Instructor: Dr. Declan McKernan
Course: PM309 Cardiovascular Drugs
Email: declan.mckernan@nuigalway.ie
Understand chronic hypertension, its determinants/risk factors, and long-term pharmacological management.
Comprehend the impact of ischemic heart disease, its determinants/risk factors, disease subtypes, and long-term pharmacological management.
Explain heart failure, its determinants/risk factors, and how it can be managed pharmacologically in the long term.
A prevalent disease and a major risk factor for cardiovascular events:
Stroke
Coronary artery disease (CAD)
Peripheral vascular disease
Heart failure (HF)
Chronic kidney disease (CKD)
Primary (Essential) Hypertension:
Affects 90-95% of hypertensive individuals
Multifactorial (genetic & environmental causes)
Secondary Hypertension:
Has a defined cause (e.g., hyperaldosteronism, oral contraceptives, renal disease)
BP Formula: BP = Cardiac Output (CO) x Systemic Vascular Resistance (SVR)
Components of CO: Heart Rate (HR) and Stroke Volume (SV)
Factors influencing BP:
Heart rate: Sympathetic activity
Stroke volume: Loading conditions (preload & afterload) and contractility
Systemic vascular resistance: Overall vascular tone
2017 ACC/AHA Guidelines: Recommendations for high blood pressure management
SPRINT trial (2015):
Association of hypertension with morbidity and mortality
Systolic BP targets: <120 mm Hg (normal), <140 mm Hg (stage 1), >140 mm Hg (stage 2)
Systematic Review Studies:
Major Cardiovascular Events: Risk reduction per 10 mm Hg reduction in systolic BP
Cardiovascular disease types:
Coronary Heart Disease: RR 0.83
Stroke: RR 0.73
Heart Failure: RR 0.72
All-cause mortality: RR 0.87
Higher CO: Results in higher output hypertension
Renal function:
Excessive Na+ and water retention leads to volume-based hypertension
Neuroendocrine function: Endocrine abnormalities can lead to excess catecholamines or thyroid hormones
Asymptomatic for years; identify at-risk patients
Recommended modifications:
Weight loss
Increased physical activity
Smoking cessation
Diet: low-fat, low-sodium
Alcohol reduction, manage oral contraceptives & steroids
Pharmacological agents target CO and/or SVR:
Diuretics, beta-blockers, calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs), ACE inhibitors
Anticipate counter-regulatory responses that may require dose adjustments
CCBs:
Target vascular resistance and heart rate
Direct arterial vasodilators:
Affect CO, HR, and intravascular volume
ACE inhibitors:
Affect vascular resistance through AT II reduction
Leading cause of mortality in Ireland (36% of deaths)
Two broad categories:
Chronic CAD
Acute Coronary Syndromes (ACS)
Due to ischemia; types include stable, unstable, and variant
Mechanism: Imbalance between O2 supply and demand
Treatment strategies:
Aspirin, beta-blockers, nitrates, ACE inhibitors
Management of ACS involves immediate reperfusion therapy
Systolic Heart Failure (HFrEF): Weakens heart muscle, decreased ejection fraction
Diastolic Heart Failure (HFpEF): Stiff heart muscle, issues with relaxation
Goals: Optimize CO, manage fluid overload
Pharmacological interventions include diuretics, ACE inhibitors, beta-blockers
Hypertension, IHD, and heart failure are interconnected conditions requiring comprehensive pharmacological management strategies.