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2. Hypertension - Definition
Hypertension can be defined as the level of blood pressure
at which there is risk to the organs or vasculature.
Based largely on epidemiological studies.
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5. Primary Hypertension - Definition
The category of hypertension when the cause is unknown.
There are probably several different genetic causes as well
as a complex interplay of polygenetic and environmental
factors.
Includes approximately 90% of cases.
Also referred to as essential hypertension.
Approximately 20% of all adults in US are affected.
Even though the underlying cause usually is not known,
hypertension can usually be very effectively treated.
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6. Secondary Hypertension - Definition
The category of hypertension when the cause is secondary
to renal, endocrine, anatomic disorders etc.
Includes approximately 10% of cases.
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7. Hypertension - Clinical Significance
1. Heart disease
2. Stroke
3. Kidney failure
4. Blindness
Effects usually are not apparent until after 10 or more years of
sustained high blood pressure.
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8. Treatment Strategies
A. Lifestyle Modifications
low fat diet rich in vegetables and fruit
reduction of excess body weight
limited alcohol consumption
daily aerobic exercise
smoking cessation
reduction of sodium uptake
B. Drug Therapy
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9. Treatment Strategies
. Additional Risk factors for cardiovascular disease
smoking
dyslipidemia
diabetes mellitus
age older than 60
sex (men and postmenopausal women)
family history of cardiovascular disease
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10. Treatment Strategies
Risk Group A
No risk factors
No cardiovascular disease
No Target organ damage
Risk Group B
At least one risk factor not including diabetes mellitus
No cardiovascular disease
No target organ damage
Risk Group C
Cardiovascular disease
Target organ damage
Diabetes mellitus
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11. Treatment Strategy
Blood Pressure Risk group A Risk group B Risk group C
High-normal
Stage 1
Stage 2
lifestyle
modification
lifestyle
modification
lifestyle
modification
lifestyle
modification
lifestyle
modification
(up to 6 months)
drug therapy drug therapy
drug therapy
drug therapy
(140-159/90-99)
(130-139/85-89)
(160-179/100-109)
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15. Drugs Used To Decrease Blood Pressure
Very effective at lowering blood pressure
Usually do not correct the underlying defect
Drug therapy is usually life-long
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16. Diuretics
One of the most common, effective and inexpensive drug classes
for the treatment of hypertension.
Several different classes of diuretics are effective including the
thiazides, loop diuretics and K+
sparing diuretics.
Prototype: hydrochlorthiazide
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17. Diuretics
Inhibit renal tubular reabsorption resulting in a reduction of
body salt and water.
The mechanism of long-term blood pressure reduction still
is not completely clear.
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18. Drugs Acting on the Angiotensin System
A. Angiotensin Converting Enzyme (ACE) Inhibitors
X
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19. ACE Inhibitors - Mechanism
Inhibit conversion of angiotensin I to angiotensin II
Potentiate actions of bradykinin by inhibiting its degradation
bradykinin degradation products
ACE
(bronchoconstriction)
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20. ACE Inhibitors - Characteristics
Little or no increase in heart rate
Reduces ventricular hypertrophy
Side effects: cough, angioedema and rash
Over-all a very safe class of drugs
Prototype: captopril
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22. Drugs Acting on the Angiotensin System
B. Angiotensin Receptor Antagonists
Inhibit the action of angiotensin II by antagonizing one of its
receptors
Similar effects as the ACE inhibitors
Lack the effect on the kinins which results in a lower
incidence of cough and rash
Prototype: losartin
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23. Beta Blockers
Competitively antagonizes the effects of the sympathetic
effectors norepinephrine and epinephrine.
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24. Beta Blockers
Blockade of B1-adrenergic receptors in ventricle decreases
contractility and the SA node decreases the rate of contraction.
Blockade of B-Blockers inhibit renin release which also
contributes to a decrease in blood pressure.
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25. Beta Blockers
Prototype: propanolol
Side effects: Causes bronchoconstriction due to B-2 receptor
blockage.
Over-all well tolerated
Beta blockers should not be discontinued abruptly
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26. Calcium Channel Blockers
Bind to receptors of calcium channels in cardiac and vascular
smooth muscle.
Prevent Ca+2
influx into the smooth muscle cells which reduces
the contraction of the blood vessels and heart rate.
The different calcium channel blockers differ in their relative
effects on vascular and cardiac tissue.
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27. Calcium Channel Blockers
Side effects are generally mild.
Can cause a reflex increase in heart rate (tachycardia) in
response to the vasodilation.
Representative drug: felodipine
Since they act on arterioles, not veins postural hypotension is
rare.
Frequently combined with a B-blocker
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29. Alpha1-Adrenergic Blockers
Side effects: orthostatic (postural) hypotension and
reflex tachycardia
Prototype: prazosin.
Blockade of the alpha1-adrenergic receptors results in
vasodilation of both the arterial and venous beds .
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30. Alpha1-Adrenergic Blockers
It is usually necessary to take a diuretic with these drugs.
B-blockers are also frequently co-administered with these drugs.
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31. Direct-Acting Vasodilators
Directly relaxes the vascular smooth muscle
Several drugs in this category are very quick acting and
are mainly used for hypertensive emergencies
Side effects include reflex tachycardia and edema. As a result
these drugs are frequently combined with a B-blocker and a
diuretic
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32. Direct-Acting Vasodilators
Nitrovasolators release nitric oxide (NO)
activation of guanylate cyclase
[cGMP]
stimulation of a cGMP-dependent kinase and a
decreased cytosolic [Ca+2]
relaxation of vascular smooth musclewww.indiandentalacademy.com
33. Direct-Acting Vasodilators
Several other direct-acting vasodilators that work through
poorly defined mechanisms
Examples of nitrovasolators include nitroglycerin and sodium
nitroprusside
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34. Centrally Acting Drugs
Antihypertensive effect results from action in the CNS causing
a reduced sympathetic nerve firing rate.
Prototype: clonidine
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35. Centrally Acting Drugs
Clonidine activates alpha2 and imidazoline receptors in the
vasomotor center of the medulla which inhibits the sympathetic
nervous system.
Considered a second-line drug or for special cases
(ie methyldopa in pregnant hypertensive patients).
A reduced heart rate and cardiac output account for reduction
in blood pressure.
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36. Centrally Acting Drugs
An advantage of these drugs is that they do not cause
postural hypotension
Side effects - hypertensive rebound if there is an abrupt
withdrawal
-dry mouth, sedation
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37. Additional Considerations
Different ethnic groups have a greater probability of
responding to the different drug categories
Approximately two thirds of the US population aged 65 or
older have hypertension.
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38. Additional Considerations
Hypertension during pregnancy poses a risk for both mother
and fetus.
preclampsia
Hypertension is a major risk factor for kidney and
cardiovascular problems in patients with diabetes
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