Hypertension

Question 1

What is the normal pathway which involves angiotensin converting enzyme?

Answer 1

When BP drops, renin is released by the kidneys which acts acts on angiotensinogen released by liver to form angiotensin I. ACE is then released from the lungs to convert Angiotensin I to Angiotensin II.

Question 2

What is the function of angiotensin II?

Answer 2

Acts on the adrenal gland to stimulate the release of aldosterone which acts on the kidneys to stimulate reabsorption of salt. It also acts on blood vessels stimulating vasoconstriction.

Question 3

What is the function of ACE inhibitors?

Answer 3

Inhibits the conversion of angiotensin I to angiotensin II, lowering total resistance in the blood vessels and reducing release of aldosterone (thereby reducing salt retention).

Question 4

What are some common ACE inhibitors?

Answer 4

Ramipril, Enalapril, Lisinopril, Perindopril
commonly ending in ‘pril’

Question 5

What are some common side effects of ACE inhibitors?

Answer 5

Cough (excess bradykinin), diziness, orthostatic hypotension, acute kidney injury, Hyperkalaemia (excess potassium)

Question 6

What is a rare side effect of ACE inhibitors?

Answer 6

Angioedema (swelling of the mouth). African descent and smokers most at risk

Question 7

How do Angiotensin II receptor blockers (ARB) work?

Answer 7

Work by blocking the action of angiotensin II by binding to AT1 (receptor) and preventing angiotensin II from binding.

Question 8

What are the downstream effects of ARBs?

Answer 8

Increase vasodilation and reduce aldosterone secretion, lowering salt retention.

Question 9

What are some common ARBs?

Answer 9

Candesartan, Irbesartan, Losartan
commonly ending in ‘sartan’

Question 10

What do calcium channel blockers do?

Answer 10

Prevent calcium from entering the cells. They cause peripheral vasodilation, coronary vasodilation and reduce the rate & force of contractions.

Question 11

What are the two different types of calcium channel blockers?

Answer 11

Dihydropyridines and non-dihydropyridines

Question 12

How do dihydropyridines work (CCB)?

Answer 12

Cause vasodilation of blood vessels, helping to lower hypertension

Question 13

How do non-dihydropyridines work (CCB)?

Answer 13

Slow the heart rate affecting myocardial tissue.

Question 14

What are some common dihydropyridines (CCB)?

Answer 14

nifedipine, amlodipine, felodipine
commonly ending in ‘dipine’

Question 15

What are some common side effects of calcium channel blockers?

Answer 15

Edema (from peripheral vasodilation, especially common in the ankles), flushing, dizziness, reflex tachycardia, headache

Question 16

How do thiazide-like diuretics work?

Answer 16

They inhibit sodium and water resorption in the kidneys. More sodium is excreted in urine and therefore more water. Reduced blood flow overtime decreases BP

Question 17

What are the names of some common thiazide like diuretics?

Answer 17

Bendroflumethiazide, indapamide

Question 18

What are some side effects of thiazide-like diuretics?

Answer 18

Dizziness, electrolyte imbalance, GI disturbance, gout (low doses achieve full effect with fewer side-effects)

Question 19

Why are beta blockers not an overall first line treatment?

Answer 19

Effective at reducing BP but not as effective as other drugs in reducing overall risk of stroke and cardiovascular disease

Question 20

When are beta blockers a first line treatment?

Answer 20

If younger women of child bearing age, evidence of increased sympathetic drive, intolerance/contraindications to ACE/ARBs

Question 21

What are the names of some common beta blockers?

Answer 21

Atenolol, carvedilol, metoprolol

Question 22

What are some common side effects of beta blockers?

Answer 22

• Bronchospasms in susceptible individuals (avoid in asthma)
• fatigue
• cold extremities
• nightmares
• adversely affect carb metabolism and increased risk of T2 diabetes

Question 23

What is the mechanism of alpha blockers?

Answer 23

Binds to alpha I receptors. Prevents norepinephrine from tightening the muscles in the walls of the smaller vessels allowing them to stay open, improving BP and blood flow

Question 24

What are the names of some common alpha blockers?

Answer 24

Doxazosin, prazosin

Question 25

What are some common side effects of alpha blockers?

Answer 25

dizziness, drowsiness, headache, low BP (postural hypotension), nasal congestion

Question 26

What are some key factors that contribute to BP regulation?

Answer 26

Circulatory volume, force of ventricular contractions, elasticity of arteries, peripheral resistence

Question 27

What kinds of things affect peripheral resistance?

Answer 27

Viscosity: sticky blood harder to pump Length: longer vessels=more surface area=more friction Radius: much greater significance on BP than length or viscosity

Question 28

What is the role of arterial baroreceptors and where are they located?

Answer 28

Pressure receptors located in carotid sinus and aortic arch conduct signal to medulla which then signals back though the vagus nerve to either vasodilatoe/vasoconstrict or increase/decrease HR.

Question 29

Describe the role played by atrial stretch receptors?

Answer 29

Atrial myocytes detect changes in blood volume (esp. in venous return) and release atrial naturietic peptide (ANP) which promotes secretion of sodium in urine and inhibits the secretion of ADH

Question 30

How do stroke volume, heart rate and peripheral resistance affect BP?

Answer 30

Heart rate (HR): Increases cardiac output by pumping more times per minute → raises blood pressure. Stroke volume (SV): More blood ejected per beat increases cardiac output → raises blood pressure. Peripheral resistance (PR): The amount of force exerted on circulating blood by the vasculature. Narrower or constricted blood vessels increase resistance to blood flow → raises blood pressure.

Question 31

In what circumstances can hypotension and hypertension arise?

Answer 31

Hypotension: blood loss, dehydration, sepsis, heart failure, endocrine disorders (e.g., Addison’s disease-autoimmune). Hypertension: essential (genetic, lifestyle), kidney disease, endocrine disorders (e.g., Conn’s disease (tumor of adrenal cortex), RAAS overactivity, medications.

Question 32

How is ADH involved in the long-term regulation of blood pressure?

Answer 32

Increases permeability of the kidney’s collecting ducts to water, promoting reabsorption back into the bloodstream, increasing blood volume and pressure. At higher concentrations, it causes blood vessels to constrict, increasing peripheral resistance and raising blood pressure.

Question 33

Summarize the pathophysiology of hypertension

Answer 33

Hypertension results from increased cardiac output and/or peripheral resistance due to: -Overactive sympathetic nervous system causing vasoconstriction -Excess fluid retention via RAAS activation -Impaired kidney sodium excretion -Vascular remodeling increasing resistance -Genetic and lifestyle factors also contribute, leading to sustained high blood pressure.

Question 34

What are some consequences of untreated hypertension?

Answer 34

Heart attack, stroke, narrowing of blood vessels in kidneys, atherosclerosis (narrowing of blood vessels due to plaque build-up)

Question 35

What is stage 1 hypertension?

Answer 35

Clinic blood pressure ranging from 140/90 to 159/99 mmHg.

Question 36

What is stage 2 hypertension?

Answer 36

Clinic blood pressure ranging from 160/100 to 179/119 mmHg.

Question 37

What is stage 3 hypertension?

Answer 37

Clinic systolic BP is ≥180 mmHg or clinic diastolic blood pressure ≥120 mmHg.

Question 38

What tests would you run to detect end organ damage or other complications of hypertension?

Answer 38

Urinalysis (albumin/creatinine ratio), ECG, U+E, lipid profile, BM/HbA1C, Fundoscopy, check for neurological symptoms and heart sounds

Question 39

How can hypertension be managed by lifestyle changes?

Answer 39

Weight management (1kg=1mmHg), lower alcohol intake, aerobic exercise (helps with artery elasticity), reduce salt and fat intake.

Question 40

What is cardiac output?

Answer 40

Volume of blood each ventricle pumps (L/minute)

Question 41

What is pulse pressure?

Answer 41

The difference between systolic and diastolic blood pressure

Question 42

How do beta-blockers work?

Answer 42

Act on the heart to reduce cardiac output and on the kidneys to inhibit renin secretion.