Hypertension by TAN XIN YI, NICOLE

Hypertension by TAN XIN YI, NICOLE https://padlet.com/21021333_2/r84ja7m21fc12ef8 en-us 2022-07-26 03:20:54 UTC 2022-07-26 07:26:50 UTC hello@padlet.com Hypertension 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249666439 2022-07-26 03:23:15 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249666439 Blood pressure regulation 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249667009 2022-07-26 03:24:20 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249667009 Baroreceptor 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249667616 1. Specialized neurons
2. located at aortic arch and carotid sinus in the carotid artery
3. sense change in BP e.g. increase in BP --> causes the wall of aorta and carotid artery to stretch--> more action potential from the baroreceptors]]> 2022-07-26 03:25:23 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249667616 Vasomotor center 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249668223 1. collection of integrating neurons/ group of neurons
2. Found medulla oblongata
3. Regulated on min to min basis
4. Connected to the main 4 control site of BP
5. controls the cardiac output as well as peripheral vascular resistance ]]> 2022-07-26 03:26:30 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249668223 Kidney (adrenal gland) 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249669116 1. release epinerphrine, norepniephrine, renin (RAAS)]]> 2022-07-26 03:28:10 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249669116 Heart 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249669471 1. Regulates cardiac output and heart rate]]> 2022-07-26 03:28:48 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249669471 Centrally Acting Sympathoplegics 21021333_2 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249669548 Main Function: Reduce sympathetic outflow from vasomotor centers

Drug --> false neurotransmitter α-methylnoradrenaline (MeNA) --> alpha2/ alpha1 potency ratio is much greater than that of noradrenaline --> tips scale from excitation to autoinhibitory feedback mechanism --> reduced activity of sympathetic nerves --> reduction in arterial pressure

Adverse Effects: Drowsiness, Rebound hypertension and Dry mouth

]]> 2022-07-26 03:28:55 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249669548 Arterioles 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249669759 1. regulates smooth muscles constriction and relaxation of tunica media]]> 2022-07-26 03:29:16 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249669759 Alpha1 blockade 21021333_2 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249669945 MOA:
α1 selective antagonist --> vasodilatation through blocking alpha1 receptors on arterioles and veins --> arterial pressure decrease due to decrease in resistance and capacitance vessels.

Adverse Effects:
1. Postural hypotension --> reduced blood pressure by reduced venous retun
2. Reflex tachycardia --> baroreceptor
3. Nasal congestion --> vasodilation in the nasal mucosa

E.g., Prazosin

]]> 2022-07-26 03:29:35 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249669945 Sympathoplegic Agents 21021333_2 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249670267 2022-07-26 03:30:06 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249670267 Hormones 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249671262 1. Antidiuretic hormone(ADH)
produced by hypothalamus a strong vasoconstrictor that can increase BP by raising blood volume--> increase cardiac output

2. Nitric oxide and endothelium-derived relaxing factor
produced locally by the vascular endothelium, a monolayer of endothelial cells]]> 2022-07-26 03:31:55 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249671262 Case Study 21021333_2 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249671728
1. Why do diabetic patients have higher risk of hypertension?

2. One of the drugs in this case study should ideally not be recommended. Which drug is it? And why?

3. Which antihypertensive agents are recommended for patients with diabetes?

https://diabetesjournals.org/clinical/article/22/3/137/1660/Case-Study-Treating-Hypertension-in-Patients-With

]]> 2022-07-26 03:32:51 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249671728 What is hypertension and how it is form? 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249671956 1. chronic elevation of either systolic or the diastolic BP

2. Should be consistently measured on average of 2 or more reading taken at each of 2 or more visit after initial screening

3. normally asymptomatic until organ damage is imminent

4. signs and symptoms: throbbing headache, nausea, or vommiting and etc ]]> 2022-07-26 03:33:17 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249671956 Drug acting on renin-angiotensin-aldosterone system 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249674585 2022-07-26 03:37:57 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249674585 ACE inhibitor 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249675375 2022-07-26 03:39:12 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249675375 Angiotensin II subtype 1 receptor blocker (ARB) 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249675550 2022-07-26 03:39:29 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249675550 Renin inhibitor 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249675725 2022-07-26 03:39:46 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249675725 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249677505 competitively inhibits ACE so to prevent the conversion of angiotensin I to Angiotensin II via ACE pathway which will lead to sympathetic activation, vasoconstriction and etc.

]]> 2022-07-26 03:42:37 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249677505 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249677903 1.blocks all effect of angiotensin II by blocking AT1 receptor in the arteriole smooth muscle and in adrenal gland. thus what it does is preventing binding of Angiotensin II which is a vasoactive hormone that induces vasoconstriction and stimulates the secretion of aldosterone by the adrenal cortex, which results in sodium and water retention.]]> 2022-07-26 03:43:17 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249677903 21009404 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249678823 Background: renin aids in the series of enzymatic step to cleave off amino acid from angiotensinogen to angiotensin I and then to angiotensin II which is a potent vasoconstrictor

This prevent angiotensin II to be formed and prevent stimulation of Aldosterone that is also part of raising blood pressure]]> 2022-07-26 03:44:48 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249678823 Diuretics https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249692021 2022-07-26 04:08:48 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249692021 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249692289 Therapeutically useful diuretics :

- Loop diuretics :

act on thick ascending loop of Henle
most powerful diuretics in comparison with thiazides
capable of causing excretion 25% of filtered Na+
can cause torrential urine flow and Hypokalemia (muscle cramp and weakness) and postural hypertension

- Thiazide diuretics :

act on early distal tubule
reduces Ca2+ excretion ( advantages in older patients at risk of osteoporosis)
adverse effects of Hypokalemia

- Potassium-sparing diuretics/ aldosterone antagonists –

act on collecting tubules and ducts
limited diuretic action alone because distal Na+/K+ exchange the site on which they act accounts for reabsorption of only 2% of filtered Na+
can help to prevent hypokalemia when combined with loop diuretics or thiazides , compete with aldosterone for its intracellular receptor , which thereby inhibits distal Na+ retention and K+ secretion
side effects are Hyperkalemia and postural hypertension

]]> 2022-07-26 04:09:21 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249692289 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249692855 - act of increasing the amount of urine produced by the kidneys
- it increases the secretion of Na+ (natriuresis) and H2O by decreasing the reabsorption of Na+ and Cl- from filtrate
- most diuretics have direct action the nephron act from the tubular lumen and reaches their sites of action by being secreted into proximal tubule

]]> 2022-07-26 04:10:25 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249692855 Calcium Channel Blockers https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249693203 2022-07-26 04:11:05 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249693203 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249693526

Ca2+ antagonists block Ca2+ entry to cells by preventing the opening of voltage gated L-type calcium channels

site of action: heart and smooth muscles (inhibits the Ca2+ entry caused by the depolarization in these tissues

↓contractility, ↓conductivity of the heart; ↓O2 demand

Verapamil which is relatively cardioselective (antidysrhythmic action) whereas most of the dihydropyridines (example : nifedipine) and exerts a greater effect on the smooth muscle (mainly on resistance vessels) and reduces PVR , diltiazem is intermediate.

]]> 2022-07-26 04:11:44 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249693526 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249693928 Clinical uses & side effects

antidysrhythmic (mainly verapamil)
angina (e.g. diltiazem)
hypertension

Adverse Effects :

Non-dihydropyridines (diltiazem and verapamil)

-Bradycardia (↓ HR) due to decreases cardiac contractility

-Constipation

Dihydropyridines (amlodipine and nifedipine)

- Peripheral oedema

]]> 2022-07-26 04:12:30 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249693928 Answers 21021333_2 https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249792201
Q1) Higher blood glucose level --> more water in blood to regulate the blood glucose --> blood pressure increase

Q2) Glibenclamide --> Oral Sulphonylureas à Hypoglycaemia, weight gain

Gliclazide --> Oral Sulphonylureas à Hypoglycaemia, weight gain

Glipizide --> Oral Sulphonylurease à Hypoglycaemia, weight gain

Side effects of Sulphonylurease is weight gain. The patient is already obese and hence should not be given a drug that would further increase her BMI.

Q3) Ace Inhibitors à Angiotensin-converting enzyme (ACE) inhibitors prevent or delay microvascular and macrovascular complications of diabetes and are recommended as first-line antihypertensive agents in patients with diabetes. ACE inhibitors delay progression of diabetic kidney disease and more effective than other medications in delaying onset kidney failure (glomerular filtration rate) ACEIs may be used alone for BP lowering but are much more effective when combined with a thiazide-type diuretic or other antihypertensive drug.

]]> 2022-07-26 07:25:34 UTC https://padlet.com/21021333_2/r84ja7m21fc12ef8/wish/2249792201