Hypertension

VIT
What is Hypertension (HTN)?

 High blood Pressure (BP)

 Systolic pressure > 140 mm Hg

 Diastolic pressure > 90 mm Hg

 Classification of Hypertension
 Primary
 Secondary

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 Pathophysiology of High BP

 Blood pressure – is the force of blood

exerted on arteries as it flows through them
 Classification of BP – Systolic – Diastolic
(mm Hg) (mm Hg)
 Normal <120 <80
 Prehypertension 120-139 80-89
 Stage 1 Hypertension 140-159 90-99
 Stage 2 Hypertension >160 >100
 Blood Pressure Control
Mechanism
Blood Pressure

Depends on:
-Cardiac Output
-Contractility
-Fluid Volume
-Peripheral vascular resistance

Is affected by:
-Nervous system
-Kidney function
-Hormonal changes
-Capillary fluid shift
Causes of Hypertension

 Aging
 Smoking
 Obesity www.dailygalaxy.com
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 High sodium (salt) diet

 High cholesterol
 Lack of exercise
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 Drinking
 Being insulin resistant
Risk Factors of HTN
 Smoking
 Age
 Women older than 65 years of age
 Men older than 55 years of age
 Obesity
 Diabetes
 Lack of Physical activity
 Chronic alcohol consumption
 Family history of cardiovascular disease
 Sex – men and postmenopausal women
 African American 2x more likely than Whites
What are the Symptoms?

 Prehypertension and Stage 1 HTN

 Usually none
 Stage 2 HTN
 If occurs rapidly – symptoms of
Hypertensive Crisis
 Headache

 Visual
disturbances
 Nausea & vomiting
How is HTN Diagnosed?

 Usually by routine doctor’s visit

 One high BP reading does not mean you
have HTN
 Repeated BP reading will be done at
different positions
 Complete physical, medical and family
history will be performed
 Risk factors identified
Treatment of HTN

There are following steps in treating HTN

1. Lifestyle modification
2. First line treatment
3. Second line treatment
4. Third line treatment
Lifestyle Modification

 Weight reduction
 Reduction of sodium intake
 Decrease of alcohol intake
 Smoking cessation
 Increase in physical activity
 If inadequate, continue to first line
treatment
First Line Treatment

 Continue with lifestyle modification

 Initial drug selection:
 Diuretic
 Beta-blocker
 If inadequate, continue to second line
treatment
Second Line Treatment

 Adding drugs from the folloving

categories
 Angiotensine Converting Enzyme (ACE)
Inhibitor
 Calcium Channel Blocker
 Angiotensine II Receptor Blocker (ARB)
 α- blocker, α- and β-blocker
 If inadequate, continue to third line
treatment
Third Line Treatment

 Increase drug dose, or

 Substitute another drug, or
 Add a second drug from another class
 If inadequate, may need to do further
studies
 Serious organ damage may be present
Possible Outcomes of Delayed
Treatment of HTN
 Stroke
 Myocardial infarction
 Congestive heart failure
 Renal failure

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Drugs Used to Treat HTN
 Diuretics
 Furosemide (Lasix); Hydrochlorothizide
(HydroDIURIL)
 Beta blockers
 Atenolol (Tenormin); Propranolol (Inderal)

 ACE inhibitors
 Captopril (Capoten); Enalapril (Vasotec)

 ARB’s
 Irbesartan (Avapro); Losartan (Cozaar)

 Calcium channel blockers

 Amlodipine (Norvasc); Diltiazem (Cardizem)
 Site Of Action of
Antihypertensive
Drugs

 Action of Beta-Blockers
 Block vasoconstriction
 Decrease heart rate
 Decrease cardiac muscle
contraction
 Tend to increase blood flow to
the kidneys -> leading to a
decrease in the release of renin
What Are Beta-Blockers?

 Beta blockers are Beta-adrenergic

receptor blockers – they block action of
Adrenalin and Noradrenaline (SNS
stimulants), which are involved in “Fight-
or-flight’ response
 There are two types of Beta receptors
 β1 – found mostly in the heart
 Β2 – found mostly in the lungs
Classification of Beta Blockers

 β1 receptors blockers
 Atenolol (Tenormin)
 Betaxolol (Kerlone)
 Bisoprolol (Zabeta)
 Metoprolol (Lopressor, Toprol-XL)
 β1, β2 receptor blockers
 Nadolol (Corgard)
 Propranolol (Inderal, Inderal LA)
 β1, β2, α receptor blockers
 Labetolol (Normodyne, Trandate)
 Beta Blockers
Commonalities:

-One chiral center

-Aromatic ring
-Side alkyl chain
-Secondary hydroxyl
group
-Amine

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Beta Blockers – Side Effects
 Fatigue
 Orthostatic hypotension
 Weakness
 Blurred vision
 Stuffy nose
 Impotence
 Rash
 CHF
 Bradycardia
 Pulmonary edema
Treatment of Side Effects

 Changing position slowly

 Sit at the edge of bed or chair for a few
minutes before standing up
 Drink adequate amount of fluids
 Contact physician in more serious case
to adjust the dose or change the
medication