BloodPressureandDrugsSarahFu(sarah.fu@mail.utoronto.ca)MengXueShi(mengxue.shi@mail.utoronto.ca)ShuhuaSitu(shuhua.situl@mail.utoronto.ca)MonicaTran(mo.tran@mail.utoronto.ca)PresentationDate:Friday,September21,2021PHM142Fall2021Instructor:Dr.JeffreyHendersonMeasureofsystolicanddiastolicpressurePressureagainstthebloodvesselsProportionaltobloodflowTransportofnutrientsandO2RemovalofwasteandCO2DistributionofHormonesBloodPressureBloodpressureabove140/90Riskincreaseswithage2021–44%menandwomenages45-642021–45%menandwomenages65+Hypertension BlindnessStrokeHeartattackHeartfailureKidneydamageHighsaltdietObesityHereditaryStressDangersofHypertension Causes Renin-AngiotensinAldosteroneSystemLiverA:EnalaprilACEInhibitorsHHALiverBA:EnalaprilB:EsteraseACEInhibitorsHHALiverBA:EnalaprilB:EsteraseACEInhibitorsHHALiverBA:EnalaprilB:EsteraseACEInhibitorsHHALiverBA:EnalaprilB:EsteraseACEInhibitorsHHALiverBB:EsteraseC:EnalaprilatACEInhibitorsHHCHActionofBenazeprilatACEInhibitorsHHHHypotensionChestpainAbdominalpainAnemiaAdverseeffects<1%duringclinicaltrials>1%duringclinicaltrialsFatigueHeadacheDizzinessNauseaCommonininstitutionalizedelderlyOrthostaticHypotensionbaroreflexfailureorvolumedepletionSystolicbpdecrease>20mmHgDiastolicbpdecrease>10mmHgAssociatedwithhypertension,increasedageanddiabetesmellitusHypotensionSymptomsBlurredvision,headache,nausea,dizzinessRisksIncreasedincidentofcerebralvasculardiseaseMildcardio-infarctionCoronaryheartdiseaseHeartfailureCardio-vascularmortalityOrthostaticHypotensionNon-MedicinalConsumptionofsaltConsumptionofextrafluidsHeadofbedelevatedPhysicalActivityAbdominalbinderTreatmentsMedicinalPyridostigmine(Mestinon)Fludrocortisone(Florinef)Midodrine(ProAmatine)VasopressorIncreasesstandingsystolicbpMetabolitedesglymidodrineα1-agonistActivationofα-adrenergicreceptorsArterialandvenousvasoconstrictionElevatesbloodpressureMidodrineCytosolNucleusMidodrine DesglymidodrineGlycine DesglymidodrinePhospholipaseCα1-adrenergicreceptorsVasoconstriction–IncreaseBPEnzymaticcleavageβ

γαIncreaseincalciumSupinehypertensionScalpparesthesiasPilomotorreactions(goosebumps)UrinaryurgencyHeadachesAdverseEffectsSummaryHypertension

Hypertension:BP>140/90ACEconvertsangiotensinI(inactive)intoangiotensinII(active)toincreasebloodpressureAngiotensinIIisresponsibleforvasoconstriction,thirst,andreleasesaldosteroneforretentionofNa+MajorityofACEinhibitors(Enalapril),whenactivated,bindbythecarbonylgroupEnalaprilat(activeform)inhibitsACE,whichvasoconstriction,thirst,andstopsthereleaseofaldosteroneHypotensionSystolicBPdrop>20mmHgordiastolicBPdrop>10mmHgMidodrine:majormetabolitedesglymidodrinewhichactivatesadrenergicreceptorsVasopressoreffectthatcausesactivationandconstrictionofthearterialsystemAceInhibitors.09/15/12.<<:///classes/pcol/pcol425/restricted/Skidgel/ACE%20Inhibitors%20handout%202121.pdf>.AdrenalGland.<://te-deum.blogspot.ca/2021/08/recovering.html>.Barrios,V.,Escobar,C.,(2021).Antihpertensiveandorgan-protectiveeffectsofbenazepril.ExpertReviewofCardiovascularTherapy,12,1653-1724.Burt,V.L.,Whelton,P.,Roccella,E.J.,Brown,C.,Cutler,J.A.,Higgins,M.,…Labarthe,D.(1995).PrevalenceofhypertensionintheUSadultpopulation.Hypertension,25,305-313.CanadianHealthMeasuresSurvey:Bloodpressureinadults.09/13/12.<://statcan.gc.ca/daily-quotidien/100217/dq100217b-eng.htm>.eCPS.09/15/12.<s://www-e-therapeutics-ca.myaccess.library.utoronto.ca/cps.showMonograph.action#>.Figueroa,J.J.,Basford,J.R.,andLow,P.A.,(2021).Preventingandtreatingorthostatichypotension:AseasyasA,B,C.ClevelandClinicJournalofMedicine,7(5),298-306Highbloodpressure,byagegroupandsex.09/15/12.<://statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health03a-eng.htm>.HypertensioninCanada,2021.09/15/12.<://phac-aspc.gc.ca/cd-mc/cvd-mcv/ccdss-snsmc-2021/pdf/CCDSS_HTN_Report_FINAL_EN_20210513.pdf>.Jabary,N.S.,Sarabia,R.,Sanchez,T.,andGordillo,R.(2007).Midodrinetreatmentinthemanagementofsevereorthostatichypotensionafterhemangioblastomasurgery.ActaNeurochirurgica,149,303-306Kaplan,N.M.,&Victor,R.G.(2021).Kaplan’sClinicalHypertension(10thed.).Philadelphia:WoltersKluwerLiver.09/13/12.<:///blog/wp-content/uploads/2021/07/liver.jpg>.NatureofCodeBloodVessels.09/13/12.<:///~ek1388/myblog/?p=904>.Oldenburg,O.,Kribben,A.,Baumgart,D.,Philipp,T.,Erbel,R.,andCohen,M.V.,(2002).Treatmentoforthostatichypotension.CurrentOpinioninPharmacology,740-746Perazella,M.A.(2003).Efficacyandsafetyofmidodrineinthetreatmentofdialysis-associatedhypotension.ExpertOpinionDrugSafety,2(1),37-47Sherwood,L.(2007).HumanPhysiology(6thed.).Belmont:Thomson