Hypertension and Antihypertensive Drugs
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Questions and Answers

What percentage of adults are affected by hypertension?

  • 40%
  • 20%
  • 30% (correct)
  • 50%

    • What is the definition of hypertension according to the American Heart Association?

  • Arterial blood pressure higher than 160/100 mm Hg
  • Arterial blood pressure higher than 180/110 mm Hg
  • Arterial blood pressure higher than 140/90 mm Hg (correct)
  • Arterial blood pressure higher than 120/80 mm Hg

    • What is a major risk factor in the development of chronic kidney disease and heart failure?

  • Obesity
  • Diabetes
  • Hypertension (correct)
  • Hyperlipidemia

    • What is the formula for blood pressure?

    <p>BP = CO x TPR</p> Signup and view all the answers

    What is the effect of sustained arterial hypertension on blood vessels?

    <p>Damage to blood vessels</p> Signup and view all the answers

    What is the effect of diuretics on blood pressure?

    <p>Decrease blood pressure</p> Signup and view all the answers

    What is the mode of action of centrally acting sympatholytic drugs?

    <p>Decrease peripheral vascular resistance</p> Signup and view all the answers

    What is the effect of direct vasodilators on blood vessels?

    <p>Dilatation of blood vessels</p> Signup and view all the answers

    What is the direct result of decreased peripheral resistance?

    <p>Decreased blood pressure</p> Signup and view all the answers

    What is the mode of action of Calcium Channel blockers?

    <p>Inhibit calcium influx into arterial smooth muscle cells</p> Signup and view all the answers

    What is the primary mechanism of blood pressure reduction by diuretics?

    <p>Depleting body sodium stores</p> Signup and view all the answers

    Which type of diuretics is used in severe hypertension?

    <p>More powerful diuretics acting on the loop of Henle</p> Signup and view all the answers

    What is the benefit of using potassium-sparing diuretics?

    <p>Avoid excessive potassium depletion</p> Signup and view all the answers

    What is the mode of action of methyldopa?

    <p>Converted to methyl norepinephrine centrally to diminish adrenergic outflow</p> Signup and view all the answers

    What is the limitation of using methyldopa?

    <p>It has adverse effects and requires multiple daily doses</p> Signup and view all the answers

    What is the site of action of clonidine in the brain?

    <p>Medulla of the brain</p> Signup and view all the answers

    What is the primary effect of reserpine on the brain?

    <p>Impairing 5-HT-mediated transmission</p> Signup and view all the answers

    Why is propranolol particularly useful in severe hypertension?

    <p>Because it prevents reflex tachycardia</p> Signup and view all the answers

    What is a characteristic of atenolol compared to other β antagonists?

    <p>It is not appreciably metabolized</p> Signup and view all the answers

    What is a unique feature of labetalol and carvedilol?

    <p>They block α1, β1, and β2 receptors</p> Signup and view all the answers

    In what condition is labetalol particularly useful?

    <p>Gestational hypertension</p> Signup and view all the answers

    What is the primary mechanism of action of alpha1 blockers?

    <p>Selectively blocking α1 receptors in arterioles and venules</p> Signup and view all the answers

    What is a characteristic of alpha blockers in comparison to nonselective α antagonists?

    <p>They produce less reflex tachycardia</p> Signup and view all the answers

    What is the optimal way to use alpha blockers?

    <p>In combination with a β blocker and a diuretic</p> Signup and view all the answers

    What is the primary mechanism by which ACE inhibitors reduce the risk of heart failure and kidney disease?

    <p>By reducing the hemodynamic effects of angiotensin II</p> Signup and view all the answers

    Which of the following is a contraindication for the use of ACE inhibitors during pregnancy?

    <p>All of the above</p> Signup and view all the answers

    What is the primary difference between ACE inhibitors and angiotensin receptor blockers?

    <p>Their mechanism of action</p> Signup and view all the answers

    Which of the following is a common side effect of ACE inhibitors that is not typically seen with angiotensin receptor blockers?

    <p>Dry cough</p> Signup and view all the answers

    What is the primary reason why ACE inhibitors are not recommended during the first trimester of pregnancy?

    <p>Risk of teratogenic effects</p> Signup and view all the answers

    Which of the following is a benefit of angiotensin receptor blockers compared to ACE inhibitors?

    <p>Less effect on bradykinin metabolism</p> Signup and view all the answers

    What is the primary mechanism by which angiotensin receptor blockers reduce the risk of heart failure and kidney disease?

    <p>By blocking the angiotensin II receptor</p> Signup and view all the answers

    Which of the following is a common side effect of angiotensin receptor blockers that is similar to ACE inhibitors?

    <p>All of the above</p> Signup and view all the answers

    What is the most likely cause of a 45-year-old man's persistent, dry cough after starting therapy for hypertension?

    <p>Enalapril</p> Signup and view all the answers

    Which medication may cause reflex tachycardia and/or postural hypotension on initial administration?

    <p>Prazosin</p> Signup and view all the answers

    What medication can precipitate a hypertensive crisis following abrupt cessation of therapy?

    <p>Clonidine</p> Signup and view all the answers

    What medication is likely to cause hyperkalemia in a patient with hypertension?

    <p>Losartan</p> Signup and view all the answers

    Which medication is an angiotensin receptor blocker (ARB)?

    <p>Losartan</p> Signup and view all the answers

    What medication is a calcium channel blocker?

    <p>Nifedipine</p> Signup and view all the answers

    Study Notes

    Hypertension

    • Hypertension is the most common cardiovascular disease, affecting approximately 30% of adults.
    • It is defined as arterial blood pressure higher than 140/90 mm Hg by the American Heart Association and 160/95 mm Hg by the World Health Organization.
    • Hypertension, unless rapid in onset and severe, does not produce noticeable symptoms.
    • Sustained arterial hypertension damages blood vessels in the kidney, heart, and brain, making it an important risk factor in the development of chronic kidney disease and heart failure.
    • Early diagnosis and proper treatment of hypertension can significantly decrease morbidity and mortality.

    Factors Influencing Blood Pressure

    • BP = CO x TPR (Blood Pressure is equal to Cardiac Output multiplied by Total Peripheral Resistance)
    • The autonomic nervous system and the renin-angiotensin-aldosterone system (RAAS) respond to a decrease in blood pressure.

    Classification of Antihypertensive Agents

    • Diuretics: Lower blood pressure by depleting the body of sodium and reducing blood volume.
    • Sympatholytic agents:
      • Centrally acting sympatholytic drugs (methyldopa and clonidine)
      • Ganglion-blocking agents (trimetaphan)
      • Adrenergic neuron-blocking agents (guanethidine)
      • Adrenoceptor antagonists (α & β blockers)
    • Direct vasodilators: Produce relaxation of vascular smooth muscle, primarily in arteries and arterioles, resulting in decreased peripheral resistance and blood pressure. Examples include hydralazine and minoxidil.
    • Calcium Channel blockers: Inhibit calcium influx into arterial smooth muscle cells.
    • Agents that block production or action of angiotensin:
      • Angiotensin-Converting Enzyme (ACE) Inhibitors
      • Angiotensin Receptor-Blocking Agents

    Diuretics

    • Diuretics lower blood pressure primarily by depleting body sodium stores.
    • Effective in lowering blood pressure by 10-15 mm Hg in most patients.
    • Often used in combination with sympatholytic and vasodilator drugs in severe hypertension.
    • Thiazide diuretics are suitable for patients with mild or moderate hypertension and normal renal and cardiac function.
    • More powerful diuretics are necessary in severe hypertension.
    • Potassium-sparing diuretics are useful to avoid excessive potassium depletion and to enhance the natriuretic effects of other diuretics.

    Methyldopa

    • Converted to methyl norepinephrine centrally to diminish adrenergic outflow from the CNS.
    • Also an α2 agonist.
    • Common side effects include sedation and drowsiness, particularly in the elderly.
    • Limited use due to adverse effects and the need for multiple daily doses.
    • Mainly used for management of hypertension in pregnancy, where it has a record of safety.

    Clonidine

    • MOA: Exerts hypertensive effect at α-adrenoceptors in the medulla of the brain.
    • Reserpine is no longer used as an antihypertensive drug due to central effects, especially depression.

    Adrenoceptor Antagonists

    • Propranolol: Useful for lowering blood pressure in mild to moderate hypertension, especially in preventing reflex tachycardia in severe hypertension.
    • Atenolol, Betaxolol, and Bisoprolol: β1-selective blockers, effective in lowering blood pressure, with fewer central nervous system-related effects.

    Alpha1 Blockers

    • Prazosin, terazosin, and doxazosin produce antihypertensive effects by selectively blocking α1 receptors in arterioles and venules.
    • Reduce arterial pressure by dilating both resistance and capacitance vessels.
    • Less reflex tachycardia compared to nonselective α antagonists.
    • More effective when used in combination with other agents.

    ACE Inhibitors

    • Adverse effects: dry cough, hyperkalemia, skin rash, and swelling of tissues (angioedema), and severe hypotension.
    • Contraindicated during the second and third trimesters of pregnancy due to fetal hypotension, anuria, and renal failure.

    Angiotensin Receptor-Blocking Agents

    • Examples: Losartan, valsartan, candesartan, and irbesartan.
    • Mechanism of action: Block the angiotensin II receptor.
    • No effect on bradykinin metabolism.
    • Provide benefits like ACE inhibitors in patients with heart failure and chronic kidney disease.
    • Adverse effects: similar to those of ACE inhibitors, but with less frequent cough and angioedema.

    Study Questions

    • A 45-year-old man developed a persistent, dry cough after starting therapy for hypertension. The most likely cause is Enalapril.
    • Prazosin may cause reflex tachycardia and/or postural hypotension on initial administration.
    • Abrupt cessation of Clonidine therapy can precipitate a hypertensive crisis.
    • Elevated serum potassium (hyperkalemia) is likely caused by Losartan.

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    Description

    This quiz covers the basics of hypertension, its definition, and its symptoms, as well as antihypertensive drugs used to treat it. Learn about the different blood pressure thresholds used by the American Heart Association and the World Health Organization.

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