Hypertension

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Hypertension

• By Zuzana Barbret
• CHEM 4205
• Spring 2008

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What is Hypertension (HTN)?

• High blood Pressure (BP)
• Systolic pressure gt 140 mm Hg
• Diastolic pressure gt 90 mm Hg
• Classification of Hypertension
• Primary
• Secondary

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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 lt120
  lt80
• Prehypertension 120-139 80-89
• Stage 1 Hypertension 140-159 90-99
• Stage 2 Hypertension gt160 gt100

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Blood Pressure Control Mechanism

• Blood Pressure
• Depends on
• Cardiac Output
• Contractility
• Fluid Volume
• Peripheral vascular resistance
• Is affected by
• Nervous system
• Kidney function
• Hormonal changes
• Capillary fluid shift

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Causes of Hypertension

• Aging
• Smoking
• Obesity
• High sodium (salt) diet
• High cholesterol
• Lack of exercise
• Drinking
• Being insulin resistant

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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

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Facts About Hypertension

• According to American Society of HTN
• 50 millions of Americans are affected
• More than 90 of cases have no cause
• Children whos parents have HTN will more likely
  be affected
• HTN is called a SILENT KILER due to having no
  warning signs or symptoms but increases ones
  risk of cardiovascular collapse
• Due to not being aware of having HTN, only ¼ of
  people are being treated

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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

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How is HTN Diagnosed?

• Usually by routine doctors 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

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Treatment of HTN

• There are following steps in treating HTN
• Lifestyle modification
• First line treatment
• Second line treatment
• Third line treatment

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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

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First Line Treatment

• Continue with lifestyle modification
• Initial drug selection
• Diuretic
• Beta-blocker
• If inadequate, continue to second line treatment

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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

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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

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Possible Outcomes of Delayed Treatment of HTN

• Stroke
• Myocardial infarction
• Congestive heart failure
• Renal failure

www.nlm.nih.gov
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Hypertension Treatment
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Drugs Used to Treat HTN

• Diuretics
• Furosemide (Lasix) Hydrochlorothizide
  (HydroDIURIL)
• Beta blockers
• Atenolol (Tenormin) Propranolol (Inderal)
• ACE inhibitors
• Captopril (Capoten) Enalapril (Vasotec)
• ARBs
• Irbesartan (Avapro) Losartan (Cozaar)
• Calcium channel blockers
• Amlodipine (Norvasc) Diltiazem (Cardizem)

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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 -gt
  leading to a decrease in the release of renin

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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

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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)

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Beta Blockers

• Commonalities
• One chiral center
• Aromatic ring
• Side alkyl chain
• Secondary hydroxyl group
• Amine

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Discovery of Beta Blockers

• Started in 1950s 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 hearts
  adrenaline-responsive beta-receptors
• Hence the name Beta-Blockers
• He was awarded the Nobel Prize in 1988 for this
  and other discoveries

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Beta Blockers Side Effects

• Fatigue
• Orthostatic hypotension
• Weakness
• Blurred vision
• Stuffy nose
• Impotence
• Rash
• CHF
• Bradycardia
• Pulmonary edema

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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

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How Much the Drug Cost?
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Propranolol

• Initial Dose in treating HTN
• - 80mg PO 2x/day
• 80mg extended release form 1x/day
• Increase at 3-7 day intervals to max daily dose
  of 640mg
• Maintanance dose
• 120-240mg daily
• 120-160mg extended release form

Nursing2007 Drug Handbook
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Propranolol Metabolism
Part of my future research
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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

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QUESTIONS?

• ???

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References

• Beta Blockers common dosage guidelines (2008).
  The clinicians 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?imgurlh
  ttp//www.ualberta.ca/csps/JPPS4(2)/R.Mehvar/Fig2
  .gifimgrefurlhttp//www.ualberta.ca/csps/JPPS4(
  2)/R.Mehvar/betablockers.htmh629w490sz9hle
  nstart7tbnid-br7jKXMxHZijMtbnh137tbnw107
  prev/images3Fq3Dpropranolol26gbv3D226hl3Den
  26sa3DG
• 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
  ReportsBest Buy Drugs Retrieved March 13, 2008
  from http//www.consumerreports.org/health/resourc
  es/pdf/best-buy-drugs/2pager_BetaBlockers.pdf