Questions and Answers
What is the definition of hypertension according to the criteria presented?
Which factor is NOT associated with essential hypertension?
Which of the following classes of antihypertensive drugs primarily depletes body sodium stores to lower blood pressure?
What role do baroreceptors play in blood pressure regulation?
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What is the most frequently used class of diuretics for managing hypertension?
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Which mechanism primarily allows for long-term blood pressure control?
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What potential toxicity is associated with diuretics in hypertensive patients?
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Which of the following antihypertensive drug classes is not primarily focused on the sympathetic nervous system?
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How does a fall in blood pressure affect the carotid baroreceptors?
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Which of the following is NOT a factor contributing to essential hypertension?
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In which scenario are diuretics typically used as part of hypertension treatment?
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What effect does increased sympathetic activity have on blood pressure?
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How does the RAAS contribute to increases in blood pressure?
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What is the primary purpose of using beta-blockers in combination with vasodilators in severe hypertension?
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Which beta-blocker is considered selective and hydrophilic?
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What is a significant adverse effect commonly associated with ACE inhibitors due to raised bradykinin levels?
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Which of the following effects is NOT a result of angiotensin-converting enzyme inhibitors?
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Which condition is a contraindication for the use of ACE inhibitors?
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Which of the following drugs is classified as an angiotensin receptor blocker?
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What is the mechanism of action of angiotensin-converting enzyme inhibitors?
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Which adverse effect is associated with ACE inhibitors and is considered rare but serious?
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Study Notes
Introduction to Hypertension
- Hypertension is a prevalent cardiovascular disease characterized by sustained high blood pressure, defined as greater than 140/90 mmHg.
Blood Pressure Classification and Etiology
- Essential Hypertension (90%): No identifiable cause; influenced by family history and environmental factors.
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Environmental Contributing Factors:
- Stress
- Obesity
- High sodium intake
- Smoking
- Alcohol consumption
- Lack of physical exercise
Regulation of Blood Pressure
- Blood Pressure Equation: Blood pressure is inversely proportional to cardiac output (C.O) multiplied by peripheral vascular resistance (PVR).
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Control Mechanisms:
- Physiological regulation is maintained through the heart, kidneys, arterioles, and post-capillary venules.
- Baroreceptors and the sympathetic nervous system are critical for maintaining blood pressure.
- Carotid baroreceptors respond to blood vessel wall stretch; decreased blood pressure results in increased sympathetic output, enhancing heart activity and PVR.
Baroreflex Response
- The baroreflex reacts to:
- Postural changes
- Decreased PVR due to vasoconstrictors
- Reduced intravascular volume from sodium restriction, diuretics, blood loss, or congestive heart failure
Renin-Angiotensin-Aldosterone System (RAAS)
- The kidneys play a crucial role in long-term blood pressure control by regulating blood volume.
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Mechanisms:
- Increased renal salt and water reabsorption due to decreased renal perfusion pressure.
- Renin release leads to angiotensin II formation, causing vasoconstriction and aldosterone secretion, which ultimately raises blood pressure.
Classification of Antihypertensive Drugs
- Diuretics
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Sympathetic System Agents:
- Central acting: Clonidine, Moxonidine, Methyldopa
- Beta-adrenergic blockers: Propranolol, Atenolol
- Alpha-adrenergic blockers: Prazocin, Doxazocin
- Adrenergic neuronal blockers: Reserpine
- Angiotensin-Converting Enzyme Inhibitors (ACEIs)
- Angiotensin II Receptor Blockers (ARBs)
- Calcium Channel Blockers (CCBs)
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Vasodilators:
- Arterial: Hydralazine, Minoxidil, Fenoldopam, Diazoxide
- Mixed: Sodium nitroprusside
Diuretics
- Reduce blood pressure by depleting sodium and lowering blood volume.
- Used as initial therapy for mild to moderate hypertension; combined with other classes for severe cases.
- Thiazides are the most common diuretics, typically prescribed at low doses (e.g., Hydrochlorothiazide 12.5mg daily).
- Side effects include hypokalemia, hypomagnesemia, increased lipids, impaired glucose tolerance, hyperuricemia, and potential sexual impairment.
Beta-Adrenoceptor Blockers
- Effective for all hypertension grades; often combined with vasodilators to mitigate reflex tachycardia.
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Common Preparations:
- Propranolol: Non-selective, lipophilic; dosage starts at 20mg and adjusted for effect.
- Atenolol: Selective, hydrophilic; prescribed at 50-100mg once daily.
- Carvedilol: Vasodilatory and beta-blocking agent; dosage of 3.125-12.5mg once daily.
- Labetalol: Alpha and beta blocker used intravenously for emergencies.
Angiotensin-Converting Enzyme Inhibitors (ACEIs)
- Inhibit formation of angiotensin II, leading to vasodilation and decreased aldosterone levels.
- Benefits include reduced myocardial hypertrophy and preservation of vasodilators like bradykinin.
- Common ACEIs include enalapril, captopril, lisinopril, and ramipril.
Adverse Effects of ACEIs
- 1st dose hypotension; initiate with low doses.
- Potential side effects: skin rash, persistent dry cough, temporary taste loss, proteinuria, nephrotic syndrome, neutropenia, hyperkalemia, angioedema, fetopathic effects, and risk of acute renal failure.
Angiotensin Receptor Blockers (ARBs)
- Competitive antagonists of Angiotensin II receptor type 1 (AT1), offering alternatives to ACEIs in hypertension management.
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Description
This quiz explores the fundamentals of hypertension, including its classification, etiology, and regulation. Understand the factors contributing to high blood pressure and the physiological mechanisms involved in its control. Perfect for anyone looking to deepen their knowledge of cardiovascular diseases.
