Hypertension Therapeutics

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  1. What is hypertension defined as?
    • untreated systolic pressure of 140mmhg or higher or a diastolic pressure of 90 mmhg or higher
    • taking antihypertensive medication
    • being told twice by a physician or other healthcare  professional that one has htn
  2. What is the breaking age when female have a higher % of htn?
    60 yo
  3. what race has the highest percent of htn?
  4. what is the major determinant of SBP?
  5. what is the major determinant of DBP?
  6. What are the four components of blood pressure?
    • SBP cardiac contraction
    • DBP cardiac relaxation
    • Pulse Pressure arterial wall tension
    • Mean arterial pressure average pressure throughout the cardiac cycle
  7. What is essential htn?
    • indentifying exact underlying abnormality not usually possible
    • with a variety of contributors
    • genetics
    • humoral mechanisms
    • neuronal regulations
    • peripheral autoregulatroy components
    • vascular endothelial mechanisms
    • electrolytes and other chemicals
  8. What are the humoral mechanisms?
    • RAAS (Renin-->angiotensinogen to angiotensin I --> Ang II = VC, stimulates aldosterone Na reabsorption, inc symp nervous system)
    • Natriuretic Hormone (inhibits Na and K ATPas and interfers with  na  transport across cells membranes
    • Insulin Resistance
  9. What are the neuronal regulation mechanisms?
    • Stimulation of
    • B1 inc rate and contractility
    • B2 VD
    • A1 VC
    • A2 inhibitory effect on the vasomotor center to decrease BP
    • (Ang II increases outflow from vasomotor center)
  10. What are the DZ that cause secondary HTN?
    • CKD
    • Cushing's syndrome
    • coartation of the aorta
    • Obstructive sleep apnea
    • Parathyroid dz
    • pheochromocytoma
    • Primary aldosteronism
    • Renovascular dz
    • thyroid dz
  11. What are the drug that cause secondary HTN?
    • Antidepressants
    • Corticosteroid
    • Cocaine
    • Cyclosporine
    • Cox inhibitors
    • Estrogens
    • Erythropoetin
    • Ergots
    • Ma Huang, other herbals
    • NSAIDS
    • PPA, PSE
    • Sibutramine
    • Some Heavy Metals
    • Tacrolimus
  12. What is htn a strong predictor of?
    • stroke
    • nephropathy/ESRD
    • CAD/MI
    • CHF/LVH
    • PVD
    • retinopathy
  13. What are the risk factors CV dz?
    • HTN
    • Cigarette
    • Obesity
    • Physical inactivity
    • Dyslipidemia
    • Diabetes Mellitus
    • Microalbuminuria grf <60
    • Age 55men 65women
    • Family history
  14. What are the target organ damage of htn?
    • heart dz,(mi, coronary revascularization,hf, left ventricular hypertrophy
    • stroke,tia
    • nephropathy
    • peripheral artieral dz
    • retinopathy
  15. What are the goal bp?
    60 and older?
    59 and younger?
    • 150/90
    • 140/90
    • 140/90
    • 140/90
  16. What are the dz states that should have bp <130/80
    • CAD
    • DM
    • CKD
    • Framingham >10%
    • according to American heart association
  17. What are the lifestyle modification?
    • lose weight
    • limit alcohol
    • increase aerobic physical activity
    • reduce na intake
    • maintain adequate K
    • maintain catt mgtt
    • stop smoking
    • reduce dietary saturate fate and cholesterol
  18. What are the medications that are first line tx for htn?
    • Diuretics
    • ACEi
    • ARB
    • CCB
  19. Tell me about the thiazide diuretics
    • HCTZ, chlorthalidone, indapamide, metolazone
    • moa Distal tubule, reduces peripheral vascular resistnace
    • AE: dec Na, K, Mg, Water
    •       inc Ca uric acid glucose, lipids, photosensitivity
  20. What is thiazides place in tx?
    • 1st line option
    • considered good add on therapy to almost any other drug
    • Indapamaide does not effect lipids
    • Metolazone, indapamide work at low CrCl
  21. What is considered the backbone of antihypertensive regimens in previous JNC?
  22. When should thiazides be avoided?
    • low CrCl (which ones are preferred in low CrCl?)
    • Gout
    • Avoid high dose in hyperlidiemia and DM
  23. What are loop diuretic place in therapy?
    • Most pronounced diuresis of all diuretics but short duration of action does not make ideal antihtn
    • most effective for HTN in pts with renal impairment
  24. What is K sparing diuretics place in therapy?
    • combination with thiazides to reduce effect on K
    • Spironolactone drug of choice in pt with cirrhosis
    • Avoid in renal insufficency
    • Use caution when combining with ACei or other K sparing meds
  25. What is acei place in therapy?
    • first line in most pts
    • dec mortality in DM type I, II, CHF
    • also appropriate in hypertensive nephropathy
  26. When should acei be avoided?
    • bilateral renal artery stenosis
    • prego
    • use caution in: renal insufficiency (can tolerate SCr of 0.5mg/dL to 1
    • volume depletion
  27. What is arb place in therapy?
    typically utilized in those intolerant to acie
  28. When should you avoid arbs
    • volume depletion
    • prego
  29. What is ccb place in therapy?
    • DCCB are first line therapy
    • well tolerated add on to other agents
    • may be preferred over thiazide type diuretics in combo with acei
  30. When should ccb be avoided?
    • with HF
    • caution with: bb, possibly contribute to CHD,
Card Set:
Hypertension Therapeutics
2014-03-14 20:52:38
Hypertension Therapeutics
Hypertension Therapeutics
Hypertension Therapeutics
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