TREATMENT OF HYPERTENSION

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Andrea Willis
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1 TREATMENT OF HYPERTENSION Aim of treatment BP Goals Main items of treatment Lifestyle modification When to start drug Rx Pharmacological therapy 1. Relief of symptoms 2. Prevention of complications and target organ damage 3. Improve quality of life 4. Improve mortality Benefits of Lowering BP: Average Percent Reduction Ø Stroke incidence 35-40% Ø Myocardial infarction 20 25% Ø Heart failure 50% All be treated to <140/90 mm Hg Except : diabetes (<85 mm Hg diastolic) In 80 years age, SBP: mmhg, can go <140 mmhg if the patient is fit and healthy- mentally & physically 1. Life style modifications 4. Treatment in special situations: 2. Diagnosis and treatment of the cause in secondary Ø Elderly HTN Ø Children 3. Drug therapy Ø Diabetics Ø Chronic kidney disease 1. Diet: Weight reduction Salt restriction the degree depends on the severity of HTN High K and Ca intake 2. Exercise and increase physical activity 3. STOP Smoking and alcohol intake 4. Relaxation therapy Consider BP level and correlate with overall risk: Cardiovascular risk factors Overt cardiovascular disease Asymptomatic organ damage Diabetes Chronic kidney disease. First line drugs Second line drugs 1. Diuretics especially thiazide 2. ACE Inhibitor & ARBs 3. Calcium channel blockers 4. B- Blockers 5. Alfa 2 blockers 1. Centrally acting drugs alfa- methyl dopa 2. Direct vasodilators hydralazine, minoxidil 3. Other anti- adrenergic drugs reserpine, guanithidine, alfa 1 blockers 4. Others Thiazide and thiazide like Chlorothalidone Hygertone 25-50mg Hydrochlorothazide Esidrex Indapamide Natrilex 1.5mg Diuretics Loops diuretics Furosmide Lasix mg Torsemide Examide 5 20 mg K retaining diuretics Spironolactone Aldactone mg Amiloride Midamor 5 mg B- Blockers Propranolol Inderal mg Atenolol Tenornin mg Bisoprolol Concor 5-10 mg Carvidelol Dilatrend mg Metaprolol Betaloc mg Sotalol Betacor mg

ACE Inhibitors Captopril Capoten 25-150mg Enalapril Ezapril 5-40 mg Lisinopril Zestril 10-40 mg Ramipril Tritace 2.

2 ACE Inhibitors Captopril Capoten mg Enalapril Ezapril 5-40 mg Lisinopril Zestril mg Ramipril Tritace mg Prindopril Coversyl 5-10mg Fosinopril Monopril mg Calcium channel blockers Angiotensin receptor blockers Alfa- blockers Centrally acting drugs Nifidepine Adalate or epilate mg Amlodopine Norvasc 5-20 mg Verapamil Isoptin mg Deltiezem Altiezem mg Losartan Cozaar mg Valsartan Tareg mg Candisartan Atacand 8-32mg Irbesartan Approval mg Prazocin Minipress 6-15 mg Doxazocin Cardura 1-4 mg Alfa methyl DOPA Aldomet mg Clonidine Catapress mg ESC guidelines 2013 Treatment and Risk

AS CA,ACEI MI BB,ACEI,ARB Microalbuminuria ACEI,ARB Angina BB,CA Renal dysfunction HF D,BB,ACEI,ARB,

3 ESH Guidelines 2013: Drug combinations Selection of anti- HTN drugs Subclinical organ damage Clinical events LVH ACEI,CA,ARB Stroke Any Asympt. AS CA,ACEI MI BB,ACEI,ARB Microalbuminuria ACEI,ARB Angina BB,CA Renal dysfunction HF D,BB,ACEI,ARB, Aldo A Conditions AF ARB,ACEI,BB,CA ISH D,CA ESRD ACEI,ARB,D MS ACEI,ARB,CA PAD CA DM ACEI,ARB LV dysfunction ACEI Pregnancy CA,MD,BB Black D,CA Treatment algorism

4 BP Control in Adult ACC 2013

5 Definition Causes Drugs in HTN emergencies Hypertensive emergencies It is a state of severe HTN that need rapid BP control with parenteral therapy. Cardiac Brain Renal Others 1. Hypertensive 1. Acute renal failure encephalopathy 2. Malignant HTN 2. Cerebral stroke thrombotic or hemorrhagic 1. Acute LVF and pulmonary edema 2. Acute aortic dissection 3. Acute coronary syndrome 1. Eclampsia of pregnancy 2. Postoperative 3. Crises of pheochromocytoma 4. Drug withdrawal clonidine, B- Blockers 5. Acute intermittent porphyria Drug Dose Onset Side effects Uses Furosemide 20-40mg/1-2h 2-3h Volume depletion With other drugs IV Nitroglycerine µg /min 2-5 min. Headache CAD Na nitroprusside µg/kg Immediate Thiocynate toxicity All case Labetalol 20-80mg /10min 5-10 Nausea, vomiting HB All except acute HF Diazoxide 5mg/ kg over 15 min 5-10 Salt retention Not in CAD, Ao dissection Esmolol µg/kg bolus µg/kg/min 5-10 Hypotension Aortic dissection post- operative HTN Hydralazine mg IM/IV min Headache, flushing Eclampsia

Introductory Clinical Pharmacology Chapter 41 Antihypertensive Drugs

Introductory Clinical Pharmacology Chapter 41 Antihypertensive Drugs Blood Pressure Normal = sys