Lecture Notes on Hypertension and Related Topics

Introduction

• The focus of the lecture is on hypertension and related pharmacological treatments.
• Emphasis on understanding medication mechanisms, side effects, and patient education.

Hypertension Overview

• Importance of Understanding: Understanding medication mechanisms helps in educating patients about side effects.
• Classifications: Diuretics, such as Rosemite and Hydrochlorothiazide, are critical.
• Side Effects: Different drug classes have unique side effects, e.g., diarrhea, electrical problems.
• Patient Education: Understanding labeling on medications and diets (DASH diet) is essential.

Patient Prioritization and Education

• Prioritization Chart: Start with airway issues, then Maslow's physiological needs, and further prioritize based on acute vs. chronic issues.
• Patient Education: Importance of understanding sodium content, especially in diets like the DASH diet, and label interpretation.

Hypertension Classification

• American Heart Association Standards: Normal, elevated, stage 1, stage 2, hypertensive crises.
• Symptoms: Headaches, fatigue, ear swooshing; silent in many patients.
• Impact of Uncontrolled Blood Pressure: Damage to small vessels in organs (eyes, brain, heart, kidneys).

Blood Pressure Checks and Issues

• Importance of Accurate Blood Pressure Checks: Ensures proper diagnosis and management.
• Common Problems: Inaccurate checks due to improper methods, e.g., not waiting before measurement.
• Family History Influence: Genetic predispositions influence blood pressure.

Medications and Blood Pressure Management

• Mechanisms of Action: Medications affect fluid volume, heart rate, and vascular resistance.
• Drug Classes: ACE inhibitors, ARBs, Calcium Channel Blockers.
• Racial and Gender Differences in Medication Response: African Americans typically respond better to diuretics and calcium channel blockers.

Lifestyle Modifications

• Diet: DASH diet recommended (low sodium, high potassium).
• Exercise: Importance of regular physical activity (150 minutes of moderate activity per week).
• Alcohol and Smoking: Limit alcohol intake; aim to quit smoking.

Special Considerations

• Elderly Patients: More susceptible to medication side effects; goals may differ.
• Children's Hypertension: Rise due to decreased physical activity and poor diet.

Hypertensive Crises

• Types: Hypertensive urgency vs. emergency.
• Management: Requires different treatment approaches, often involving rapid medical intervention.

Pharmacology Overview

ACE Inhibitors and ARBs

• Mechanism: Blocks conversion in the renin-angiotensin system, reducing vasoconstriction.
• Side Effects: Cough, hyperkalemia (potassium retention), risk of hypotension.

Calcium Channel Blockers

• Mechanism: Relaxes blood vessels, reduces heart workload.
• Side Effects: Edema, constipation, dizziness, headache.

Vasodilators

• Example Drugs: Hydralazine, Sodium Nitroprusside.
• Use in Emergencies: Sodium Nitroprusside in hypertensive emergencies, but risk of cyanide toxicity.

Diuretics

• Types: Thiazide (e.g., Hydrochlorothiazide), Loop (e.g., Furosemide), Potassium-sparing (e.g., Spironolactone).
• Mechanism: Increase urine output to reduce fluid volume.
• Considerations: Monitor electrolytes, risk of dehydration, frequent urination.

Conclusion

• Importance of Regular Monitoring: Regular check-ups and patient education are critical for managing hypertension.
• Medication Adherence: Vital for effective blood pressure management; side effects should be communicated clearly.

Final Note

• Prepare for potential questions on exams related to hypertension management, pharmacology, and lifestyle modifications.