Hypertension and Cardiovascular Quiz

Pharmacology II - Topics Covered

• Cardiovascular system disorders are covered, including atherosclerosis and associated conditions (hypertension, coronary heart disease, chronic heart failure, cerebrovascular disease, and peripheral artery disease). Infections like endocarditis and rheumatic heart disease, and electrical impulse generation and conduction defects, and congenital heart disease are also mentioned.
• Asthma and Chronic Obstructive Pulmonary Disease (COPD) are included.
• Antihistamines, cough suppressants, and medications for the common cold are also listed.
• Gastrointestinal (GI) issues such as diarrhea, vomiting (emesis), constipation, and hyperacidity are covered.
• Medications for endocrine system issues like diabetes and adrenal, estrogen, and androgen imbalances are discussed.
• Pain management is a topic, as well as drugs for bone disorders and obesity related issues.

Cardiovascular Disorders

• The diagram shows a human body outline with major blood vessels, including the anterior vena cava, liver vein, kidneys, brain, pulmonary artery, lungs, digestive tract, and aorta.
• Atherosclerosis and related conditions, including hypertension (high blood pressure), coronary heart disease (CHD), chronic heart failure (CHF), cerebrovascular disease (stroke), and peripheral artery disease are presented.
• Infections like endocarditis and rheumatic heart disease, and electrical impulse generation and conduction defects, are mentioned.
• Also includes congenital heart disease.

Subsequent Disease States

• The presentation includes a diagram showing how vascular disease, angina, and sudden/ gradual death are related stages of disease progression.

Cardiovascular Risk Factors

• Risk factors for cardiovascular disease include physical inactivity, smoking, overweight, psychosocial factors, hyperlipidemia (high blood lipids), hypertension (high blood pressure), and diabetes.
• A list of family history, ethnic background, gender, and age as non-modifiable risk factors is included.

CV Risk Assessment

• For adults without known cardiovascular disease (CVD), a comprehensive assessment of CVD risk considers modifiable factors like smoking, blood pressure, serum lipids, waist circumference, nutrition, physical activity, and alcohol intake.
• Non-modifiable risk factors include age, sex, family history of premature CVD, and relevant social factors including cultural identity and socioeconomics.
• Related conditions include diabetes, chronic kidney disease (e.g., albuminuria, urine protein, eGFR), familial hypercholesterolaemia, and atrial fibrillation (if found during evaluation).

Antihypertensive Drugs

• A list of learning objectives relating to antihypertensive drugs includes: classification, pathophysiology, mechanisms of action (diuretics, ACE inhibitors, ARBs, beta-blockers, alpha-blockers, CCBs, vasodilators, and central sympatholytics), common adverse effects, pharmacotherapy for hypertension and emergencies, and preparation and dosage.

Aetiology and Types of Hypertension

• The majority(90-95%) of hypertension cases are primary (essential) hypertension, with no specific cause identified.
• Secondary hypertension (5-10%) is caused by other underlying diseases like renal disease, Cushing's syndrome, pheochromocytoma, hypothyroidism, drug-induced (e.g., NSAIDs, oral contraceptives, corticosteroids), or pregnancy.

Classification of Hypertension

• Blood pressure classification using systolic and diastolic measurements (e.g., normal, pre-hypertensive, Stage I, Stage II, hypertensive emergency).

Physiology of Basic Hypertension Regulation

• Blood pressure (BP) is calculated as Cardiac Output (CO) multiplied by Systemic Vascular Resistance (SVR).
• According to the hydraulic equation, arterial blood pressure is directly proportionate to the product of blood flow (cardiac output), and resistance to blood flow through small arteries (peripheral vascular resistance).

Normal Regulation of Blood Pressure

• BP is a product of blood flow (CO) and the resistance to blood flow in small blood vessels (PVR).

Factors Influencing Blood Pressure

• Factors affecting arterial blood pressure include cardiac output, heart rate, contractility, filling pressure, blood volume, venous tone, peripheral resistance, and vascular structure and function.

Mechanisms Controlling Blood Pressure

• Mechanisms maintaining blood pressure include baroreceptors and the sympathetic nervous system, and the renin-angiotensin-aldosterone system.
• Details about how blood pressure is maintained include moment-to-moment regulation of cardiac output, peripheral resistance, and the roles of the kidneys and autonomic nerves (baroreflexes). Local production of vasoactive substances in blood vessels is also involved.

Baroreceptors and the Sympathetic Nervous System

• Baroreceptors in the carotid sinus and aortic arch sense changes in blood pressure.
• The sympathetic nervous system mediates moment-by-moment adjustments to blood pressure based on these signals.

Renin-Angiotensin-Aldosterone System (RAAS)

• The RAAS involves a sequence of events that regulate blood pressure and fluid balance, including renin release from juxtaglomerular cells, angiotensin I conversion to angiotensin II, and the secretion of aldosterone. The process of water and sodium retention and release is part of the RAAS (Renin, Angiotensin I, Angiotensin II, and Aldosterone).

Lifestyle Modification

• Lifestyle modifications include weight reduction (BMI, waist circumference), reducing salt intake, increasing physical activity, modifying dietary habits (diet rich in fruits, vegetables, low-fat dairy, and low in saturated and total fat), and limiting alcohol intake.

Risks of Not Treating Hypertension

• Consequences of untreated hypertension include cardiovascular risk, target organ damage (eyes, brain, kidneys, heart), retinopathy, optic neuropathy, haemorrhagic stroke, encephalopathy, and left ventricular hypertrophy.

Hypertension

• Hypertension is characterized by increased vascular resistance, increased cardiac output, increased blood volume, and increased venous return.

Antihypertension Medications

• Antihypertensive medications such as vasodilators, sympathetic inhibitors, diuretics, and renin-angiotensin blockers target different aspects of hypertension's pathophysiology.

Treatment Strategies

• Treatments for hypertension include using a combination of one or two drugs depending on whether HTN is in Stage I or Stage II.
• The goal is reduction of morbidity and mortality from cardiovascular and renal impacts.

Individualized Care

• Treatment planning should consider the coexistence of other conditions like diabetes mellitus, chronic kidney disease and protein urea, and the age of the patient.
• The target blood pressure goals will be different for each condition and age group.

Patient Compliance

• Patient non-compliance is a major contributor to treatment failure in patients with hypertension (HTN).
• Medications' adverse effects and the complexity of dosing contribute to problems with treatment adherence.

Anti-HTN Drugs

• Includes a list of medications used to treat hypertension, including diuretics, β-adrenoceptor blockers, ACE inhibitors, Ang II receptor blockers (ARBs), Renin inhibitors, Calcium channel blockers (CCBs), a-adrenoceptor blockers, a/β adrenoceptor blockers, centrally acting adrenergic drugs and vasodilators.

Diuretics

• Diuretics, including thiazide, thiazide-like, loop, and potassium-sparing diuretics, work by increasing the excretion of sodium and water.
• Diuretics' adverse effects such as hypokalemia, hyponatremia, hyperuricemia, volume depletion, hypercalcemia, and hyperglycemia may occur and management of such effects are also included.
• Thiazide and loop diuretics mechanisms, uses, and adverse effects are explained in detail.
• Details about potassium sparing diuretics, their action on the kidney nephrons, uses, and implications are explained.

Actions of Diuretic Classes

• Thiazide-like diuretics inhibit Na+ and Cl- transporter.
• Loop diuretics inhibit Na+, K+, and 2Cl- transporter.
• Potassiums-sparing diuretics inhibit the action of aldosterone.

Lifestyle Modification - Actions

• Lifestyle modifications play an important role in controlling blood pressure.
• Reducing weight, lowering salt intake, and increasing physical activity can aid in lowering blood pressure.

Risks of Not Treating Hypertension - Actions

• Untreated hypertension has several negative consequences, including increased risk of cardiovascular health problems, damage to target organs, retinopathy, and potentially life-threatening issues.

Beta-Adrenoceptor Blockers

• These agents lower cardiac output and reduce renin release, reducing both heart rate and contractility, thereby reducing blood pressure.
• Various Beta-Blockers like Propranolol, Atenolol, Pindolol, Metoprolol, Acebutolol, Esmolol, Carvedilol, Labetalol are listed.

Beta-Adrenoceptor Blockers - Actions

• Reduction in cardiac output, renin release, and peripheral resistance are the key mechanisms of action of beta blockers.
• Short-acting agent like Esmolol has a shorter duration of action compared to other long-acting beta-blockers.
• Beta-blockers with partial agonist activity include Pindolol and Acebutolol.
• Benefits and side effects of Beta Blockers are also included.

Antagonists of both α and β adrenoceptors (Labetalol and Carvedilol)

• Actions of these drugs include production of peripheral vasodilation reducing blood pressure without changing serum lipids or glucose. Clinical uses include use in hypertension and heart failure.
• Labetalol can be used as an alternative or intravenously during sudden blood pressure emergencies to lower blood pressure.
• Clinical trials have demonstrated Carvedilol's benefits in patients with stable chronic heart failure, including possible beneficial impact on mortality and hospitalization rates.

Adverse Effects of Beta Blockers

• CNS effects like fatigue, depression, dizziness, and hallucinations can occur with some beta blockers.
• Bronchoconstriction may happen in those with asthma or COPD.
• Stopping these drugs suddenly can trigger arrhythmias.
• There are several metabolic consequences including hypoglycemia which requires careful monitoring.
• Side effects like decreased metabolic effects, and increased risk of lipid anomalies can also occur.

ACE-Inhibitors

• Used as first-line therapy for people at high risk of coronary disease, diabetes mellitus (with potential slowing of diabetic nephropathy), previous history of a stroke, heart failure (reducing left ventricular hypertrophy), recent myocardial infarction (MI) to prevent ventricular remodeling, and chronic kidney disease.
• The mechanisms of action involve inhibiting the angiotensin-converting enzyme (ACE).
• Common examples of these medications like Captopril, Enalapril, Ramipril, and Lisinopril are provided.
• Adverse effects including dry cough (in 10% of patients), angioedema (rare and possibly life-threatening), skin rash/fever, altered taste, hyperkalemia (enhanced in use with other drugs), hypotension, elevated serum creatinine levels and teratogenic potential (precautions during pregnancy) are included.

ARBs

• Similar to ACE inhibitors in actions and uses, but with a less frequent side effect of dry cough and angioedema.
• Examples of Angiotensin II Receptor Blockers (ARBs) - Losartan, Candesartan, Olmesartan, Azilsartan, and Valsartan, are presented.

Renin Inhibitors (Aliskiren)

• Similarities and differences in side effects to ACE inhibitors and ARBs, including a possible risk of dry cough and angioedema, and diarrhea.

Calcium Channel Blockers (CCBs)

• Two groups, dihydropyridines (DHPs) and non-dihydropyridines (NDHPs), are described, along with common medications from each subtype.
• Dihydropyridines (DHPs) primarily affect blood vessels, while non-dihydropyridines (NDHPs) affect both blood vessels and the heart.
• Dihydropyridines (DHPs) like Amlodipine, Nifedipine, Felodipine, Clevidipine, and Nimodipine are listed.
• Nondihydropyridines (NDHPs) - Verapamil and Diltiazem- are listed.

Actions of Calcium Channel Blockers (CCBs)

• Calcium channel blockers (CCBs) decrease calcium ion flow. This causes mainly dilation of blood vessels and reduced cardiac contractility.
• The mechanism of action involves blocking voltage-gated calcium channels.
• CCBs can be used as initial or additional therapy for hypertension (HTN) with other comorbidities (e.g., asthma, diabetes mellitus, peripheral vascular disease),
• Clinical uses include procedures involving angina, hypertension, atrial fibrillation, and subarachnoid hemorrhage.

Dihydropyridines (DHPs)

• Actions of DHPs have a higher affinity for vascular smooth muscle cells.
• Possible increased risk for MI with high doses and short-acting CCBs due to excessive vasodilation and reflex cardiac stimulation.

Non-Dihydropyridines (NDHPs)

• NDHPs block calcium channels in the heart and vascular smooth muscles.
• They have negative inotropic and dromotropic effects.

Therapeutic Uses of CCBs

• CCBs are useful in treating HTN, angina, atrial fibrillation, and subarachnoid hemorrhage. Initial or supplementary treatment for various cardiovascular diseases is indicated.

Adversse Effects of CCBs

• These can include first-degree AV block, constipation, dizziness, headache, fatigue, peripheral edema, gingival hyperplasia, Hypotension, and heart failure is a contraindication.

α1-Adrenergic Receptor Blockers

• This class of blood pressure medications is no longer strongly recommended as first line therapy.
• The drugs Prazosin, Terazosin, and Doxazosin dilate arteries and veins, lower peripheral vascular resistance and blood pressure, and may cause reflex tachycardia and postural hypotension.

Centrally Acting Adrenergic Drugs

• Clonidine and Methyldopa are included in this class.
• Clonidine acts as a central alpha-2 agonist, inhibiting sympathetic outflow from the cardiovascular control center and lowering blood pressure. This helps in controlling symptoms in hypertension and can be particularly helpful in pregnant women.
• Methyldopa works centrally as an alpha-2 agonist and is often used in pregnancy. Both drugs can cause side effects like lethargy, sedation, constipation and xerostomia.

Vasodilators

• The presentation covers Hydralazine, Minoxidil, and Nitroprusside.
• Vasodilators cause dilation of blood vessels, decreasing peripheral vascular resistance and lowering blood pressure.
• Hydralazine can be used in gestational hypertension.
• They are generally not for initial usage in treating HTN on their own, but can be useful in hypertensive emergencies.

Adverse Effects of Vasodilators

• Specific side effects like headache, nausea, sweating, tachycardia, arrhthmias, angina, lupus-like syndrome for Hydralazine, hypertrichosis (growth of body hair) for Minoxidil, and potential cyanide toxicity and methemoglobinemia with Nitroprusside.

Hypertensive Emergency

• Rare and potentially life-threatening, characterized by rapid blood pressure elevation potentially causing target organ damage (stroke, myocardial infarction (MI)).
• CCBs, vasodilators (nitroglycerin, nitroprusside, hydralazine), adrenergic blockers (phentolamine, esmolol, labetalol), and dopamine agonists (Fenoldopam) are used in treatment, depending on the situation.

How to manage side effects of certain categories of antihypertensive drugs

• Methods to address adverse effects associated with different types of antihypertensive medications (CCBs, β-blockers, ACE-I, ARBs, diuretics).

Test your knowledge on hypertension, its classifications, and related cardiovascular diseases. This quiz covers essential concepts including primary and secondary hypertension, mechanisms of antihypertensive drugs, and common adverse effects. Perfect for students in medical or health-related programs.