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Hypertension – Origins
Questions 1 When did hypertension enter medical nosography as a disease? It all started in antiquity with the recognition of the pulse as a sign of life, death, and disease. The Mesopotamian epic of Gilgamesh (c. 2600 BCE) records the…
Baroreflex Dysfunction
Questions 1 What is the baroreflex? The baroreflex is a critical mechanism in the homeostatic regulation of blood pressure. Blood pressure is monitored continually by receptors located in the carotid arteries, aorta, lungs, coronary arteries, and the splanchnic vasculature of…
Orthostatic Hypotension
Questions 1 What physiologic responses prevent blood pressure from decreasing acutely when we stand? After assuming the upright position, gravitational forces shift ∼700 mL of blood volume to the lower part of the body, mostly in the splanchnic vascular circulation. This…
Role of Device Therapy
Questions 1 What do we mean by device therapies in hypertension? Device therapies refers to interventions that are used to reduce blood pressure (BP). These interventions can be surgical, or with interventional angiographic procedures targeting the mechanism of hypertension. The…
Drug-Drug and Pharmacogenetic Interactions
Questions 1 What are the possible mechanisms by which medications or supplements affect antihypertensive medication effectiveness? The mechanisms by which medications or supplements may impact antihypertensive effectiveness include modulating the metabolism of the antihypertensive medication and activating molecular mechanisms which…
Alpha-2 Agonists
Questions 1 How do alpha-2 agonists reduce blood pressure? Norepinephrine activates the alpha-2 adrenergic receptor in the brain, which serves as a negative feedback mechanism to suppress the sympathetic nervous system. Drugs with alpha-2 agonist activity mimic this effect centrally,…
Beta-Blockers
Questions 1 What is the clinical pharmacology of β-adrenergic receptor blockers? β-Adrenergic receptor blockers (beta-blockers) competitively inhibit the β-adrenergic receptors and by doing so act as antihypertensive drugs. Although the exact mechanisms through which these agents lower systemic blood pressure…
Alpha Antagonists
Questions 1 How do alpha adrenergic receptors contribute to blood pressure regulation? Alpha adrenergic receptors are G protein coupled receptors (GPCR) that are found in various locations in the human body. In the context of hypertension their most important peripheral…
Potassium-Sparing Diuretics
Questions 1 How do potassium-sparing diuretics work? Potassium-sparing diuretics block the reabsorption of sodium through the epithelial sodium channel (ENaC) in exchange for potassium in the connecting tubule (CNT) and collecting duct (CD). Traditional potassium-sparing diuretics (amiloride, triamterene) directly block…