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Heiman.pharm.HTN

HTN concepts.physiology

QuestionAnswer
Prehypertension SBP: 120-139 DBP: 80-89 Lifestyle modification needed No antihypertensive indicated
Stage 1 Hypertension SBP: 140-159 DBP: 90-99 Lifestyle modification needed. May consider ACE inhibitor, ARB, beta blocker, CCB, or combination
Stage 2 hypertension SBP: >160 or DBP: >100 Lifestyle modification needed 2 drug therapy for most (usually thiazide-type diuretic & ACE inhibitor or ARB or beta blocker, or CCB)
Neuronal mechanisms of BP control:Peripheral nervous system alpha and beta receptors.
Neuronal mechanisms of BP control: Baroreceptor reflex Nerve endings in the walls of large arteries. Feedback mechanism triggers vasodilation when BP increases acutely. These reflexes may be blunted in the elderly.
Neuronal mechanisms of BP control: Central nervous system Vagal nuclei, Vasomotor center.
Neuronal mechanisms of BP control: Peripheral autoregulation Renal:Changes in Na and water retention. Local tissue autoregulation: These processes are related to oxygen demand.
Humoral mechanisms of BP control: Renin-angiotensin-aldosterone: Regulation of Na, K, and fluid balance. Natriuretic hormone: Regulation of Na balance.
Humoral mechanisms of BP control:cont'd Hyperinsulinemia and insulin resistance. Possible increases in renal Na retention. Possible enhanced sympathetic nervous system activity. Growth hormone like activity.
Lifestyle modifications: Weight loss. Limit alcohol intake. Increase aerobic activity. Reduce Na intake to 2.4 G/d or less. Maintain dietary K, Ca, and Mg. Reduce intake of dietary saturated fat and cholesterol. Stop smoking.
High risk with compelling indication: Heart failure Diuretic. beta blocker. ACE inhibitor. ARB. Aldosoterone antagonist.
High risk with compelling indication: Post myocardial infarction Beta blocker. ACE inhibitor. Aldosterone antagonist.
High risk with compelling indication: High coronary disease risk: Diuretic. Beta blocker. ACE inhibitor. CCB.
High risk with compelling indication:Diabetes Diuretic. Beta blocker. ARB. ACE inhibitor. CCB.
High risk with compelling indication: Chronic kidney disease ACE inhibitor. ARB.
High risk with compelling indication: Recurrent stroke prevention Diuretic. ACE inhibitor.
Special Populations: Asthma, COPD, peripheral arterial disease; Avoid β-blockers. Elderly;Centrally acting agents and α-blockers are generally avoided Elderly are sensitive to sympathetic inhibition leading to postural hypotension. Start w/ low dose.
Special populations: Children: Secondary HTN more common. Pregnancy: Methlydopa (Aldomet)‏ Labetalol (Trandate, Normodyne) ACE inhibitors and ARBs are contraindicated.
Special Populations African – American: May be more Na sensitive, more responsive to diuretic therapy, β-blockers, ACE inhibitors, and ARBs may not be as good for monotherapy.
Diuretic Resistance Ability of diuretic to increase NaCl excretion declines with time May need to add second drug Causes Patient noncompliance Impaired bioavailability Renal failure Drugs NSAIDS, captopril, cimetidine, antihypertensives
Created by: DianaB
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