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Hypertension : BP DIASTOLIC SYSTOLIC Normal < 130 < 85 Mild hypertension 140 - 159 90 - 99 Moderate hypertension 160 - 179 100 - 109 Severe Hypertension 180 - 209 110 - 119

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Page 1: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Hypertension :BP DIASTOLIC SYSTOLIC

Normal < 130 < 85

Mild hypertension

140 - 159 90 - 99

Moderate hypertension

160 - 179 100 - 109

Severe Hypertension

180 - 209 110 - 119

Page 2: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Typical Diurnal Blood Pressure Rhythm in a "Dipper"

                                                                                      

Page 3: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180
Page 4: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180
Page 5: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180
Page 6: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Classification of antihypertensives :

ACE inhibitors : Captopril, Enalapril. Angiotensin Antagonist : Losartan Calcium channel blockers : Verapamil,

Diltiazem, Nifedipine. Beta adrenergic blockers : Propranolol. Alpha adrenergic blockers : Prazosin.

Page 7: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Diuretics : Thiazides : Hydrochlorothiazides ,

Metolazone, Indapamide. High ceiling diuretics : Furesomide,

Bumetanide, Ethacrynic acid K sparing diuretics : Spironolactone,

Triamterene, AmilorideAlpha -2 agonist: Clonidine, Methyldopa

Page 8: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Vasodilators: Arteriolar : Hydralazine, Minoxidil. Arteriolar + Venous : ACE

inhibitors Venodilator : Nitrates

Page 9: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Angiotensin Converting Enzyme (ACE) Inhibitors:

Captopril, Lisinopril, Enalapril, Ramipril, Benazepril, Fosinopril

Reduction in arterial resistance (after load)

Reduction in venous tension (preload)

Reduction in aldosterone secretion

Page 10: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180
Page 11: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180
Page 12: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Indications for ACE inhibitors includes: Congestive heart failure (CHF) Hypertension Left ventricular dysfunction Prevention of nephropathy in

diabetes mellitus

Page 13: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Adverse effects: Common adverse effects includes

hypotension, cough, hyperkalemia. Rash and taste disturbances with

captopril AngioedemaCautions and contraindications: Pregnancy Bilateral renal artery stenosis

Page 14: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

ANGIOTENSIN RECEPTOR

BLOCKERS ARB (AT 1 BLOCKERS):

Losartan, Erbesartan, Candesartan Competitive antagonists of

Angiotensin II No inhibition of ACE or breakdown

of bradykinin

Page 15: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Antihypertensives agents

Page 16: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Hydralazine : Direct arteriolar vasodilator. Release of nitric oxide cause the

vasodilation of the arteries. Reflex sympathetic system activation

can cause tachycardia. Norepinephrine release from nerve

endings can increase myocardial contractility

Page 17: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Hydralazine : Adverse effects Throbbing headache , palpitation SLE – in slow acetylators or on

prolonged use at a higher dose Precipitation of angina and MI

Page 18: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Hydralazine : Uses Hypertension not controlled by first

line of anti hypertensives Can be used hypertension of

pregnancy Hypertensive emergencies

Page 19: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Minoxidil : Arteriolar vasodilator - K channel

activator Chronic therapy – excess growth of

hair on face, back and arms Used in life threatening hypertension Used in hypertension with renal

failure

Page 20: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

Hypertensive emergencies : Sodium Nitroprusside NTG Diazoxide Hydralazine Enalaprilat Nicardipine Esmolol Nifedipine - Sublingual

Page 21: Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180

 

THE CHOICE OF THE ANTIHYPERTENSIVE IN PATIENTS WITH CONCOMITANT DISEASES.

 

Concomitantdisease

 

Antihypertensive drugDiuretics ß-

block.Ca-block.

ACE-inhibitor

 

Diabetes

C.I AVOID  

OK INDI CATED

 Gout

AVOID   

--   

--   

--

 Dyslipidemia

C.I AVOID   

--   

--

 Angina pectoris

 

--   I I   

--

 Cardiac failure

I judicious

OK   I

 Pregnancy

  C.I

 Cautious

  OK AVOID


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