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Hypertension – Drug Treatment

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Hypertension is having high blood pressure so the pressure in the blood vessels becomes raised the purpose of treating hypertension is to reduce the risk of heart failure stroke coronary events and renal impairment there is different stages of hypertension which can be classified into stage 1 2 and severe hypertension in stage 1 the blood pressure is greater than

Or equal to 140 over 90 millimeters of mercury in stage 2 the blood pressure is greater than or equal to 160 over 110 millimeters of mercury and in severe hypertension the systolic is greater than 180 or the diastolic is greater than 110 so in stage 1 hypertension you treat the patient who is less than 80 years old only if the kidney or heart are affected or if

They’re diabetic or if the patient has a 10 year cardiovascular risk which is greater than 20 percent stage 2 all the patients are treated and severe hypertension is a medical emergency before treating hypertension with medication changes in lifestyle can be done to help reduce strain on the heart and reduce the blood pressure these lifestyle changes include stop

Smoking reducing weight reducing alcohol and caffeine intake and reducing salt and saturated fat intake the drug treatment for hypertension depends on the age of the patient so if the patient is below the age of 55 first line medication include either an ace inhibitor or an angiotensin receptor blocker if either of these drugs are contraindicated or not tolerated

By the patient a beta blocker can be given instead second line involves the addition of a calcium channel blocker however if a calcium channel blocker is not tolerated or the patient cannot have it due to real risk of heart failure for example a thiazide related diuretic can be used instead for example chlorthalidone or indapamide if the blood pressure remains

High despite this third line means adding a thiazide related diuretic to the ace inhibitor or angiotensin receptor blocker and calcium channel blocker fourth line involves the addition of a low dose spironolactone or increasing the dose of the thiazide diuretic that was added in step 3. if the patient is older than 55 or if afro-caribbean descent the treatment

Differs slightly first-line medication is a calcium channel blocker and if this is not tolerated or there is a risk of heart failure a directive can be given instead second line involves the addition of an ace inhibitor or angiotensin receptor antagonist step 3 and 4 are the same as they would be when treating an under 55 year old patient if at any stage a

Thiazer diuretic is contraindicated an alpha or beta blocker can be given instead despite this treatment if there is a great risk of cardiovascular disease a statin or aspirin can be added in order to reduce the risk of an event this drug treatment for hypertension is a stepwise approach and each step is normally tried for four weeks before moving to the next

Step blood pressure targets differ depending on the age or medical condition the patient has if the patient is below the age of 80 the blood pressure target is below 140 over 90 millimeters of mercury if over the age of 80 the blood pressure target is below 150 over 90 millimeters of mercury if the patient has kidney disease the aim is to keep the blood pressure

Below 140 over 90 millimeters of mercury however if the patient has chronic kidney disease the blood pressure should be below 130 over 80 millimeters of mercury a diabetic blood pressure target is below 140 over 80 millimeters of mercury and if the diabetes is causing complications of the eyes or kidney the target is below 130 over 80 millimeters of mercury if

The patient is pregnant and has chronic hypertension the blood pressure target is below 150 over 100 millimeters of mercury the treatment for hypertension differs slightly for different conditions if the patient is pregnant for example methyl dopa is normally the first choice lebetzello is the second choice and if these agents have failed nephedipine can also be

Used acinibitus and angiotensin receptor blockers should be avoided as they decrease fetus blood pressure and inhibit their growth in patients with renal disease hypertension is normally treated with an ace inhibitor this is because it slows down the process of renal impairment by inhibiting the renin-angiotensin aldosterone system or a high-dose loop diuretic

Can also be used in renal disease but a thiazide diuretic will not work severe hypertension is normally managed by reducing the blood pressure gradually over 24 to 48 hours with either libetylo or a calcium channel blocker like amlodipine or philodepine there is other antihypertensive drugs that can be classified into three groups firstly vasodilators which have a

Potent hypotensive effect meaning they reduce blood pressure very powerfully especially when used with a beta blocker or a thiazide diuretic vasodilators will increase cardiac outpost and cause tachycardia so it is important to give them with a beta blocker vasodilators can also cause retention of fluid causing the fluid to build up and because of this should

Be given with a diuretic examples include hydralazine which is used for resistant hypertension but very rarely minoxidil for severe hypertension and sildenafil for pulmonary hypertension pulmonary hypertension is increased blood pressure in the arteries of the lungs the second group is called centrally acting hypertensive drugs these drugs work on the central

Nervous system and cause it to reduce the sympathetic tone so they work by preventing the speeding up of the heart rate examples include a methyl dopa which is used in pregnancy as mentioned before clonidine which can cause side effects like flushing another problem with clonidine is that if it stops suddenly it can cause rebound hypertension and so increase

Blood pressure even more and the last drug in this class is moxinidine the third group is alpha receptor blocking drugs which work by blocking the alpha receptors causing the blood vessels to dilate an issue with alpha blockers is that they can reduce blood pressure very rapidly after the first dose and should be taken at bedtime to avoid standing examples

Include doxazosin prazosine and terrazosine

Transcribed from video
Hypertension – Drug Treatment By ThePrescribingGuide