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Done by

.B. Mo
Intro
Hypertension
mmHg 140< mmHg 90<

Systolic Blood Diastolic Blood


(Pressure (SBP (Pressure (DBP

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Arterial BP

Peripheral
Cardiac Output
Resistance

Filling Arteriolar
Heart Rate Contractility
Pressure Volume

Blood Volume Venous Tone


…Cont
Categories of
Hypertension

Stage 1 Stage 2
Normal Prehypertension
Hypertension Hypertension
( 80< / 120< ( ( 80-89 / 120-139 (
( 90-99 / 140-159 ( ( 100≤ / 160≤ (

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Main
Complications

Congestive Heart Myocardial Cerebrovascular


Renal Damage
Failure Infarction Accidents
…Cont
Types of
Hypertension

Essential Secondary

A disorder of unknown origin affecting the


Secondary to other disease processes
Blood Pressure regulating mechanisms

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Environmental
Factors

Stress Na+ Intake Obesity Smoking


Mechanisms for Controlling
BP
Baroreflexes Renin-Angiotensin-aldosteron
system
Mediated The sympathetic NS The kidney
By
Responsible Rapid, moment-to-moment regulation Long-term control
for
Place of & Aortic arch The kidney
receptors carotid sinuses
A fall in Blood Pressure causes the The baroreceptors in the kidney will
baroreceptors to send impulses to activate the Renin-Angiotensin-
Mechanism :the cardiovascular centers which will aldosteron system, which will
Sympathetic & parasympathetic :cause
output Vasoconstriction by angiotensin II -
&renal sodium reabsorption -
blood volume by aldosterone
Treatment Strategies
 The goal of antihypertensive therapy is to reduce cardiovascular & renal
morbidity and mortality.

 Usually we use one drug (thiazide diuretic) unless it is inadequate to control


the blood pressure so we add a second drug (β-blocker) and maybe third
(vasodilator).

 Individualized Care:
some people respond better to one class of drug than they do to another:

1) Black patients: respond well to diuretics & Ca++ channel blockers,


but β-blocker or ACE inhibitors is less effective.

2) Elderly: respond well to ACE inhibitors & diuretics, while β-blocker


& α-antagonists are less tolerated.

3) Concomitant diseases: hypertension may coexist with other diseases


that can be aggravated by the drugs (f 19.4).
…Cont
 Patient Compliance:
- Lack of patient compliance is the most common reason for failure of
antihypertensive therapy.

- Therapy is generally to prevent the disease rather than to relieving the


patient’s discomfort.

- The main adverse affect between middle-aged & elderly men is


decreasing the libido and inducing impotence.
Diuretics
 Recommended as the first-line drug therapy for hypertension.
 Diuretics are superior to β-blockers in older adults.

Diuretics Used in patients


with inadequate
kidney function

Thiazide Loop

Renal vascular
resistance
Ca++] in urine] Ca++] in urine] Renal
blood flow
Thiazide Diuretics
 Example: hydrochlorothiazide .

 Action: - lower BP by increasing Na+ & water excretion.


- Spironolactone is often used with thiazides because it has the
additional benefit of diminishing the cardiac remodelation.

 Therapeutic uses: - decrease BP in both supine & standing position.


(postural hypotension is rarely observed except in elderly)

- Useful in combination with other antihypertensive


drugs that cause water & Na+ retention.

- Useful: black & elderly.


Not useful: patients with inadequate kidney function.
…Cont
 Pharmacokinetics: - orally active.
- absorption & elimination rates vary.
- may compete with uric acid for elimination.
(ligands for the organic acid secretory system of the nephron)

K+ levels should
be monitored in Adverse
patients predisposed Effects
to cardiac arrhythmias

Hypokalemia Hyperuricemia Hyperglycemia


Hypomagnesemia
( 70% ) )( 70% )( 10%
Done by
.B. Mo