Podcast
Questions and Answers
True or false: Hypertension is defined as a sustained systolic blood pressure of greater than 120 mm Hg
True or false: Hypertension is defined as a sustained systolic blood pressure of greater than 120 mm Hg
False
True or false: Hypertension can lead to an increased incidence of renal failure, heart failure, and stroke
True or false: Hypertension can lead to an increased incidence of renal failure, heart failure, and stroke
True
True or false: Effective pharmacologic lowering of blood pressure has been shown to prevent damage to blood vessels
True or false: Effective pharmacologic lowering of blood pressure has been shown to prevent damage to blood vessels
True
True or false: There are three main drug classes recommended for the treatment of hypertension
True or false: There are three main drug classes recommended for the treatment of hypertension
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True or false: Adding angiotensin receptor blockers is the next step after improving treatment with diuretics?
True or false: Adding angiotensin receptor blockers is the next step after improving treatment with diuretics?
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True or false: Beta blockers are added after improving angiotensin converting enzyme inhibitor or treatment?
True or false: Beta blockers are added after improving angiotensin converting enzyme inhibitor or treatment?
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True or false: Aldosterone antagonists and fixed doses of hydralazine and isosorbide dinitrate are initiated in patients with persistent symptoms despite optimal doses of angiotensin converting enzyme inhibitors and beta blockers?
True or false: Aldosterone antagonists and fixed doses of hydralazine and isosorbide dinitrate are initiated in patients with persistent symptoms despite optimal doses of angiotensin converting enzyme inhibitors and beta blockers?
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True or false: Once a patient takes an angiotensin converting enzyme inhibitor or the optimal dose, and if the patient continues to experience symptoms, either can be replaced with sacubitril/valsartan?
True or false: Once a patient takes an angiotensin converting enzyme inhibitor or the optimal dose, and if the patient continues to experience symptoms, either can be replaced with sacubitril/valsartan?
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True or false: Finally, digoxin and ivabradine are added to achieve symptomatic benefit only in patients undergoing optimal drug therapy for high frequency?
True or false: Finally, digoxin and ivabradine are added to achieve symptomatic benefit only in patients undergoing optimal drug therapy for high frequency?
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ACE inhibitors are not recommended as first-line treatment for hypertension in patients with a history of heart disease or diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease
ACE inhibitors are not recommended as first-line treatment for hypertension in patients with a history of heart disease or diabetes, stroke, heart failure, myocardial infarction, or chronic kidney disease
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ACE inhibitors work by increasing aldosterone secretion, resulting in increased sodium and water retention
ACE inhibitors work by increasing aldosterone secretion, resulting in increased sodium and water retention
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Common side effects of ACE inhibitors include dry cough, rash, fever, altered taste, hypotension, and hyperkalemia
Common side effects of ACE inhibitors include dry cough, rash, fever, altered taste, hypotension, and hyperkalemia
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ARBs, beta-blockers, and diuretics are not other drug classes used to treat hypertension
ARBs, beta-blockers, and diuretics are not other drug classes used to treat hypertension
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The choice of medication for hypertension does not depend on its effect on overall cardiovascular morbidity and mortality
The choice of medication for hypertension does not depend on its effect on overall cardiovascular morbidity and mortality
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Placebo-controlled studies have shown ACE inhibitors to reduce cardiovascular events primarily due to their BP-lowering effect
Placebo-controlled studies have shown ACE inhibitors to reduce cardiovascular events primarily due to their BP-lowering effect
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ACE inhibitors are not recommended for compelling indications such as high coronary disease risk or history, diabetes, stroke, heart failure, myocardial infarction, and chronic kidney disease
ACE inhibitors are not recommended for compelling indications such as high coronary disease risk or history, diabetes, stroke, heart failure, myocardial infarction, and chronic kidney disease
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ACE inhibitors' mechanism of action includes reducing aldosterone secretion, leading to decreased sodium and water retention
ACE inhibitors' mechanism of action includes reducing aldosterone secretion, leading to decreased sodium and water retention
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ACE inhibitors have been shown to reduce cardiovascular morbidity and mortality in a broad sense
ACE inhibitors have been shown to reduce cardiovascular morbidity and mortality in a broad sense
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ACE inhibitors do not impact both preload and afterload, reducing cardiac work
ACE inhibitors do not impact both preload and afterload, reducing cardiac work
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Side effects of ACE inhibitors do not include dry cough, rash, fever, altered taste, hypotension, and hyperkalemia
Side effects of ACE inhibitors do not include dry cough, rash, fever, altered taste, hypotension, and hyperkalemia
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β-blockers are contraindicated in hypertensive patients with heart conditions like atrial fibrillation, previous myocardial infarction, angina pectoris, and chronic heart failure
β-blockers are contraindicated in hypertensive patients with heart conditions like atrial fibrillation, previous myocardial infarction, angina pectoris, and chronic heart failure
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Propranolol undergoes extensive first-pass metabolism and takes several weeks to develop full effects
Propranolol undergoes extensive first-pass metabolism and takes several weeks to develop full effects
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Prazosin, doxazosin, and terazosin are α1 adrenoreceptor-blocking agents that decrease peripheral vascular resistance and lower arterial blood pressure by causing relaxation of both arterial and venous smooth muscle
Prazosin, doxazosin, and terazosin are α1 adrenoreceptor-blocking agents that decrease peripheral vascular resistance and lower arterial blood pressure by causing relaxation of both arterial and venous smooth muscle
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Hydralazine and minoxidil are vasodilators that directly relax smooth muscles and are used for heart failure symptomatic relief
Hydralazine and minoxidil are vasodilators that directly relax smooth muscles and are used for heart failure symptomatic relief
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Sacubitril/valsartan is an alternative to ACE inhibitors or ARBs, while digoxin and Ivabradine are added only in patients with heart failure on optimal pharmacotherapy
Sacubitril/valsartan is an alternative to ACE inhibitors or ARBs, while digoxin and Ivabradine are added only in patients with heart failure on optimal pharmacotherapy
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Heart failure is classified into four stages, each requiring different treatment approaches and combination therapies
Heart failure is classified into four stages, each requiring different treatment approaches and combination therapies
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Diuretics are introduced first to manage symptoms of volume overload, followed by ACE inhibitors or ARBs, β-blockers, aldosterone antagonists, and hydralazine and isosorbide dinitrate, with Sacubitril/valsartan as an alternative to ACE inhibitors or ARBs, and digoxin and Ivabradine added only in optimal pharmacotherapy cases
Diuretics are introduced first to manage symptoms of volume overload, followed by ACE inhibitors or ARBs, β-blockers, aldosterone antagonists, and hydralazine and isosorbide dinitrate, with Sacubitril/valsartan as an alternative to ACE inhibitors or ARBs, and digoxin and Ivabradine added only in optimal pharmacotherapy cases
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Reversible bronchospastic diseases, second- and third-degree heart block, and severe peripheral vascular disease encourage the use of β-blockers
Reversible bronchospastic diseases, second- and third-degree heart block, and severe peripheral vascular disease encourage the use of β-blockers
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β-blockers may cause bradycardia, CNS side effects, and hypotension
β-blockers may cause bradycardia, CNS side effects, and hypotension
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Loop diuretics are used first in the treatment of heart failure, followed by ACE inhibitors or ARBs, β-blockers, aldosterone antagonists, and hydralazine and isosorbide dinitrate
Loop diuretics are used first in the treatment of heart failure, followed by ACE inhibitors or ARBs, β-blockers, aldosterone antagonists, and hydralazine and isosorbide dinitrate
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Heart failure, or cardiac failure, is classified into four stages and treated with a combination of drugs
Heart failure, or cardiac failure, is classified into four stages and treated with a combination of drugs
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The treatment of heart failure involves the use of vasodilators, α1 adrenoreceptor-blocking agents, and loop diuretics
The treatment of heart failure involves the use of vasodilators, α1 adrenoreceptor-blocking agents, and loop diuretics
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Calcium channel blockers should be avoided in high doses due to increased risk of myocardial infarction
Calcium channel blockers should be avoided in high doses due to increased risk of myocardial infarction
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Dihydropyridines have a greater affinity for vascular calcium channels than for calcium channels in the heart
Dihydropyridines have a greater affinity for vascular calcium channels than for calcium channels in the heart
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Most calcium channel blockers have short half-lives after an oral dose
Most calcium channel blockers have short half-lives after an oral dose
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Constipation occurs in approximately 10% of patients treated with Verapamil
Constipation occurs in approximately 10% of patients treated with Verapamil
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Verapamil should be avoided in patients with congestive heart failure or atrioventricular block
Verapamil should be avoided in patients with congestive heart failure or atrioventricular block
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β-Blockers are a treatment option for hypertensive patients with concomitant heart disease or heart failure
β-Blockers are a treatment option for hypertensive patients with concomitant heart disease or heart failure
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Calcium channel blockers are classified into three chemical classes
Calcium channel blockers are classified into three chemical classes
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Dizziness, headache, and fatigue caused by decreased blood pressure are more frequent with dihydropyridines
Dizziness, headache, and fatigue caused by decreased blood pressure are more frequent with dihydropyridines
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Dihydropyridines are particularly beneficial in treating hypertension
Dihydropyridines are particularly beneficial in treating hypertension
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Sustained-release preparations of calcium channel blockers are available for longer-term treatment
Sustained-release preparations of calcium channel blockers are available for longer-term treatment
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Verapamil is a diphenylalkylamine calcium channel blocker
Verapamil is a diphenylalkylamine calcium channel blocker
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Benzothiazepines include Diltiazem as a calcium channel blocker
Benzothiazepines include Diltiazem as a calcium channel blocker
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ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, resulting in increased production of aldosterone and increased salt and water retention
ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, resulting in increased production of aldosterone and increased salt and water retention
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ACE inhibitors have side effects such as dry cough and angioedema, and are contraindicated in pregnancy due to fetotoxicity
ACE inhibitors have side effects such as dry cough and angioedema, and are contraindicated in pregnancy due to fetotoxicity
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ARBs work by blocking the action of angiotensin II at its receptor, resulting in increased production of aldosterone and increased salt and water retention
ARBs work by blocking the action of angiotensin II at its receptor, resulting in increased production of aldosterone and increased salt and water retention
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Renin inhibitors, such as aliskiren, inhibit the production of angiotensin I from renin, making them a later intervention in the renin-angiotensin-aldosterone system than ACE inhibitors or ARBs
Renin inhibitors, such as aliskiren, inhibit the production of angiotensin I from renin, making them a later intervention in the renin-angiotensin-aldosterone system than ACE inhibitors or ARBs
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ARBs increase bradykinin levels and decrease nephrotoxicity in diabetes
ARBs increase bradykinin levels and decrease nephrotoxicity in diabetes
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Renin inhibitors, like ACE inhibitors and ARBs, are contraindicated during pregnancy
Renin inhibitors, like ACE inhibitors and ARBs, are contraindicated during pregnancy
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ACE inhibitors undergo hepatic metabolism, except for captopril and Lisinopril
ACE inhibitors undergo hepatic metabolism, except for captopril and Lisinopril
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Fosinopril requires dose adjustment in patients with renal impairment
Fosinopril requires dose adjustment in patients with renal impairment
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Enalaprilat is available intravenously
Enalaprilat is available intravenously
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ARBs have similar adverse effects to ACE inhibitors, but with increased risks of cough and angioedema
ARBs have similar adverse effects to ACE inhibitors, but with increased risks of cough and angioedema
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ARBs are not fetotoxic
ARBs are not fetotoxic
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Renin inhibitors, such as aliskiren, are a later intervention in the renin-angiotensin-aldosterone system than ACE inhibitors or ARBs
Renin inhibitors, such as aliskiren, are a later intervention in the renin-angiotensin-aldosterone system than ACE inhibitors or ARBs
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Study Notes
-
β-blockers are primarily used in hypertensive patients with heart conditions like atrial fibrillation, previous myocardial infarction, angina pectoris, and chronic heart failure.
-
Reversible bronchospastic diseases, second- and third-degree heart block, and severe peripheral vascular disease discourage the use of β-blockers.
-
Propranolol undergoes extensive first-pass metabolism and takes several weeks to develop full effects.
-
β-blockers may cause bradycardia, CNS side effects, and hypotension.
-
Prazosin, doxazosin, and terazosin are α1 adrenoreceptor-blocking agents that decrease peripheral vascular resistance and lower arterial blood pressure by causing relaxation of both arterial and venous smooth muscle.
-
Hydralazine and minoxidil are vasodilators that directly relax smooth muscles and are used for heart failure symptomatic relief.
-
Heart failure, or cardiac failure, is classified into four stages and treated with a combination of drugs; loop diuretics are used first, followed by ACE inhibitors or ARBs, β-blockers, aldosterone antagonists, and hydralazine and isosorbide dinitrate.
-
Sacubitril/valsartan is an alternative to ACE inhibitors or ARBs, while digoxin and Ivabradine are added only in patients with heart failure on optimal pharmacotherapy.
-
Heart failure is classified into four stages, each requiring different treatment approaches and combination therapies.
-
Diuretics are introduced first to manage symptoms of volume overload, followed by ACE inhibitors or ARBs, β-blockers, aldosterone antagonists, and hydralazine and isosorbide dinitrate, with Sacubitril/valsartan as an alternative to ACE inhibitors or ARBs, and digoxin and Ivabradine added only in optimal pharmacotherapy cases.
-
ACE inhibitors and ARBs are classes of medications used to treat high blood pressure.
-
ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, resulting in decreased production of aldosterone and decreased salt and water retention.
-
ACE inhibitors have side effects such as dry cough and angioedema, and are contraindicated in pregnancy due to fetotoxicity.
-
ACE inhibitors undergo hepatic metabolism, except for captopril and Lisinopril. Fosinopril does not require dose adjustment in patients with renal impairment, and enalaprilat is available intravenously.
-
ARBs, such as losartan, are alternatives to ACE inhibitors. They work by blocking the action of angiotensin II at its receptor, resulting in decreased production of aldosterone and decreased salt and water retention.
-
ARBs do not increase bradykinin levels and decrease nephrotoxicity in diabetes. Adverse effects are similar to ACE inhibitors but with decreased risks of cough and angioedema. ARBs are also fetotoxic.
-
Renin inhibitors, such as aliskiren, inhibit the production of angiotensin I from renin, making them an earlier intervention in the renin-angiotensin-aldosterone system than ACE inhibitors or ARBs.
-
Renin inhibitors, like ACE inhibitors and ARBs, are contraindicated during pregnancy.
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Description
Test your knowledge about calcium-channel blockers, their recommended uses, and potential risks. Learn about the classes of calcium-channel blockers and their effects on hypertensive patients with diabetes or angina.
