, sexual disfunction, diarrhoea can occur.
Explain the difference between Carvedilol and Atenolol?
- Carvedilol - Non selcetive BB and has alpha1 antagonist activity.
- Atenolol - Selective BB. Suppresses renin/angiotensin system.
What is the main aim of Diuretics?
- Fluid Loss - ECF Loss -BV loss- BP lowering
- BP=CO x TPR (Total Peripheral Resistance)
What does Frusemide do?
- Causes decreased potassium levels when it takes the water
- Acts on the medullary part of henle loop
- Lowers tonicity of medullary interstitium
- It is a loop diuretic - Most effective and common
Why would Thiazides be a drug of choice?
- Acts on the cortical segments of Henle Loop. Higher up in the loop.
- More concentrated fluid enters the tubule
- Less water reabsorption
- Electrolyte loss is a possible problem
- 2nd diuretic perscribed to counter balance potassium loss
Why would an osmotic diuretics only be given via IV route?
- They will give you rocket fuel as they don't metabolise, as it has a laxatise effect.
- Mannitol - Given in an emergency
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