As a result of increased arterial rigidity, patients with ISH have a widened pulse pressure (the difference between systolic and diastolic pressure). When elastic properties of the arterial wall diminish and arteries beome more rigid, this “dumping” of pressure changes during the cardiac cycle also decreases. Then, this elastic recoil of the arterial wall contributes the diastolic flow of the blood and diastolic pressure. Normally during systole, the heart ejects the blood under a certain pressure that is dumped by elastic properties of the aorta and major arteries. The mechanism leading to this is believed to be decreased elasticity of the arterial wall, which leads to an increased systolic BP, without concurrent increase (and even decrease) in diastolic BP. Isolated systolic HTN is an important cause of AHN in elderly patients. If the effect of a beta blocker is not satisfactory, a nitrate can be added to the regimen. Pt with ANGINA and HTN, give Beta blockers.Don’t use vasodilators like hydralazine,CCBs,Nitrates etc because they cause reflex tachycardia. In pts with aortic dissection, lower the BP using Beta Blockers.In pts with benign essential tremors use propranolol as anti hypertensive.
Beta blockers can worsen the symptoms of peripheral vascular disease They are also metabolically neutral, not affecting plasma lipid profile. If they have intermittent claudication and other stenotic issues throughout their body, the best initial choice for tx of HTN in this pt seems to be a dihydropyridine calcium channel blockers, ie amlodipine.Beta blockers such as atenolol are indicated as 1st line antihypertensive in pts with angina, status post MI, or low ejection fraction.ACE inhibitors are the 1st line agent for HTN in pts with diabetes, chronic kidney disease, and CHF.Hydralazine should not be used as a first-line therapy for HTN because it requires up to 4 times daily dosing.
post-mi patients should be on a beta blocker and an ace inhibitor.diabetics and pts with reduced lv systolic dysfunction should always be started with an aceinhibitor first.U S M LE S T E P 2 C K UW N OT E S O Orriiggiinnaallllyy bbyy:: g geennxxrraavveerr EEddiitteedd bbyy:: g giirrll^ ^iinntteerrrruup ptteed dĬARDIOLOGY: Hypertension/Hypotension For pts with HTN, in the absence of a specific indication or contraindication, diuretics and beta blockers are still recommended as the initial drug treatment.
0 kommentar(er)
