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Pharm Ch 47

exam 5

Primary Hypertension/essential hypertension - most common form of hypertensive disease - Has no identifiable cause - diagnosis made by ruling out probable causes - patients will experience rise in bP throughout their lives
Secondary Hypertension - an elevation in BP brought on by an identifiable primary cause, - curable if actual cause is treated
Diagnosis of HTN - diagnosis should be made on several BP readings - If BP is high on one visit (but not dangerous) BP should be taken again on two subsequent office visits - 2 readings should be taken 5 minutes apart with high reading noted in contralateral arm
Diagnostic tests - electrocardiogram, complete urinalysis, hemoglobin, hematocrit, - blood levels of sodium, K+, Ca+, creatinine, uric acids, triglycerides, and cholesterol
ultimate Treatment goals - to reduce cardiovascular and renal morbidity and mortality
Sodium Restriction - All people with hypertension should consume below 2300 mg of sodium daily
Dash Diet - diet rich in fruits, vegetables, and low-fat dairy products & low in total fat, saturated fat, and cholesterol -Also encourages whole-grain products, nuts, poultry, & recommends minimal intake of red meat & sweets
Alcohol restriction - men 1/ounce/day - women 0.5 ounce/day
Aerobic exercise - Activity of walking 30-45 minutes a day most days of the week
Maintenance of Ca & K+ - both associate with reduced chance of hypertension
Principal determinants of BP - Cardiac output: influenced by HR, myocardial contractility, blood volume, & venous return of blood to the heart (Arterial pressure = CO x PERIPHERAL RESISTANCE) -
What increases vascular resistance? - arteriolar constriction
Systems that help regulate BP - Sympathetic baroreceptor reflex: Beta Blocker used to prevent reflex tachycardia - RAAS: elevated BP with the release of renin from the juxtaglomerular cells of the kidney - Renal regulation of BP: When BP falls, glomerular filtration rate (gfr) falls
Brainstem - hypertensive drugs act in brainstem to supress sympathetic outflow to the heart and blood vessels resulting in decreased HR, decreased myocardial contraction, and vasodilation
Sympathetic ganglia - reduces sympathetic stimulation of the heart and blood vessels - sympathetic ganglia blockers only used in hypertensive emergencies
Terminals of adrenergic nerves - decrease the release of NE resulting in decreased sympathetic stimulation of the heart and blood vessels
Beta 1 Adrenergic receptors on the heart - prevents sympathetic stimulation of the heart
Alpha 1 adrenergic receptors on blood vessels - promotes dilation of aterioles and veins
Vascular smooth muscle - Sodium Nitroprusside is used only in hypertensive emergencies and others used for chronic hypertension
renal tubules - promote salt and water excretion
beta 1 receptors on Juxtaglomerular cells - suppresses release of renin
Block of Renin - decreases conversion of angiotensinogen to angio 1
Angiotension converting enzyme - suppresses formation of angio II
Created by: KristinL