Antihypertensive Drugs

Antihypertensive Agents Blood Pressure As blood is pumped through the arteries, it creates pressure within the wall of the arteries. Blood Pressure As the heart contracts, this increased pressure is called the Systolic Pressure

Blood Pressure As the heart relaxes and fills, this decreased pressure is called the Diastolic Pressure

Blood Pressure Blood pressure is written as a fraction of Systolic over Diastolic pressure in mm of Hg (mercury). Normal less than 120/80 mmHg Systolic BP Diastolic BP 90-119 mmHg 60-79 mmHg

Blood Pressure Blood pressure is VITAL to our functions of life. A blood pressure of zero is a sign of death. Blood pressure is a VITAL sign. Lets take a Blood Pressure Korotkoff sound Hypertension Hypertension is High Blood Pressure HTN

Hypertension Hypertension is measured by consistent elevation in blood pressure, either Systolic = > 120 mmHg or

Diastolic = > 80 mmHg

Hypertension Remember : NORMAL is < 120/80

Hypertension Long standing, uncontrolled HTN damages blood vessels resulting in many types of organ damage. Essential Hypertension Essential HTN is the most common form of HTN. Cause of Essential HTN is unknown. Essential Hypertension Essential HTN has many risk factors: Family History of HTN Sex Race Salt Stress Obesity, lack of exercise Smoking Secondary HTN

Unlike essential HTN, secondary HTN has a specific cause for the elevated blood pressure. Secondary HTN Kidney Disease

Pheochromocytoma Cushings Disease Pregnancy Vascular Anomalies Neurologic Disease Symptoms of HTN HTN usually has NO symptoms. It is usually detected on a routine visit to a medical clinic. Symptoms of HTN HTN usually has NO symptoms. This is why it is so difficult to convince people to take medication for HTN. Symptoms of HTN HTN can cause many indirect symptoms. Headache and visual changes, especially during stress are common early symptoms. Symptoms of HTN When HTN is severe enough to cause acute visual , neurologic, or any other ORGAN DAMAGE, this is called Malignant Hypertension

Symptoms of HTN HTN usually has NO symptoms. It is usually detected on a routine visit to a medical clinic. HTN damages Blood Vessels Long term sustained HTN damages blood vessels Blood vessels exposed to high blood pressure become thickened and hardened, making them less flexible. Arteriosclerosis

Blood vessels exposed to high blood pressure become thickened and hardened, making them less flexible. HTN damages Blood Vessels Fatty deposits can form on the arteries called plaques, which cause the artery to narrow and become blocked. This is called Atherosclerosis. Atherosclerosis Know the difference Arteriosclerosis is hardening of the arteries. This condition not only thickens the wall of arteries, but also causes stiffness and a loss of elasticity. Over time, the arteries become harder and harder as they are slowly damaged by high blood pressure. Know the difference Atherosclerosis is the most common type of arteriosclerosis, or hardening of the arteries, and caused by plaque building up in the vessel. Over time the plaque causes thickening of the walls of the artery. Stiffness and a loss of elasticity also result. Know the difference! To clarify, a patient with arteriosclerosis (hardened arteries) may not have atherosclerosis (plaque), but a patient with atherosclerosis does have arteriosclerosis. Patients often have both conditions. HTN damages Blood Vessels Blood vessels exposed to high blood pressures become thickened and hardened, making them less flexible. Arteriosclerosis HTN damages Blood Vessels Fatty deposits can form on the arteries called plaques, which cause the artery to narrow and become blocked. Atherosclerosis Infarction

When narrow arteries become blocked and blood supply to an organ is stopped, organ damage results. This damage is called infarction. HTN causes Brain Damage HTN is a major cause of stroke. brain attack Cerebrovascular accident (CVA) Cerebral infarction apoplexy

HTN causes Brain Damage Aneurysm With high blood pressure, a weakening of the arterial wall may balloon out (aneurysm) and burst causing hemorrhage (bleeding) and even death. Aneurysm Aneurysm Although aneurysm can occur on any artery, the two most common places for aneurysm are: Brain Cerebrovascular Aneurysm Aorta Abdominal Aortic Aneurysm HTN damages the eyes Because HTN damages the blood vessels, HTN damages the blood supply to the eyes, and can lead to blindness. HTN damages the eyes HTN damages the Kidneys Because HTN damages the blood vessels, HTN also damages the kidneys, this is called nephrosclerosis and can lead to kidney failure. HTN damages the Heart Because HTN damages the blood vessels, HTN also damages the heart by infarction, hypertrophy, or cardiomyopathy.

The kidneys help regulate BP The kidneys play an important role in the long-term regulation of blood pressure. How the kidneys control BP Immediate Control Parasympathetic NS

Sympathetic NS Adrenergic NS

Long Term Control Kidneys and Blood Pressure Kidneys help regulate the balance of salt and water in the body. Kidneys excrete water soluble waste substances, salt and water. Kidneys are Filters The kidneys contain millions of microscopic filtering unit, called nephrons, which are the working components of the kidneys. Kidneys are Filters Many substances cannot pass through the filters and remain in the blood. Kidneys are Filters Many substances pass through the filters (like glucose) but are reabsorbed back into the blood. Kidneys are Filters Many substances pass through the filters and are excreted into the urine. Kidneys regulate Blood Volume When blood volume decreases, kidneys will retain salt and water. When blood volume increases, kidneys will excrete salt and water.

Renal Hormones and Volume Control Blood volume is monitored by the kidneys and continually adjust water and salt levels help maintain consistent blood pressure. Renal Hormones and Volume Control The blood vessels supplying the nephrons contain special cells that detect blood pressure. Renal Hormones and Volume Control If blood pressure falls below a set point, a renal hormone called RENIN is secreted into the blood stream. Renin and Volume Control Renin converts angiotensin to angiotensin 1, which is converted to angiotensin 2 by the lungs. Renin and Volume Control Angiotensin 2 causes vasoconstriction which increases blood pressure. Renin and Volume Control Angiotensin 2 also stimulates the adrenal cortex to produce Aldosterone. Aldosterone and Volume Control Aldosterone acts on the kidneys to keep salt and water in the blood, resulting in increased blood volume. The Adrenal Gland The Adrenal Gland Medulla Inside secretes Adrenaline or Epinephrine Cortex Outside Aldosterone (mineralocorticoid) Hydrocortisone (glucocorticoid)

Androgens ( sex hormone) Antidiuretic Hormone (ADH) and Volume Control Antidiuretic Hormone (ADH) also called Vasopressin, secreted by the brain in response to low blood pressure, acts on the kidneys to retain water, resulting in increased blood volume. Drugs for HTN Adrenergic Antagonists blockers Beta Blockers propranolol atenolol Sympatholytic Drugs for HTN Adrenergic Antagonists blockers (peripheral) alpha blockers doxazosin Sympatholytic Drugs for HTN Central agonist Clonidine Clonidine stimulate alpha adrenergic receptors in the brain, reduces sympathetic NS, decreasing peripheral vascular resistance and renal vascular resistance,decreasing heart rate and blood pressure.

Drugs for HTN Thiazide diuretic Hydrochlorothiazide (HCTZ)

Available in combinations

Drugs for HTN Angiotensin Converting Enzyme Inhibitors ACE inhibitors captopril

Drugs for HTN Angiotensin II receptor blockers Losartan, valsartan, telmisartan

Drugs for HTN Calcium Channel Blockers (CCB) Dilates arterioles Relaxes smooth muscles Come in 3 classes

Drugs for HTN Calcium Channel Blockers Nifedipine is a dihydropyridine CCB

Drugs for HTN Calcium Channel Blockers Verapamil is a phenylalkylamine CCB

Drugs for HTN Calcium Channel Blockers Diltiazem is a benzothiazepine CCB

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