Hypertension Quiz Chapter 1

Pharmacology for Pharmacy Technicians, 4th Edition

• The book is by Kathy Moscou PhD RPh MPH and Karen Snipe CPhT AS BA MEd
• Copyright 2025 by Elsevier Inc.

Chapter 18: Treatment of Hypertension

• The chapter covers the treatment of hypertension
• The lesson objectives include: defining hypertension terminology, listing risk factors, identifying complications, explaining the role of coronary heart disease, and identifying lifestyle changes to reduce risk.

Lesson 18.1: Hypertension

• Objective 1 (Terminology): Students will learn terminology related to hypertension treatment
• Objective 2 (Risk Factors): Students will identify risk factors for hypertension (e.g., age, diabetes, family history, obesity)
• Objective 3 (Complications): Students will list complications of untreated or poorly controlled hypertension
• Objective 4 (Coronary Heart Disease): Students will explain the role of coronary heart disease in hypertension development
• Objective 5 (Lifestyle Changes): Students will identify lifestyle changes to lessen hypertension risk

Key Terms

• Aldosterone: Hormone promoting sodium and fluid reabsorption in the body.
• Angiotensin II: Powerful vasoconstrictor activated by the renin-aldosterone-angiotensin system.
• Angiotensin-converting enzyme: Enzyme converting angiotensin I to angiotensin II.
• Cardiac output: Blood volume ejected by the left ventricle per minute.
• Diastolic blood pressure: Blood pressure when the heart is relaxed.
• Diuretic: Medication promoting urination.
• Hyperkalemia: Elevated serum potassium.
• Hypertension: High blood pressure.
• Isolated systolic hypertension: Systolic blood pressure elevated while diastolic is within normal limits.
• Metabolic syndrome: Key risk factor for hypertension; involved in atherosclerosis and cardiovascular diseases.
• Orthostatic hypotension: Drop in blood pressure during transition from lying, sitting, to standing.
• Peripheral vascular resistance: Resistance to blood flow in peripheral arteries.
• Renin-aldosterone-angiotensin system: System activated in response to low blood flow to the kidneys, leading to elevated blood pressure, blood volume, and vasoconstriction.
• Systolic blood pressure: Blood pressure when the heart is contracting (pumping).

Blood Pressure

• Average normal blood pressure: 120 (systole) / 80 (diastole) mm Hg.
• BP Formula: BP = CO x PR (Cardiac output x Peripheral resistance)

Blood Pressure Control

• Regulatory sites: Kidneys, heart, blood vessels, central nervous system and sympathetic nerves

Hypertension Risk Factors (1 of 3)

• Metabolic syndrome: Leads to atherosclerosis and cardiovascular diseases.
• Chronic kidney disease: Related to hypertension development
• Thyroid disease: Impacts hypertension risk
• Cushing's syndrome: Increases hypertension risk
• Sleep apnea: Linked to higher hypertension risk.
• Prescription and OTC (Over-the-counter) drugs: Some medications can increase blood pressure.

Hypertension Risk Factors (2 of 3)

• NSAIDs (nonsteroidal anti-inflammatory drugs): COX-2 inhibitors can raise blood pressure.
• Cocaine and amphetamines: These stimulate higher blood pressure.
• Diet pills: Certain diet pills may elevate blood pressure.
• Oral contraceptives: Associated with hypertension risk
• Glucocorticosteroids: Raise blood pressure
• Mineralocorticoids: (e.g., aldosterone) linked to hypertension risk
• Cyclosporin and tacrolimus: Linked to hypertension risk
• Erythropoietin: Associated with blood pressure elevations.
• Licorice: Linked to hypertension risk.
• Herbals: (e.g., ma huang, ephedra, bitter orange) These raise blood pressure

Hypertension Risk Factors (3 of 3)

• Age: Risk increases with age (over 55 in males, and 65 in females).
• Diabetes mellitus: Impacts hypertension risk significantly.
• Family history of heart disease: Individuals with a family history are at greater risk of hypertension.
• Obesity: High body weight increases hypertension risk
• Tobacco usage: Tobacco use relates to elevated blood pressure.
• Decreased physical activity: Lack of exercise may elevate blood pressure risk.
• Increased LDL or low HDL: Elevated levels of LDL cholesterol and low HDL cholesterol are risk factors.
• Diet high in salt or saturated fats: A high-salt or high-saturated fat diet may contribute to increased blood pressure.
• Excessive alcohol consumption: High alcohol intake increases hypertension risk

Blood Pressure Classifications

• Normal Blood Pressure: Below 120/80 mmHg
• Stage 1 Hypertension: 135/85 mmHg (automated or out-of-office measurement)
• Stage 2 Hypertension: 140/90 mmHg (non-automated office blood pressure)
• Goal in diabetes: <130/80 mmHg
• Prehypertension: Blood pressure values above normal but below stage 1 hypertension
• Preeclampsia and gestational hypertension: Conditions occurring during pregnancy associated with elevated blood pressure

Complications of Untreated/Poorly Controlled Hypertension

• Stroke: A major complication, leading to brain damage.
• Myocardial infarction: (Heart attack): High blood pressure significantly increases risk.
• Damage to arteries: Due to high blood pressure, blood vessel walls degrade over time.
• Nephropathy: Kidney damage
• Retinopathy: Eye damage

Nonpharmacological Management of Hypertension (1 of 2)

• Lowering blood pressure by 5 mmHg reduces coronary heart disease risk by 9%.

Nonpharmacological Management of Hypertension (2 of 2)

• Weight loss: Reducing body weight can help lower blood pressure.
• Diet modifications: Healthy diet choices are vital.
• Physical activity: Regular exercise lowers hypertension risks.
• Limited alcohol consumption: Lowering alcohol intake is helpful to blood pressure reduction.
• Discontinuation of tobacco use: Quitting smoking improves hypertension management.

Lesson 18.2: Drugs Used to Treat Hypertension

• Objective 1 (Drug Categorization): List and categorize medications used for hypertension.
• Objective 2 (Mechanism of Action): Describe how each drug class lowers blood pressure (mechanism of action).
• Objective 3 (Drug Endings): List common endings used in hypertension drug classes.
• Objective 4 (Look-alike/Sound-alike): Recognize significant drug look-alike/sound-alike issues..
• Objective 5 (Warnings): Identify warning labels and precautions for hypertension drugs.

Drugs Used in the Treatment of Hypertension: Thiazide Diuretics

• Chlorothiazide, Chlorthalidone, Hydrochlorothiazide (HCTZ), Indapamide, Metolazone, and Polythiazide

Thiazide Diuretics: Mechanism of Action (MOA)

• Decrease reabsorption of Na+, H2O, and Cl-.
• Reduces blood volume
• Decreases cardiac output
• Decreases peripheral resistance

Thiazide Diuretics: Adverse Reactions

• Hypokalemia (Low potassium levels)
• Hyponatremia (Low sodium levels)
• Hypomagnesia (Low magnesium levels)
• Hypochloremia (Low chloride levels)
• Hyperuricemia (High uric acid levels)
• Hyperglycemia (High blood sugar)
• Photosensitivity (increased skin sensitivity to light)
• Nausea and vomiting
• Dehydration

Drugs Used in the Treatment of Hypertension: Loop Diuretics

• Bumetanide, Furosemide, and Torsemide

Loop Diuretics: MOA

• Blocks Na+/K+ co-transporter in ascending loop of Henle
• Absorbed from the gastrointestinal (GI) tract
• High protein binding (98%)

Loop Diuretics: Adverse Reactions

• Dehydration
• Hypotension
• Photosensitivity
• Hypokalemia
• Hyperuricemia

Drugs Used in the Treatment of Hypertension: Potassium-Sparing Diuretics

• Amiloride and Triamterene

Aldosterone Antagonists

• Spironolactone and Eplerenone

Diuretics: MOA

• Potassium-sparing diuretics: Inhibit sodium reabsorption while preventing potassium loss
• Aldosterone antagonists: Block aldosterone's sodium channel effects, increase renin and aldosterone, increasing urinary excretion of hormones

Potassium-Sparing Diuretics: Adverse Reactions

• Nausea and vomiting
• Hyperkalemia

Drugs Used in the Treatment of Hypertension: Aldosterone Receptor Antagonists

Adverse reactions include: hyperkalemia, nausea, unpleasant taste, gynecomastia, hirsutism, impotence, and menstrual irregularities.

Drugs Used in the Treatment of Hypertension: Angiotensin-Converting Enzyme Inhibitors

• Benazepril, Captopril, Enalapril, Fosinopril, Lisinopril, Moexipril, Perindopril, Quinapril, Ramipril, and Trandolapril

Angiotensin-Converting Enzyme Inhibitors: MOA

• Inhibit angiotensin-converting enzyme
• Reduces angiotensin II and aldosterone levels
• Reduces sodium reabsorption in renal tubes
• Accumulates bradykinin
• Reduces peripheral resistance

Angiotensin-Converting Enzyme Inhibitors: Adverse Reactions

• Cough
• Light-headedness
• Diarrhea
• Hypotension
• Nausea or vomiting
• Hyperkalemia
• Skin rashes
• Airway obstruction (angioedema)

Angiotensin II Receptor Agonists

• Candesartan, Eprosartan, Irbesartan, Losartan, Olmesartan, Telmisartan, and Valsartan

Angiotensin II Receptor Agonists: MOA

• Competitive antagonists at the angiotensin II receptor site
• Inhibits angiotensin II-stimulated growth of smooth muscle
• Reduces ventricular and arterial hypertrophy

Angiotensin II Receptor Agonists: Adverse Reactions

• Fatigue
• Abdominal pain
• Dizziness
• Dry mouth
• Constipation
• Impotence
• Muscle cramps

Beta-Adrenergic Blockers (Beta Blockers)

• Selective: Acebutolol, Atenolol, Betaxolol, Bisoprolol, Metoprolol
• Nonselective: Nadolol, Penbutolol, Pindolol, Propranolol, Timolol

Beta-Adrenergic Blockers (Beta Blockers): MOA

• Decreases heart rate, especially during exercise
• Reduces blood pressure by dilating blood vessels
• Constricts air passages by stimulating surrounding muscles
• Lowers cardiac output

Beta-Adrenergic Blockers (Beta Blockers): Adverse Reactions

• Dizziness
• Lethargy
• Nausea
• Palpitations
• Impotence
• Bradycardia (slow heart rate)
• Bronchoconstriction
• Hypoglycemia (low blood sugar)
• Cardiac rhythm disturbance
• Congestive heart failure
• Depression

Alpha₁ Blockers

• Doxazosin, Prazosin, and Terazosin

Alpha₁ Blockers: MOA

• Dilate blood vessels
• Produce vascular relaxation
• Reduce peripheral resistance
• Reduce LDL (low-density lipoprotein) cholesterol levels

Calcium Channel Blockers

• Amlodipine, Diltiazem, Felodipine, Isradipine, Nicardipine, Nifedipine, Nisoldipine, and Verapamil

Calcium Channel Blockers: MOA

• Dihydropyridines: Lower blood pressure by relaxing blood vessels.
• Phenylalkylamines and benzothiazepines: Decrease cardiac workload, heart rate, and heart contractions

Calcium Channel Blockers: Adverse Reactions

• Dihydropyridines: Dizziness, Flushing, Headache
• Phenylalkylamines and benzothiazepines: Bradycardia, Constipation

Central-Acting Alpha₂-Agonists

• Clonidine, Guanfacine, Methyldopa, and Reserpine

Central-Acting Alpha₂-Agonists: MOA

• Methyldopa: Reduces sympathetic activity, blood vessels dilate, and peripheral resistance decreases
• Clonidine: Inhibits norepinephrine release from CNS and peripheral sites
• Reserpine: Depletes norepinephrine stores in CNS and peripheral sites

Central-Acting Alpha₂-Agonists: Adverse Reactions

• Sedation
• Dry mouth
• Orthostatic hypotension
• Impotence
• Constipation

Direct Vasodilators

• Hydralazine and Minoxidil

Direct Vasodilators: MOA

• Hydralazine and minoxidil: Relax vascular smooth muscle
• Reduce blood pressure, peripheral resistance

Direct Vasodilators: Adverse Reactions

• Orthostatic hypotension
• Headaches
• Gastrointestinal upset
• Sodium and fluid retention
• Palpitations or arrhythmias
• Lupus-like syndrome (hydralazine)
• Facial hair growth (minoxidil)

Direct Renin Inhibitors

• Aliskiren

Direct Renin Inhibitors: MOA

• Blocks angiotensinogen conversion to angiotensin I
• Blocks angiotensin II and aldosterone release.
• Interrupts RAAS system at the beginning

Direct Renin Inhibitors: Adverse Reactions

• Diarrhea
• Dizziness
• Headaches
• Hyperkalemia

Common Endings

• Thiazide diuretics: "-thiazide"
• Loop diuretics: "-semide"
• ACE inhibitors: "-pril"
• Angiotensin II antagonists: "-sartan"
• Beta-adrenergic blockers: "-olol"
• Alpha₁-adrenergic antagonists: "-zosin"

Look-Alike/Sound-Alike Drugs (1-9) [Numerous drug lists]

• Many drug name comparisons demonstrating look-alike/sound-alike issues.

Warning Labels (Multiple)

• Many warnings for different drug classes related to hypertension, some addressing pregnancy, food interactions (e.g., grapefruit or salt), supervision, and potential side effects (e.g., dizziness or light-headedness).

Test your knowledge on hypertension with this quiz that covers essential topics such as blood pressure regulation, lifestyle factors, and risk groups. Explore how various substances and conditions affect blood pressure and learn about classifications and complications associated with hypertension.