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Hypertension (Risk factor (smoking, Obesity, Hyperlipidaemia, Diabetes,…
Hypertension
Risk factor
smoking
Obesity
Hyperlipidaemia
Diabetes
left ventricular hypertrophy
Drugs
Diuretics
thiazide
reduce the risk of
stroke
coronary heart disease
cardiovascular death
decrease blood volume
reduce venous return
reduce cardiac output
reduce blood pressure
Gradually cardiac output return to normal
reduce peripheral resistance
possible mechanism
no direct effect on vasodilation
but vasodilate due to reduction in body Na+
cause secondary reduction in intracellular Ca+
1 more item...
side effect
Hypokalaemia
Diabetes mellitus
Gout
low dose
insignificant metabolic effect
effective in older patients over 55 yrs
Type
Chlortalidone
Indapamide
at lower dose
vasodilation more prominent
at higher dose
diuretic effect more prominent
dose
immediate- release medicine
2.5 mg daily
modified -release medicine
1.5 mg daily
to be taken in the morning
contraindication
hypercalcaemia
hyponatraemia
hypokalaemia
symptomatic hyperuricaemia
Bendroflumethiazide
Xipamide
Metolazone
Vasodilators
most important drugs
ACEI
reduce the risk of
stroke
coronary heart disease
cardiovascular death
ARB
reduce the risk of
stroke
coronary heart disease
cardiovascular death
calcium channel blocker
reduce the risk of
stroke
coronary heart disease
cardiovascular death
other vasodilators
largely superseded by most important drugs
B blockers
Higher incidence of stroke
but can be used in
angina
heart failure
MI
reduce cardiac output
reduce BP
with continue treatment
cardiac output return to normal
block of B1 receptor in renal juxtaglomerular granule cells
reduce secretion of renin
Adverse effect
common
cold hand
fatigue
less common but serious
provocation of asthma
raise triglyceride level
decrease high density lipoprotein cholesterol
Type
B1/B2
propanolol
B1 selective
no liver metabolism
Type
metoprolol
atenolol
bisoprolol
cannot penetrate to blood brain barrier
centrally acting drugs
little use
Target organ damage
brain
haemorrhagic stroke
Heart
Left ventricular hypertrophy
left ventricular failure
Kidney
Renal failure
retina
retinopathy
Treatment
Without risk factor
systolic BP
less than 160 mmHg
Diastolic BP
less than 100 mmHg
With risk factor
lower threshold are appropriate
the most important mechanism for reducing BP
to decrease vascular tone
for mid hypertension
increase exercise
weight reduction
reduced alcohol comsumption
moderate reduction in salt comsumption
drug treatment