Systolic BP

Modification Recommendation Approximate Systolic BP Reduction, Range... 

Systolic BP less than 220 mm Hg or diastolic BP less than 120 mm Hg... 

Invasive hemodynamic monitoring should be considered in patients who are refractory to initial therapy, whose volume status is unclear, or who have clinically significant hypotension such as systolic BP <80 mm Hg. Such monitoring helps guide treatment and classify patients into four specific hemodynamic subsets based on cardiac index and pulmonary artery occlusion pressure (PAOP). Refer to textbook Chap. 16 (Heart Failure) for more information. 

Chronic hypotension (systolic BP <105 mmHg). Primary idiopathic hypotension generally has no clinical importance. If symptoms such as lassitude and dizziness occur, a program of physical exercise instead of drugs is advisable. 

Hypersensitivity reactions While taking -blockers, patients with a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge, either accidental, diagnostic, or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction. Renal/Hepatic function impairment Rarely, use of carvedilol in patients with CHF has resulted in deterioration of renal function. Patients at risk appear to be those with low blood pressure (systolic BP less than 100 mm Hg), ischemic heart disease. 

Acute Ml - In hemodynamically stable patients within 24 hours of the onset of symptoms of acute Ml, the first dose is 5 mg, followed by 5 mg after 24 hours, 10 mg after 48 hours and then 10 mg once daily. Continue dosing for 6 weeks. Patients with a low systolic BP (120 mm Hg or less) when treatment is started or during the first 3 days after the infarct should be given a lower 2.5 mg dose. If hypotension occurs (systolic BP 100 mm Hg or less), a daily maintenance dose of 5 mg may be given with temporary reductions to 2.5 mg if needed. If prolonged hypotension occurs (systolic BP less than 90 mm Hg for more than 1 hour), withdraw lisinopril. 

BP effects In clinical trials, duloxetine treatment was associated with mean increases in BP, averaging 2 mm Hg systolic and 0.5 mm Hg diastolic and an increase in the incidence of at least 1 measurement of systolic BP over 140 mm Hg compared with placebo. Measure BP prior to initiating treatment and periodically throughout treatment. 

Diastolic BP (DBP), which measures the pressure in the arteries when the heart is at rest, was largely unaffected by the intervention. Systolic BP (SBP), or the maximum pressure exerted when the heart contracts, did change in response to CCM supplementation in most children. The data specifically showed that over 12 weeks, children in the lowest quartile of baseline daily Ca intake (150- < 347 mg/1000 kcal) were affected most significantly by CCM supplementation in terms of a reduction in systolic BP (effect estimate -3.5 mm Hg), whereas children in the highest quartile of baseline daily Ca intake (514- < 882 mg/1000 kcal) demonstrated no appreciable reduction in systolic BP due to CCM supplementation. Children in quartiles two and three of the baseline Ca intake benefited from a CCM-induced reduction in SBP with the effect estimated to be -2.8 mm Hg and -1.3 mm Hg, respectively. The overall trend for the estimated effect of Ca intake on BP across quartiles was highly significant p = 0.009). 

Blood pressure—if the patient s systolic BP is less than 90 mm Hg, withhold the medication and notify fhe physician... 

Hypotension (systolic BP less than 90 mm Hg) manifested as dizziness, nausea, diaphoresis, headache, cold extremities, fatigue Occasional... 

Improve survival in patients after a myocardial infarction (MI) PO Initially, 5 mg, then 5 mg after 24 hr, I0mgafter48hr,then 10 mg/dayfor 6 wk.Forpatients wit blow systolic BP, give 2.5 mg/day for 3 days, then 2.5-5 mg/day. 

Contraindications Cardiogenic shock, MI with a heart rate less than 45 beats/minute or systolic BP less than 100 mm Hg, overt heart failure, second- or third-degree heart block, sinus bradycardia... 

The doxazosin arm of the ALLHAT study was stopped early the doxazosin group had a 25%greater risk of combined cardiovascular disease events which was primarily accounted for by a doubled risk of CHF vs the chlorthalidone group doxazosin was also found to be less effective at controlling systolic BP an average of 3 mm Hg may want to consider primary antihypertensives in addition to a-blockers for BPH symptoms... 

Hypotension (a reduction in either diastolic or systolic BP) maybe associated with bradycardia, orthostatic hypotension and, rarely, syncope. The risk of hypotension increases as dosage increases BP may decrease within 1 hr after administration. 

VALIANT (48) Acute Ml within 24 hours 10 days signs of HF LVEF < 0.40 systolic BP >100mmHg 14,703 Valsartan, 160 mg, daily vs. captoprii, 50 mg, 3 times/day vs. captoprii, 50 mg, 3 times/day plus valsartan, 160 mg, daily No differences in all causes of mortality between valsartan and captoprii no differences in all causes of mortality between combined therapy vs. captoprii. 

Systolic BP < 90 mmHg Heart rate < 40 beats min Ventricular arrhythmias requiring suppression Heart failure... 

Arterial BP is the measnred pressnre in the arterial wall in millimeters of mercury. Two arterial BP values are typically measured, systolic BP (SBP) and diastolic BP (DBP). SBP is achieved during cardiac contraction and represents the peak valne. DBP is achieved after contraction when the cardiac chambers are filling and represents the nadir value. The difference between SBP and DBP is called the pulse pressure and indicates arterial wall tension. Mean arterial pressnre (MAP) is the average pressure throughout the cardiac cycle of contraction. It is sometimes used clinically to represent overall arterial BP. During a cardiac cycle, two-thirds of the time is spent in diastole and one-third in systole. Therefore, the MAP can be estimated by using the following equation ... 

Norepinephrine (NE) has little effect on p2 receptors. It increases TPR and both diastolic and systolic BP. Positive inotropic action of NE causes a small to moderate increase in pulse pressure (PP). Compensatory vagal reflexes tend to overcome the direct positive chronotropic effects of NE (reflex bradycardia may ensue), but the positive inotropic effects are maintained. 

Epinephrine increases HR, systolic BP, and PR Its effects on diastolic blood pressure depend on dose. At moderate to high doses, alpha activation predominates, leading to increases in TPR, diastolic pressure, and mean BP. At low doses, beta activation predominates, resulting in a decrease in TPR and diastolic pressure, although mean BP may not decrease significantly. 

Answer C. A decrease in mean blood pressure, an increase in pulse pressure, plus a marked increase in heart rate are characteristic of a drug like isoproterenol. PVR and mean BP are decreased because of activation of p2 receptors in the vasculature. Systolic BP decreases less than diastolic BP because of activation of receptors in the heart, leading to an increase in stroke volume, as well as the increase in heart rate. 

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