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Hypertension

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Hypertension

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    1. Hypertension By Zuzana Barbret CHEM 4205 Spring 2008

    2. What is Hypertension (HTN)? High blood Pressure (BP) Systolic pressure > 140 mm Hg Diastolic pressure > 90 mm Hg Classification of Hypertension Primary Secondary

    3. Pathophysiology of High BP Blood pressure – is the force of blood exerted on arteries as it flows through them Classification of BP – Systolic – Diastolic (mm Hg) (mm Hg) Normal <120 <80 Prehypertension 120-139 80-89 Stage 1 Hypertension 140-159 90-99 Stage 2 Hypertension >160 >100

    4. Blood Pressure Control Mechanism

    5. Causes of Hypertension Aging Smoking Obesity High sodium (salt) diet High cholesterol Lack of exercise Drinking Being insulin resistant

    6. Risk Factors of HTN Smoking Age Women older than 65 years of age Men older than 55 years of age Obesity Diabetes Lack of Physical activity Chronic alcohol consumption Family history of cardiovascular disease Sex – men and postmenopausal women African American 2x more likely than Whites

    7. Facts About Hypertension According to American Society of HTN 50 millions of Americans are affected More than 90% of cases have no cause Children who’s parents have HTN will more likely be affected HTN is called a “SILENT KILER” due to having no warning signs or symptoms but increases one’s risk of cardiovascular collapse Due to not being aware of having HTN, only ¼ of people are being treated

    8. What are the Symptoms? Prehypertension and Stage 1 HTN Usually none Stage 2 HTN If occurs rapidly – symptoms of Hypertensive Crisis Headache (pulsating behind eyes more in the AM) Visual disturbances Nausea & vomiting

    9. How is HTN Diagnosed? Usually by routine doctor’s visit One high BP reading does not mean you have HTN Repeated BP reading will be done at different positions Complete physical, medical and family history will be performed Risk factors identified

    10. Treatment of HTN There are following steps in treating HTN Lifestyle modification First line treatment Second line treatment Third line treatment

    11. Lifestyle Modification Weight reduction Reduction of sodium intake Decrease of alcohol intake Smoking cessation Increase in physical activity If inadequate, continue to first line treatment

    12. First Line Treatment Continue with lifestyle modification Initial drug selection: Diuretic Beta-blocker If inadequate, continue to second line treatment

    13. Second Line Treatment Adding drugs from the folloving categories Angiotensine Converting Enzyme (ACE) Inhibitor Calcium Channel Blocker Angiotensine II Receptor Blocker (ARB) a- blocker, a- and ß-blocker If inadequate, continue to third line treatment

    14. Third Line Treatment Increase drug dose, or Substitute another drug, or Add a second drug from another class If inadequate, may need to do further studies Serious organ damage may be present

    15. Possible Outcomes of Delayed Treatment of HTN Stroke Myocardial infarction Congestive heart failure Renal failure

    16. Hypertension Treatment

    17. Drugs Used to Treat HTN Diuretics Furosemide (Lasix); Hydrochlorothizide (HydroDIURIL) Beta blockers Atenolol (Tenormin); Propranolol (Inderal) ACE inhibitors Captopril (Capoten); Enalapril (Vasotec) ARB’s Irbesartan (Avapro); Losartan (Cozaar) Calcium channel blockers Amlodipine (Norvasc); Diltiazem (Cardizem)

    18. Site Of Action of Antihypertensive Drugs Action of Beta-Blockers Block vasoconstriction Decrease heart rate Decrease cardiac muscle contraction Tend to increase blood flow to the kidneys -> leading to a decrease in the release of renin

    19. What Are Beta-Blockers? Beta blockers are Beta-adrenergic receptor blockers – they block action of Adrenalin and Noradrenaline (SNS stimulants), which are involved in “Fight-or-flight’ response There are two types of Beta receptors ß1 – found mostly in the heart ?2 – found mostly in the lungs

    20. Classification of Beta Blockers ß1 receptors blockers Atenolol (Tenormin) Betaxolol (Kerlone) Bisoprolol (Zabeta) Metoprolol (Lopressor, Toprol-XL) ß1, ß2 receptor blockers Nadolol (Corgard) Propranolol (Inderal, Inderal LA) ß1, ß2, a receptor blockers Labetolol (Normodyne, Trandate)

    21. Beta Blockers

    22. Discovery of Beta Blockers Started in 1950’s when “Heart disease had become a serious epidemic” By Sir James Black, an English physician and a basic scientist who started research in Glasgow Veterinary School laboratory His goal was to find a drug that would decrease the oxygen demand in the heart He developed the first Beta-blocker – Propranolol (Inderal) in 1964 It successfully blocked the heart’s adrenaline-responsive beta-receptors Hence the name “Beta-Blockers” He was awarded the Nobel Prize in 1988 for this and other discoveries

    23. Beta Blockers – Side Effects Fatigue Orthostatic hypotension Weakness Blurred vision Stuffy nose Impotence Rash CHF Bradycardia Pulmonary edema

    24. Treatment of Side Effects Changing position slowly Sit at the edge of bed or chair for a few minutes before standing up Drink adequate amount of fluids Contact physician in more serious case to adjust the dose or change the medication

    25. How Much the Drug Cost?

    26. Propranolol

    27. Propranolol Metabolism

    28. Further Research Development of propranolol from the lead compound Pharmacokinetics and pharmacodynamics of propranolol in our body Interview with heart specialists at Atlanta Medical Center about current treatment of HTN Interview with my family members and clients with HTN – how is their life affected by this condition

    29. QUESTIONS? ???

    30. References Beta Blockers – common dosage guidelines (2008). The clinician’s Ultimate Reference Retrieved March 15, 2008 from http://www.globalrph.com/beta.htm Karch, A. (2006). Focus on Nursing Pharmacology. (3rd. Ed.). Philadelphia: Lippincott Williams &Wilkins Pharmacokinetics and Pharmacodynamics Mehvar, R.; Brocks, D. R. (2001). Stereospecific of Beta-Adrenergic Blockers in Humans. J Pharm Pharmaceut Sci 4(2), 185-200. Retrieved march 15, 2008 from http://images.google.com/imgres?imgurl=http://www.ualberta.ca/~csps/JPPS4(2)/R.Mehvar/Fig2.gif&imgrefurl=http://www.ualberta.ca/~csps/JPPS4(2)/R.Mehvar/betablockers.htm&h=629&w=490&sz=9&hl=en&start=7&tbnid=-br7jKXMxHZijM:&tbnh=137&tbnw=107&prev=/images%3Fq%3Dpropranolol%26gbv%3D2%26hl%3Den%26sa%3DG Popple, I. (2004, October 14). How Beta-Blockers came To Be. McGill Reporter, 37(3), 2004-2005. Retrieved March 15, 2008 from http://www.mcgill.ca/reporter/37/03/black/ Propranolol tablets Retrieved March 15, 2008 from psyweb.com Treating the High Blood Pressure and Heart Disease: Beta-blockers. (2008). Consumer Reports:Best Buy Drugs Retrieved March 13, 2008 from http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/2pager_BetaBlockers.pdf

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