HYPERTENSION (SILENT KILLER) Chronic medical condition HTN, HPN, HT Systolic increase in arterial pressure HTN is elevated blood

ed blood pressure. BP is force of blood pushing against the walls of arteries as it floe through them Systolic (heart contract) Diastolic (heart relax) Measured in mmHg If untreated leads to Arterioseclerosis (hardening of arteries) Heart attack Stroke Enlarged heart Kidney damage

ARTERIOSCLEROSIS HTN MAKES arteries & veins thicker & harder Cholerstrol & fat deposit inside the walls Blood clots trapped in the narrow blood vessels Arteries may not deliver sufficient blood flow Reduced blood flow leads to heart attack If arteries of brain blocked results in stroke HTN makes the heart to work harder to pump the blood to body Extra workload make the heart muscle thicken & stretch Heart enlargement results in insufficient pumping of blood HTN not treated results heart failure HTN thickens the arteries of kidneys resulting low activity of kidneys Kidney failure 25% of people who receive kidney dialysis have kidney failure caused by HTN

Muhammad Abdullah (DP-307-936)

TYPES WITH CAUSES: PRIMARY HTN: HTN without known cause Potential causes AGE: STRESS: Mental & physical stress BP increases with age Alteration in peripheral resistance & decrease compliance of blood vessels

SODIUM INTAKE: Reducing to 6080mmol/day reduce BP

ALCOHOL: Increases BP

WEIGHT: Obeise have high BP than normal weight persons

SECONDARY HTN: Caused by another medical condition

RENAL DISEASES: Polycystic diseases Renal artery stenosis Muhammad Abdullah (DP-307-936)

Renin secreting tumors

DRUG INDUCED: Oral contraceptives Corticosteroids

PREGNANCY: Pre- eclampsia

GROWTH HORMONE EXCESS: Acromegaly

CATECHOLAMINE EXCESS: Pheochromocytoma

OTHERS: Coaractation of aorta

Muhammad Abdullah (DP-307-936)

SYMPATHETIC ADRENERGIC SYSTEM

BARO-RECEPTORS

Present at carotid & Aortic arch & blood vessels

Arteriolar dilation & constriction

BLOOD PRESSURE

CARDIAC OUTPUT

TOTAL PERIPHERAL RESISTANCE (TPR)

Facilitate release of NE & inhibit reuptake of NE Enhance sympathetic function

HEART RATE

STROKE VOLUME

Stimulate the release of Aldosterone

ALDOSTERONE

Increase sodium reabsorption Increase fluid volume Increase blood pressure

VENOUS RETURN

PLASMA VOLUME
Constriction of resistance vessels

ANGIOTENSINOGEN II ACE KIDNEY ANGIOTENSIN I

Increase TPR

Stimulate the release of Vasopressin/ADH Stimulate kidneys to increase fluid retention Increase venous return

RENIN

Cardiac & Vascular hypertrophy

Muhammad Abdullah (DP-307-936)

Stroke volume= the amount of blood ejected from left ventricle each cardiac cycle (70ml at rest) Nitric oxide = release from vascular endothelial in response of high blood pressure CLINICAL MENIFESTATIONS: Headache Nose bleeding Flushing Confusion Sleep disturbance Impotence Blurred vision

DIAGNOSIS: Electrocardiogram Echocardiogram Doppler ultrasound Sphygmomanometer

TREATMENT: In overweight = loss of weight results un BP reduction 2.5/1.5 mm Hg per kg Reduce salt intake High intake of food rich in fiber reduce CV risk Controlled intake of calories & saturated fat Regular dynamic exercise for 30 minutes daily Avoid alcohol Stop smoking to reduce CV risk bc it doest increase BP (notes wrong)

Muhammad Abdullah (DP-307-936)

Increase water intake (good circulation & blood quality) Laugh more less stress

MEDICATIONS: Thiazide diuretics: Inhibit reabsorption of sodium & chloride in thick ascending loop of Henle & distal tubules Increase potassium & bicarbonate excretion Decrease calcium excretion Uric acid retention Hydrochlorthiazide

POTASSIUM SPARING DIURETICS: Interfere with sodium reabsorption at distal tubules Decrease potassium excretion Weak diuretics when used alone Spironolactone

LOOP DIURETIC Act on ascending limb of loop of Henle Inhibit reabsorption of sodium & chloride Furosemide

ALPHA ADRENERGIC BLOCKING AGENT: Selectively block post synaptic alpha receptors Dilate arterioles & veins Prazosin

BETA BLOCKERS:

Muhammad Abdullah (DP-307-936)

Used as initial agent in combination with other drugs (thiazide) Atenolol, propranolol

ALPHA/BETA BLOCKERS: Blocks alpha, beta 1, beta2 receptors Decrease BP Labetolol

PERIPHERAL VASODILATORS: Relax blood vessels Improve blood flow Hydralazine, minoxidil

CALCIUM CHANNEL BLOCKER, Dihydropyridine: Binds L-type calcium channels in vascular smooth muscles Vasodilation Decrease BP Effective as mono therapy in blacks & elderly patients Amlodipine

CALCIUM CHANNEL BLOCKER, Non-Dihydropyridine: Binds to L-type calcium channels in SA node & AV node as well as in myocardium & vasculature More effective in black patients Dilitazem, verapamil

ACE INHIBITOR: Competitive inhibitor of ACE Reduce Angiotensin II level

Muhammad Abdullah (DP-307-936)

Decrease aldosterone secretion Captopril

ANGIOTENSIN II RECEPTOR BLOCKER ARBs: Use in patients who are unable to tolerate ACE inhibitors Losartan

ALDOSTERONE ANTAGONST: Stimulate presynaptic alpha 2 adrenergic receptors in brain stem Reduce sympathetic nervous activity Methyldopa, clonidine

RENIN INHIBITORS: Newer class Act on renin system feedback loop

VASODILATORS: Nitroglycerine affects venous system & decrease preload Nitroprusside decrease both preload & afterload, helps to decrease myocardial oxygen demand

DOPAMINE ANTAGONIST: Decrease peripheral vascular resistance Increase renal blood flow, dieresis , natriuresis Fenoldopam

COMBINATION THERAPY: Therapy starts with single agent Transfer to combination as needed Muhammad Abdullah (DP-307-936)

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Enalapril + hydrochlorthiazide Metoprolol + hydrochlorthiazide Triamterene + hydrochlorthiazide Valsartan + hydrochlorthiazide Vaslasrtan + amlodipine + hydrochlorthiazide Therapeutic class Loop diuretics Potassium sparing diuretics Peripheral vasodilator Centrally acting anti hypertensive Vasodilator Alpha 2 blocker ACE inhibitor ARBs Ca-channel blocker Generic Furosemide Spironolactone Hydralazine Methyl DOPA Sodium nitroprusside Vinposetine Prazosin HCl Captopril Losartan 1. Nifedepine 2. Amlodipine 3. Felodipine 4. Dilitazem 1. Atenolol 2. Propranolol Brand Lasix (Sonafi Aventis) Diuton (Medera) Hydralazine HCL (Zafa) Aldopa (Irza) Nitriate (Actimed) Cavinton () Minipresss (Pfizer) Capoten (BMS) Cozaar I. Procaride II. Norvasc(Pfizer) III. Plendil IV. Dilzem (Parkedavis) I. Tenormin (ICI) II. Inderal (ICI) Dose (mg) Tabs 20,40mg Inj 40mg 25-200mg IV inj 5mmol 250mg IV inj 3mg/kg/min 5mg 4mg-20mg 50mg 50-100mg 1. Tabs 30mg 2. Tabs 5-10mg 3. Tabs 5-10mg 4. Tabs 5-10mg 1. Tabs 2550mg 2. 0.5-1 mg/kg/day Frequency OD OD or divided doses Over 10-14minutes TDS

TID OD BD OD OD for all

10

Beta blocker

OD for all

Muhammad Abdullah (DP-307-936)