4 Drugs for Hypertension 2024 PDF

2024 OVERVIEW OF HYPERTENSION and its treatment (includes the most recent changes) I. BLOOD PRESSURE CATEGORIES We no longer use age as the main determining factor for starting treatment for high blood pressure. Note that what used to be a normal blood pressure is now considered to be a high blood p...

2024 OVERVIEW OF HYPERTENSION and its treatment (includes the most recent changes) I. BLOOD PRESSURE CATEGORIES We no longer use age as the main determining factor for starting treatment for high blood pressure. Note that what used to be a normal blood pressure is now considered to be a high blood pressure. Initial treatment is still usually a thiazide diuretic or calcium channel blocker, ACE inhibitor or ARB. If the target BP is not reached within about a month of initial therapy, sometimes the dose of the initial drug will be increased and sometimes a second drug will be added. II. TYPES OF HYPERTENSION Primary or essential hypertension (90 – 95%)—no identifiable cause, but factors such as obesity, high alcohol intake, insulin resistance, high salt intake, aging, sedentary lifestyle and stress are involved. May have no symptoms, but if not treated BP risesfor the rest of your life. Secondary (10%)—when cause is known such as renal or central nervous system disorders III. CONSEQUENCES OF HYPERTENSION End result is an increase in morbidity and mortality, heart disease (MI, HF, and angina), kidney disease, and stroke. Sometimes the elevated BP is not detected until then. IV. MANAGEMENT OF CHRONIC HYPERTENSION Basic Considerations: Diagnosis is based on several BP readings, feet flat (it’s true that BP is high at doctor’s office!) Benefits of Lowering Blood Pressure—unequivocal—morbidity is decreased and life is prolonged. Therapeutic Interventions—most patients need combination of lifestyle changes and medications LIFESTYLE MODIFICATIONS (NOT drugs)is still a high priority. Sodium Restriction—important but may be short acting DASH eating plan—Dietary Approaches to Stop Hypertension Alcohol Restriction—one drink per day may be beneficial Aerobic Exercise—regular exercise reduces risk Smoking cessation—BP rises when smoking Weight Loss—helps reduce BP, and helps enhance response toBP meds USE THE ABOVE IN A TEACHING PLAN! V. REVIEW OF BLOOD PRESSURE CONTROL (CO = HR X SV) Sympathetic baroreceptors reflex—in aorta detect changes in pressure or stretch, so when BP is low, heart is stimulated Renin-Angiotensin-Aldosterone System Renal Regulation also play a role, especially for long term regulation of BP VI. CLASSES OF ANTI-HYPERTENSIVE DRUGS 1. Diuretics 2. Drugs that suppress the RAAS System—ACE Inhibitors, ARBs, Direct Renin Inhibitors, and Aldosterone Receptor Blockers. 3. Sympatholytics (Antiadrenergic Drugs) 4. Calcium Channel Blockers 5. Direct-acting vasodilators VII. HYPERTENSION DRUG THERAPY CONCEPTS Still do lifestyle changes first First-line drug choice is usually a thiazide diuretic, alone or with an ACE inhibitor. Then change dose or add other drugs if not effective, to individualize therapy. Initial drug selection is often based on comorbid conditions or special populations: o If renal disease—ACE inhibitors & ARBs are best o If diabetes—ACE inhibitors, ARBs and diuretic o African American population use calcium channel blocker or thiazide and are more likely to have severe hypertension o Beta adrenergic blockers in smaller doses work better in Asian heritage How to promote adherence to taking the prescribed medications when there are often no symptoms for high blood pressure, but there are side effects of the medications! VIII. HYPERTENSIVE EMERGENCIES—sodium nitroprusside