Hypertension

Definition: Hypertension (HTN) is defined as BP > !"#

!" mm Hg

Stage 1 HTN = !"#!!"#

!"!!! mm Hg

Stage 2 HTN > !!"#

!!"" mm Hg

• Increase (↑) Blood Pressure (BP) results in

1) Stroke 2) Ischemic Cardiomyopathy (ICM) – heart muscle is weaken and

dilated 3) Coronary Artery Disease (CAD)

All of the above resulting in Bad Outcomes

• Reduction (↓) of BP by 5% can reduce 1) Stroke (34%) 2) ICM (21%) 3) CAD

Treatment (Tx)

1) Lifestyle • Diet low in Na+ • Physical exercise • Biofeedback and Meditation • DASH – rich in nuts, fruits, vegetables

2) Medications (Side effects!) • ↓ BP • Decision is based on:

1) Underlying Diagnosis (Dx) 2) Certain comorbidities (appearance of multiple illnesses) and side effects

relating to profile

Hypertension Medication – ABCDs

A ACEi / ARBs

B B-Blockers

C Ca++ Blockers

D Diuretics

Dx useful: • BP is elevated in DM

patients and helps protect kidneys

• CHF patients help to improve ↑ EF and increase ↑ survival

• Scleroderma (chronic connective tissues) and helps protect kidney

• Young people, white

Dx useful: • CHF patients help

increase ↑ survival *Only 2 Types of B-Blockers: Carvedilol & Metopropol for increasing ↑survival

• Post MI patients help to increase ↑ survival *Any B-Blocker

• Young people, white

Dx useful: • No effect on ↑survival • African Americans • Elderly

Dx useful: • No effect on↑survival • African Americans • Elderly

Side Effects: • Angioedema (enlarge

tongue or neck swelling) patient needs to go the ER

• ↑ Cough 30% w/ ACEi than ARBs

• ↑ Hyperkalemia (abnormal high K+ in blood)

• ↓ Hyponatremia (abnormally low Na+ in blood)

• ↑ Creatinine (Cr) causing renal failure *Problematic especially in Renal Artery Stenosis. This paradoxical (doesn’t make sense when ACEi and ARBs protect w/ proteinuria, especially diabetic patients

• Contraindicated in bilateral renal stenosis

Side Effects: • B-Blockers cause ↓

HR and ↓ BP • ↑ Lipids and ↑

Cholesterol • ↑ Depression • ↑ Asthma patients • ↑ Bronchospasm in

COPD patients • ↑ K+ in hyperkalemia

Side Effects: Dihydropyridine (DHP): ends w/ -pine - Nifedipine - Amlodipine - Felodipine Causes peripheral vasodilation ↑ HR or remain the same *except Amlodipine ↑ HR especially ischemic heart disease non-DHP: - Diltiazem - Verapamil • negative (-) iontrope • ↓ contractility of the

heart • ↓ heart rate • * Good in HF patients

due (-) intrope &↓HR Edema in lower extremity Constipation Good for atrial fibrillation (AF) with rapid ventricular response works by ↓ response at AV node transmission.

Side Effects: Hydrochlorothiazide (HCTZ) - ascending loop diuretic ↑ 4 Things: 1) ↑ Ca++ 2) ↑ Uric Acid (UA) – not

good Gout patients, therefore avoid HCTZ

3) ↑ Lipids 4) ↑ Glucose – not good

Diabetic patients ↓ K+ reducing K+ causes ↑ Cr causing renal failiure ↓ Na+ cause hyponatremia and hypovolemia Furosemide (Lasix) - loop diuretic 1) ↓ Ca++ in blood ↓ K+ ↑ Cr ↓ Na+ Avoid Lasix in kidney stone patients due to ↓ Ca++ in blood which is loss in the urine. HCTZ is preferred for Ca++ retention

“The Others” α1-blockers

• Work by blocking the α1-receptor

In the peripheral vascular (blood vessels), two things can happen either

vasoconstriction (mediated by α1-receptor) or vasodilation (mediated by β receptor)

**Dobutamine (is pure β and causing ↑ HR by making the heart beat stronger

and contractility. But, it can cause vasodilation. Therefore, it is not much of

vasoconstrictor and more of + iontrope.

• End in –osins

o Terazosin

o Prazosin

• Used for BP medication

o Maybe effective in reduce BP numbers

• **Never been shown to ↓ mortality in CHF and MI

• **Can be used to prevent nightmare in PTSD patients

• Side Effect: “First Dose Hypertension” If not use to taking this medication, you

can impair the body’s ability to vasoconstrict. This would be important when

standing up causing one to pass out due to blood rushing to feet than head.

Therefore, first does should be taken orally every night before bed (PO qHS)

• PRIMARILY used in Benign Prostatic Hypertrophy (BPH) is not cancerous but

can cause obstructive uropathy, kidney obstruction, and kidney failure. It works

by causing relaxation of smooth muscles right before the urine exits the urethra.

α2-agonist