Hypertension and Dyslipidemia Lecture Notes

Jul 4, 2024

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Hypertension and Dyslipidemia

Hypertension (High Blood Pressure)

  • Blood Pressure Reading: Two numbers (e.g., 120/80 mmHg)

    • Systolic (top number): Pressure when the heart contracts
    • Diastolic (bottom number): Pressure when the heart is relaxed

  • Optimal Blood Pressure: <120/80 mmHg

  • Hypertension Staging (2017 Guidelines):

    1. Elevated Blood Pressure: Systolic >120 mmHg
    2. Stage 1 Hypertension: Systolic 130-139 mmHg or Diastolic 80-89 mmHg
    3. Stage 2 Hypertension: Systolic ≥140 mmHg or Diastolic ≥90 mmHg
    • Note: Staging is based on the highest elevated number

  • Medications for Hypertension:

    • Hydrochlorothiazide (HCTZ)
      • Class: Thiazide diuretic
      • Action: Prevents sodium reabsorption -> increased urination (diuresis)
      • Side Effects: Dizziness, low potassium, muscle cramps
    • Lisinopril
      • Brand Name: Zestril
      • Class: ACE Inhibitor
      • Action: Inhibits angiotensin-converting enzyme -> prevents vasoconstriction and sodium/water retention
      • Benefits: Heart and kidney protection (especially in diabetes)
      • Side Effects: Angioedema (life-threatening), chronic dry cough, high potassium, dizziness, kidney dysfunction
    • Amlodipine
      • Brand Name: Norvasc
      • Class: Calcium channel blocker
      • Action: Blocks calcium channels in arteries -> decreases constriction
      • Side Effects: Dizziness, fatigue, edema (fluid retention)
    • Metoprolol
      • Brand Name: Lopressor
      • Class: Beta Blocker
      • Action: Blocks beta receptors in the heart -> slows heart rate, decreases force of beats
      • Side Effects: Dizziness, fatigue, bradycardia (slow heart rate)
      • Note: Caution during vigorous exercise

  • Key Points:

    • No cure for hypertension
    • Lifestyle modifications (e.g., salt reduction, exercise) are crucial and usually lifelong
    • Some patients may need lifelong drug therapy
    • Large weight loss (e.g., post-gastric bypass) might allow discontinuation of medications

Dyslipidemia

  • Definition: Issues with cholesterol levels, including high LDL or low HDL

  • Why It Matters: Increased risk of heart attack or stroke

    • Prevention:
      • Primary: Preventing first heart attack or stroke
      • Secondary: Preventing further events after initial heart attack or stroke

  • Cholesterol Types:

    • LDL (Bad Cholesterol): Forms plaques in arteries
    • HDL (Good Cholesterol): Removes LDL from the body
    • Triglycerides: Fat particles in the blood, high levels can block arteries
    • Total Cholesterol: Sum of LDL, HDL, and 20% of triglycerides (not a good measure alone)

  • Atherosclerosis: Narrowing and hardening of arteries due to plaque build-up

    • Can lead to heart attacks and strokes if arteries become completely clogged

  • Medications for Dyslipidemia:

    • Statins (HMG CoA Reductase Inhibitors)
      • Example: Simvastatin (Zocor)
      • Action: Inhibits cholesterol production in the liver, primarily lowers LDL
      • Side Effects: Liver damage (monitored through liver function tests), Rhabdomyolysis (muscle breakdown, can cause kidney failure)
      • Contraindications: Pregnancy (Category X) and breastfeeding