Hypertension

Definition:
Hypertension (HTN) is defined as BP >
Stage 1 HTN =

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Stage 2 HTN >

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mm Hg

mm Hg

mm Hg

Increase () Blood Pressure (BP) results in

1) Stroke
2) Ischemic Cardiomyopathy (ICM) heart muscle is weaken and
dilated
3) Coronary Artery Disease (CAD)
All of the above resulting in Bad Outcomes

Reduction () of BP by 5% can reduce

1) Stroke (34%)
2) ICM (21%)
3) CAD

Treatment (Tx)
1) Lifestyle
Diet low in Na+
Physical exercise
Biofeedback and Meditation
DASH rich in nuts, fruits, vegetables
2) Medications (Side effects!)
BP
Decision is based on:
1) Underlying Diagnosis (Dx)
2) Certain comorbidities (appearance of multiple illnesses) and side effects
relating to profile

Hypertension Medication ABCDs

A
ACEi / ARBs

B
B-Blockers

C
Ca++ Blockers

Dx useful:

BP is elevated in DM
patients and helps
protect kidneys

CHF patients help to

improve EF and
increase survival

Scleroderma (chronic
connective tissues)
and helps protect
kidney

Young people, white

Side Effects:

Angioedema (enlarge
tongue or neck
swelling) patient needs
to go the ER

Cough 30% w/ ACEi

than ARBs

Hyperkalemia
(abnormal high K+ in
blood)

Hyponatremia
(abnormally low Na+ in
blood)

Creatinine (Cr)
causing renal failure
*Problematic
especially in Renal
Artery Stenosis. This
paradoxical (doesnt
make sense when
ACEi and ARBs
protect w/ proteinuria,
especially diabetic
patients

Contraindicated in
bilateral renal stenosis

Dx useful:

CHF patients help

increase survival
*Only 2 Types of BBlockers: Carvedilol &
Metopropol for
increasing survival

Post MI patients help

to increase survival
*Any B-Blocker

Young people, white

Dx useful:

No effect on survival

African Americans

Elderly

Dx useful:

No effect onsurvival

African Americans

Elderly

Side Effects:

B-Blockers cause
HR and BP

Lipids and
Cholesterol

Depression

Asthma patients

Bronchospasm in
COPD patients

K+ in hyperkalemia

Side Effects:

Side Effects:

Dihydropyridine (DHP):
ends w/ -pine
- Nifedipine
- Amlodipine
- Felodipine

Hydrochlorothiazide (HCTZ)
- ascending loop diuretic
4 Things:

Causes peripheral
vasodilation
HR or remain the same
*except Amlodipine HR
especially ischemic heart
disease
non-DHP:
- Diltiazem
- Verapamil

negative (-) iontrope

contractility of the
heart

heart rate

* Good in HF patients
due (-) intrope &HR
Edema in lower extremity
Constipation
Good for atrial fibrillation
(AF) with rapid ventricular
response works by
response at AV node
transmission.

D
Diuretics

1)
2)
3)
4)

Ca++

Uric Acid (UA) not

good Gout patients,
therefore avoid HCTZ
Lipids
Glucose not good
Diabetic patients

K+
reducing K+ causes Cr
causing renal failiure
Na+ cause hyponatremia
and hypovolemia
Furosemide (Lasix)
- loop diuretic
1) Ca++ in blood
K+

Cr

Na+

Avoid Lasix in kidney stone

patients due to Ca++ in
blood which is loss in the
urine. HCTZ is preferred for
Ca++ retention

The Others
1-blockers

Work by blocking the 1-receptor

In the peripheral vascular (blood vessels), two things can happen either
vasoconstriction (mediated by 1-receptor) or vasodilation (mediated by receptor)
**Dobutamine (is pure and causing HR by making the heart beat stronger
and contractility. But, it can cause vasodilation. Therefore, it is not much of
vasoconstrictor and more of + iontrope.

End in osins
o Terazosin
o Prazosin

Used for BP medication

o Maybe effective in reduce BP numbers

**Never been shown to mortality in CHF and MI

**Can be used to prevent nightmare in PTSD patients

Side Effect: First Dose Hypertension If not use to taking this medication, you
can impair the bodys ability to vasoconstrict. This would be important when
standing up causing one to pass out due to blood rushing to feet than head.
Therefore, first does should be taken orally every night before bed (PO qHS)

PRIMARILY used in Benign Prostatic Hypertrophy (BPH) is not cancerous but

can cause obstructive uropathy, kidney obstruction, and kidney failure. It works
by causing relaxation of smooth muscles right before the urine exits the urethra.

2-agonist