Hypertension

Hypertension

1. Treatment

   • Nonpharmacological Interventions
     • Lifestyle Modifications
       • Drug Therapy if Lifestyle Modifications Ineffective
       • DASH Diet
         • Fruits & Veggies, Low Fat & Na
       • Exercise
         • 30 min/ Day
         • Decreases Afterload
       • Weight Loss
         • BMI 18.5-24.9 kg/m2
       • Stress Reduction
       • Monitor BP
       • Sodium Reduction
         • 2.4 grams or Less
         • Decreases Preload
       • Moderate ETOH
         • 1-2 Drinks/ Day
       • Goal: Decrease Afterload
       • Goal: Increase Contractility
       • Goal: Decrease Preload
   • Pharmacological Interventions
     • Beta Blockers
       • Slows HR--LV Fills
       • Dilates Arteries
         • Decreased Afterload
       • Decreased contractility
       • Mild Vasoconstriction vs Renin
       • Non-selective vs Selective
         • Suffix -olol
       • Slows HR
     • Alpha Blockers
       • Vasodilation
         • Decreases Afterload
       • Ex: doxazosin
         • Elevated CV Risk
     • Diuretics
       • Act on Renal Tubules
         • Increase Water Excretion
       • 1st Line Therapy
       • Osmotics
         • Glomeruli
         • Ex: mannitol
       • Carbonic Anhydrase Inhibitors
         • PCT & Descending Loop of Henle
         • Ex: Acetazolamide
       • Loop Diuretics
         • Ascending Loop of Henle
           • Absorbs 25% of Na
         • Ex: furosemide
       • Ex: Spironolactone
         • Distal Convoluted Tubule
           • Reabsorbs 5% of Filtered Na
       • Thiazide-like
         • Ex: HCTZ & chlorothiazide
       • Potassium Sparing
         • Monitor K+ Level
     • Calcium Channel Blockers
       • Smooth Muscle Dilators:
       • Uses: HTN, Angina & Arrhythmias
       • Decreased Contractility
       • Reduces Afterload
       • Increases Preload
       • 1st Line Therapy
         • Black Persons
       • Ex: amlodipine & diltiazem
     • ACE Inhibitors
       • Block Conversion of Angio I to Angio II
       • Promote Renal Excretion of Na & H2O
       • Dilate Arteries to Decrease BP
       • Ex: lisinopril
         • Conversion in Lungs
           • Monitor for Cough
             • May Need to Change to ARB
             • Rechallenge
       • Monitor for Angioedema
     • Angiotension II Receptor Blockers
       • Block Angio II from Angio II Receptors
       • Ex: losartan
       • Less Angioedema than ACE I
       • Better for Post Stroke
       • Renal Protective
     • Centrally Acting Vasodilators
       • Relaxation of Vascular Smooth Muscle
       • Acts on Arterioles
         • Decrases Afterload
       • Ex: hydralazine
       • Last Line Therapy--Emergency
     • Refer to Nephrologist if Drug Therapy Ineffective
   • Preload
     • End Diastolic Pressure
       • Decrease
         • Fluid Volume
           • RAS
           • ADH
           • Natriuretic Peptides
   • Afterload
     • Resistance LV
     • Decrease
     • Block Angio II
     • Chronic Elevation = CHF
   • Contractility
     • Increase
     • Starling's Law
   • Educate Patient
   • Individualize Tx Regimen
   • Goals for Impaired Cardiac Function

2. Cardiac Output Increaased

   • Hypervolemia
     • Increased Preload
   • Stress
     • HR & SV Increased
     • Increased Preload
   • Pheochromocytoma
   • Preload Increased

3. Systemic Vascular Resistance Increased

   • Stress
   • Atherosclerosis
   • Renal Artery Disease
   • Diabetes
   • Afterload Increased

4. Blood Vessel Damage

5. Snethen_NUR 5038_F17