Discuss how you might select antihypertensive therapy for a patient.

In patients with stage 1 HTN, recommendations are to start
antihypertensive medications a target of BP less than 130/80 to
prevent patients from cardiovascular events. The
recommendation is to have lifestyle modification measures.

Recommendations are for all patients with stage 2 HTN to start
antihypertensive medications to lower BP to a target lower than
130/80 even

In patients with chronic kidney disease, the target BP is 130/80

For patients with type 2 diabetes mellitus (T2DM), it is
recommended to start on antihypertensive medications if BP is
more than 130/80 with a goal of BP lower than 130/80.

Antihypertensive medication treatment usually starts as
monotherapy after failure of conservative management with
lifestyle modification. The use of combination therapy is common
when patients fail the monotherapy approach.

Lowering blood pressure does reduce cardiovascular risks;
maintaining systolic blood pressure less than 130 mm Hg has
shown to prevent complications in patients with heart failure,
diabetes, coronary artery disease, stroke, and other
cardiovascular diseases. The response to initial monotherapy is
affected by age and race.
Outline the principles of management of cardiovascular risk.
Encourage a healthy lifestyle (smoking cessation, healthy diet, regular
physical activity, optimal weight) in everyone.
Reducing salt and alcohol intake, losing weight and increasing physical
activity
If drug treatment is commenced, a target office BP less than 130 mmHg
systolic and less than 80 mmHg diastolic is recommended
Angiotensin converting enzyme (ACE) inhibitors or angiotensin II
receptor blockers (ARBs), calcium channel blockers and thiazide
diuretics are all suitable first-line drugs, either as monotherapy or in
some combinations unless contraindicated.
compare and contrast the anatomy and chemical transmission of
the sympathetic and parasympathetic nervous systems.
The sympathetic nervous system prepares the body for the “fight
or flight” response during any potential danger. On the other
hand, the parasympathetic nervous system inhibits the body from
overworking and restores the body to a calm and composed
state. The difference between the sympathetic and
parasympathetic nervous system are differentiated, based on the
way the body responds to environmental stimuli.
Sympathetic
Parasympathetic
Involved in the fight or flight response.
Involved in maintaining
homeostasis and also, permits the
rest and digest response.
The sympathetic system prepares the
body for any potential danger.
The parasympathetic system aims
to bring the body to a state of
calm.
Sympathetic system has shorter
neuron pathways, hence a faster
response time.
Has comparatively longer neuron
pathways, hence a slower
response time.
Increases heartbeat, muscles tense up.
Reduces heartbeat, muscles
relaxes.
The pupil dilates to let in more light.
The pupil contracts.
Saliva secretion is inhibited.
Saliva secretion increases,
digestion increases.
On “fight and flight” situations,
Adrenaline is released by the adrenal
glands; more glycogen is converted to
glucose.
No such functions exist in “fight
or flight” situations.
Describe actions of sympathetic and parasympathetic nerve
stimulation on heart and blood vessels, and how these actions
regulate cardiac output and blood pressure.


If
an
increase
in
arterial
pressure
is
detected,
the parasympathetic pathway is activated to reduce the heart rate. This,
along with increasing vasodilation of vessels, acts to reduce the arterial
pressure.
If a decrease in arterial pressure is detected, the sympathetic pathway is
activated to increase the heart rate and the contractility of the heart.
This, along with increasing vasoconstriction of vessels, acts to increase
the arterial pressure.
Describe cellular actions of sympathetic and parasympathetic
nerve stimulation on sino-atrial nodes, ventricular myocytes,
and vascular smooth muscle cells.
Parasympathetic
The parasympathetic input into the heart is via the vagus nerve
(CN X). The vagus nerve forms synapses with postganglionic cells
in SAN and AVN (atrioventricular node). When stimulated,
acetylcholine binds on to M₂ receptors, which act to decrease the
slope of the pacemaker potential. This leads to a decrease in heart
rate (a negative chronotropic effect).
Sympathetic
The sympathetic input into the heart is via the postganglionic
fibres from the sympathetic trunk which innervate the SAN and
AVN. The postganglionic fibres release noradrenaline, which acts
on B₁ adrenoreceptors to increase the slope of the pacemaker
potential. This increases the heart rate (a positive chronotropic
effect), as well as the force of contraction (positive inotropic
effect).
The parasympathetic input on the SAN dominates at rest, giving a
normal resting heart rate of around 60bpm. A reduction in
parasympathetic outflow results in an initial increase in heart rate,
reaching over 100bmp. This is further brought about by an
increase in sympathetic outflow.
Describe the effects of drugs targeting the sympathetic nervous
system on the heart and blood vessels.
Sympathetic and Parasympathetic Effects of Different Drug Types
Drug type
Nicotinic agonists
Parasympa
Sympathe
Overall
Example(s)
thetic
tic effect
result
effect
Nicotine
Mimic
ACh at
preganglio
nic
synapses,
causing
activation
of
postgangli
onic fibers
and the
release of
norepinep
hrine onto
Mimic ACh
at
preganglio
nic
synapses,
causing
activation
of
postgangli
onic fibers
and the
release of
ACh onto
Most
conflicting
signals
cancel
each other
out, but
cardiovasc
ular system
is
susceptible
to
hypertensi
on and
Sympathetic and Parasympathetic Effects of Different Drug Types
Drug type
Parasympa
Sympathe
Overall
Example(s)
thetic
tic effect
result
effect
the target the target
organ
organ
arrhythmia
s
Bind to
adrenergi
c
receptors
Sympathomimetic Phenyleph
or mimics No effect
drugs
rine
sympathet
ic action
in some
other way
Increase
sympatheti
c tone
Block
binding to
adrenergi
c drug or No effect
decrease
adrenergi
c signals
Increase
parasympa
thetic tone
Sympatholytic
drugs
β-blockers
such as
propanolol
or
metoprolo
l; αagonists
Sympathetic and Parasympathetic Effects of Different Drug Types
Drug type
Parasympa
Sympathe
Overall
Example(s)
thetic
tic effect
result
effect
such as
clonidine
No effect,
except on
sweat
glands
Bind to
muscarinic Increase
receptor,
parasympa
similar to
thetic tone
ACh
Atropine,
Anticholinergics/m scopolami
uscarinic
ne,
No effect
antagonists
dimenhydr
inate
Block
muscarinic
receptors Increase
and
sympatheti
parasympa c tone
thetic
function
Parasymphathomimetics/muscari
nic agonists
Pilocarpin
e
Describe the effects of drugs targeting the parasympathetic nervous
system on the heart.
The parasympathetic nervous system decreases respiration and heart
rate and increases digestion. Stimulation of the parasympathetic
nervous system results in: Construction of pupils. Decreased heart rate
and blood pressure.
Normal heart sounds
In healthy adults, there are two normal heart sounds, often described
as a lub and a dub that occur in sequence with each heartbeat. These
are the first heart sound (S1) and second heart sound (S2), produced by
the closing of the atrioventricular valves and semilunar valves,
respectively.
Describe the social consequences of living with a chronic illness or
disability.
chronically sick people do not have lower rates of social
participation per se. However, the pattern of social participation
exhibited by people affected by chronic illness varies from the one
exhibited by people not affected.
High blood pressure has many risk factors, including:
Age. The risk of high blood pressure increases as you age. ...
Race. ...
Family history. ...
Being overweight or obese. ...
Not being physically active. ...
Using tobacco. ...
Too much salt (sodium) in your diet. ...
Too little potassium in your diet.
Lifestyle changes should be the initial approach to hypertension
management and include dietary interventions (reducing salt,
increasing potassium, alcohol avoidance, and multifactorial diet
control), weight reduction, tobacco cessation, physical exercise, and
stress management.
initial treatment of high BP Diuretics. Diuretics, sometimes called water
pills, are medications that help your kidneys eliminate sodium and
water from the body. ...
Angiotensin-converting enzyme (ACE) inhibitors. ...
Angiotensin II receptor blockers (ARBs). ...
Calcium channel blockers.