Treatment

• What happens when beta-2 receptors are activated?

  Smooth muscle relaxation -> peripheral vasodilation
• What drugs are used to treat HTN?

  Ca+2 channel blockers

  ACE inhibitors

  Angiotensin II receptor blockers (ARB)

  Diuretics
• What happens when alpha-1 receptors are activated?

  Vasoconstriction (stimulation by adrenaline or noradrenaline)
• What happens when alpha-2 receptors are activated?

  Smooth muscle contractions

  Platelet aggregation

  Inhibition of insulin secretion
• What happens when beta-1 receptors are activated?

  Increased HR (increased SAN & AVN firing)

  Increased force of contraction

  -> increased stroke volume & cardiac output
• What are the interventions of Stage 1 HTN?

  Offer treatment to everyone under 80 with at least 1 risk factor:

  • target organ damage
  • cardiovascular disease
  • renal disease
  • diabetes
  • 10 year cardiovascular risk > 20%
• What is recommended for lifestyle modifications for people with hypertension?

  Weight reduction

  Low fat & low saturated fat diet

  Low salt diet

  Limited alcohol consumption

  Dynamic exercise (30 mins brisk walk per day)

  Increased fruit & veg consumption

  Stop smoking
• What is the management of severe HTN?

  Pts with severe HTN (diastolic BP > 140 mmHg) should be admitted to hospital

  Need to reduce BP slowly (to avoid reflex response)

  Usually achieved with antihypertensives (atenolol or amlodipine)

  If require rapid control of BP (aortic dissection) -> IV sodium nitroprusside or labetalol
• When should you refer HTN pts to a specialist?

  • Pts taking ≥ 3 drugs with uncontrolled HTN (resistant HTN)
  • Suspected secondary causes
  • Young age (< 30 -40)
  • Historical features (e.g. obstructive sleep apnoea)
  • Examination findings
  • Sudden change in BP
  • Target organ damage detected with normal BP values
  • Intolerance of medicines preventing guideline-based treatment
  • Symptomatic HTN or hypotension
  • Labile or highly variable BP
  • Mild HTN when it is not clear whether a pt would benefit from BP-lowering
• What is the management of severe HTN?

  Pts with malignant or severe HTN (diastolic BP > 140 mmHg) should be admitted to hospital for treatment

  AIM: reduce diastolic BP slowly (over 24-48 hours) to around 100-110 mmHg

  → usually achieved with antihypertensives (atenolol or amlodipine)

  → can give sublingual or IV but NOT recommended as they can produce a severe fall in BP → cerebral infarction

  When you require rapid control of BP (e.g. aortic dissection) → IV sodium nitroprusside or labetalol