Done by .B.

Mo

Intro
Hypertension mmHg 140< Systolic Blood (Pressure (SBP Diastolic Blood (Pressure (DBP mmHg 90<

****************************************************
Arterial BP Peripheral Resistance Filling Pressure Venous Tone Arteriolar Volume

Cardiac Output

Heart Rate

Contractility

Blood Volume

…Cont
Categories of Hypertension

Normal ( 80< / 120< (

Prehypertension ( 80-89 / 120-139 (

Stage 1 Hypertension ( 90-99 / 140-159 (

Stage 2 Hypertension ( 100≤ / 160≤ (

**************************************************** Main Complications

Congestive Heart Failure

Myocardial Infarction

Renal Damage

Cerebrovascular Accidents

…Cont
Types of Hypertension Essential A disorder of unknown origin affecting the Blood Pressure regulating mechanisms Secondary

Secondary to other disease processes

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Environmental Factors

Stress

Na+ Intake

Obesity

Smoking

Mechanisms for Controlling BP
Baroreflexes Mediated By The sympathetic NS Renin-Angiotensin-aldosteron system The kidney Long-term control The kidney Responsible Rapid, moment-to-moment regulation for Place of receptors & Aortic arch carotid sinuses

A fall in Blood Pressure causes the The baroreceptors in the kidney will baroreceptors to send impulses to activate the Renin-Angiotensinaldosteron system, which will Mechanism :the cardiovascular centers which will :cause Sympathetic & parasympathetic Vasoconstriction by angiotensin II output
&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 Renal blood flow

Ca++] in urine]

Ca++] in urine]

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 patients predisposed to cardiac arrhythmias

Adverse Effects

Hypokalemia ( 70% )

Hyperuricemia )( 70%

Hyperglycemia )( 10%

Hypomagnesemia

Done by .B. Mo

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