1. Cardiovascular Drugs

3. As blood is pumped through the arteries, it creates pressure within the wall of the arteries
As the heart contracts, this increased pressure is called the systolic pressure

4. As the heart relaxes and fills, this decreased pressure is called the diastolic pressure

5. Blood Pressure
Blood pressure is written as a fraction of systolic over diastolic pressure in mmHg(mercury)
Normal is 120/80 mmHg

6. Blood Pressure Blood pressure is VITAL to life
A blood pressure of zero is a sign of death
Blood pressure is a VITAL sign

7. Let’s take a blood pressure

8. Hypertension
Is High Blood Pressure
HTN

9. Hypertension
Is measured by consistent elevation in blood pressure, either
Systolic ≥ 140mmHg
Diastolic ≥90mmHg

10. Hypertension
Long standing, uncontrolled HTN damages blood vessels resulting in many types of organ damage

11. Essential Hypertension
Essential HTN is the most common form of HTN
Cause of essential HTN is unknown

12. Essential Hypertension has many risk factors:
Family history of HTN
Sex
Race
Salt
Stress
Obesity, lack of exercise
Smoking

13. Secondary HTN
Unlike essential HTN, secondary HTN has a specific cause for the elevated blood pressure

14. Secondary HTN Kidney Disease
Pheochromocytoma – a type of tumor that makes too much epinephrine or too much catecholamines
Cushing’s Disease
Pregnancy
Vascular Anomalies
Neurologic Disease

15. Symptoms of HTN HTN usually has NO symptoms
It is usually detected on a routine visit to a medical clinic

16. HTN usually has NO symptoms
This is why it is so difficult to convince people to take medication for HTN

17. Symptoms of HTN HTN can cause many symptoms
Headache and visual changes, especially during stress are common early symptoms

18. Symptoms of HTN
When HTN is severe enough to cause acute visual, neurologic, or any other organ damage this is called MALIGNANT HYPERTENSION

19. HTN damages blood vessels
Long term sustained hypertension damages blood vessels
Blood vessels exposed to high blood pressures become thickened and hardened, making them less flexible

20. Arteriosclerosis
Blood vessels exposed to high blood pressures become thickened and hardened, making them less flexible

21. HTN damages blood vessels
Fatty deposits can form on the arteries call plaques, which cause the artery to narrow and become blocked
This is called Atherosclerosis

22. Know the difference between:
Arteriosclerosis
Atherosclerosis

24. Infarction
When narrow arteries become blocked and blood supply to an organ is stopped, organ damage results
This damage is called infarction

25. HTN causes brain damage
HTN is a major cause of stroke
- brain attack
- cerebrovascular accident (CVA)
- cerebral infarction
- apoplexy

26. HTN causes brain damage

27. Aneurysm
With high blood pressure, a weakening of the arterial wall may balloon out (aneurysm) and burst causing hemorrhage (bleeding) and even death

28. Aneurysm

29. Aneurysm
Although aneurysm can occur on any artery, the two most common places for aneurysm are:
Brain – cerebrovascular aneurysm
Aorta – abdominal aortic aneurysm

30. HTN damages the eyes
Because HTN damages blood vessels, HTN damages the blood supply to the eyes, and can lead to blindness

31. Normal Retina

34. HTN damages the kidneys
Because HTN damages the blood vessels, HTN damages the kidneys, this is called nephrosclerosis, and can lead to kidney failure

35. Nephron

36. HTN damages the heart
Because HTN damages the blood vessels, HTN damages the heart by infarction, hypertrophy or cardiomyopathy

37. Myocardial Infarction

38. Ventricular Hypertrophy

39. Dilated Cardiomyopathy

40. The kidneys help regulate blood pressure
The kidneys play an important role in the long-term regulation of blood pressure

41. Immediate Control Parasympathetic Nervous System
Sympathetic Nervous System/Adrenergic NS

42. Long Term Control
Kidneys

43. Kidneys and Blood Pressure
Kidneys help regulate the balance of salt and water in the body
Kidneys excrete water soluble waste substances, salt and water

44. Kidneys are Filters
The kidneys contain millions of microscopic filtering units, called nephrons which are the working components of the kidneys

45. Kidneys are Filters
Many substances cannot pass through the filter and remain in the blood
Many substances pass through the filters (like glucose) but are reabsorbed back into the blood

46. Kidneys are Filters
Many substances pass through the filters and are excreted into the urine

47. Kidneys regulate blood volume
When blood volume decreases, kidneys will retain salt and water
When blood volume increases, kidneys will excrete salt and water

48. Renal Hormones and Volume Control
Blood volume is monitored by the kidneys and continually adjust water and salt levels to help maintain consistent blood pressure

49. Renal Hormones and Volume Control
The blood vessels supplying the nephrons contain special cells that detect blood pressure

50. Renal Hormones and Volume Control
If blood pressure falls below a set point, a renal hormone called Renin is secreted into the blood stream

51. Renin and Volume Control
Renin converts angiotensin to angiotensin 1, which is converted to angiotensin 2 by the lungs
Angiotensin 2 causes vasoconstriction which increases blood pressure

52. Angiotensin 2 also stimulates the adrenal cortex to produce aldosterone

53. Aldosterone and Volume Control
Aldosterone acts on the kidneys to keep salt and water in the blood, resulting in increased blood volume

55. Medulla – inside
- epinephrine (adrenaline)
Cortex – outside
- aldosterone (mineralocorticoid)
- hydrocortisone (glucocorticoid)

56. Antidiuretic Hormone (ADH) and Volume Control
Antidiuretic Hormone (ADH) is also called Vasopressin, secreted by the brain in response to low blood pressure, acts on the kidneys to retain water, resulting in increased blood volume

57. Drugs for HTN Adrenergic Antagonists - β-blockers - “Beta Blockers”
Propanolol
Atenolol

58. Adrenergic Antagonists
- α-blockers
- alpha-blockers
Doxazosin

59. Drugs for HTN
Central α-agonist
- clonidine

60. Clonidine stimulates alpha adrenoreceptors in the brain stem
Clonidine stimulates alpha adrenoreceptors in the brain stem. This action results in reduced sympathetic outflow from the central nervous system and in decreased in peripheral resistance, renal vascular resistance, heart rate and blood pressure

61. Drugs for HTN
Thiazide diuretic
Hydrochlorothiazide (HCTZ)

62. Drugs for HTN
Angiotensin Converting Enzyme Inhibitors
ACE
Captopril

63. Drugs for HTN
Angiotensin II receptor blockers
- losartan

64. Drugs for HTN Calcium Channel Blockers - dilates arterioles
- relaxes smooth muscle
- come in 3 classes

65. Drugs for HTN Calcium channel blockers
- nifedipine is a dihydropyridine CCB

66. Drugs for HTN Calcium Channel Blocker
- Verapamil is a phenylalkylamine ccb

67. Drugs for HTN Calcium Channel Blocker
- Diltiazem is a benzothiazepine ccb