Life
Style Changes for the treatment :
Salt
(NaCl) intake of approximately 5 to 6 g per day(This translates into
approximately 2000 to 2300 mg of sodium per day) in contrast with a typical
intake of 9 to 12 g per day. A reduction to 5 g per day can decrease systolic
blood pressure about 1 to 2 mm Hg in normotensive individuals and 4 to 5 mm Hg
in hypertensive patients
The
guidelines recommend getting BMIs down to 25 kg/m2 and reducing waist circumferences to
<102 cm in men and <88 cm in women. Losing about 5 kg can reduce systolic
blood pressure by as much as 4 mm Hg.Weight loss can also improve the efficacy
of antihypertensive medications and the CV risk profile.
A
large French retrospective analysis provides good news for caffeine lovers:
investigators showed that drinking tea or coffee was associated with a small
but statistically significant reduction in systolic and diastolic blood
pressure. In addition, drinking tea and coffee was also associated with a
significant reduction in pulse pressure and heart rate, although the heart-rate
reductions were greater with tea.
Aerobic
endurance training in hypertensive patients can reduce systolic blood pressure
7 mm Hg& diastolic blood pressure 5mm Hg.
Moderation
of alcohol consumption to no more than 20–30 g of ethanol per day in men and to
no more than 10–20 g of ethanol per day in women is recommended.
Regular
exercise (walking, jogging, cycling or swimming), i.e. at least 30 min
ofmoderate dynamic exercise on 5 to 7 days per week is recommended.
Increased
consumption of vegetables, fruits, and low-fat dairy products is recommended.Patients
with hypertension should be advised to eat fish at least twice a week and 300 –
400 g/day of fruit and vegetables.
Regular
exercise (walking, jogging, cycling or swimming), i.e. at least 30 min of
moderate dynamic exercise on 5 to 7 days per week is recommended
It
is recommended to give all smokers advice to quit smoking and to offer
assistance. Pharmacological
therapy:
The
current Guidelines reconfirm that diuretics (including thiazides,
chlorthalidone and indapamide), beta-blockers, calcium antagonists,
angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor
blockers are all suitable for the initiation and maintenance of
antihypertensive treatment, either as monotherapy or in some combinations.
However,
some therapeutic issues that have recently been raised are discussed below:
Beta Blockers:
·
Equally
as effective as the other major classes of antihypertensive agents in
preventing coronary outcomes.
·
Highly
effective in preventing CV events in patients with a recent myocardial
infarction and those with heart failure.
·
A
slightly lower effectiveness of beta-blockers in preventing stroke has been
attributed to a lesser ability to reduce central SBP and pulse
pressure.However, a lower effectiveness in stroke prevention is also shared by
ACE inhibitors (but they reduce the central BP better than beta blockers).
·
To
have more side-effects and to be
somewhat less effective than RAS blockers and calcium antagonists in regressing
or delaying OD, such as LVH, carotid IMT, aortic stiffness and small artery
remodeling.
·
Some
of the vasodilating beta-blockers, such as celiprolol, carvedilol and
nebivolol—more widely used today which reduce central pulse pressure and aortic
stiffness better than atenolol or metoprolol and affect insulin sensitivity
less than metoprolol.
·
Nebivolol
has recently been shown not to worsen glucose tolerance compared with placebo
and when added to hydrochlorothiazide.
·
Finally,
beta-blockers have recently been reported not to increase, but even reduce, the
risk of exacerbations and to reduce mortality in patients with chronic
obstructive lung disease.
·
Compelling CI: Asthma, A-V block (grade 2 or 3 )
·
Possible CI: Metabolic
syndrome ,Glucose intolerance ,Athletes and physically active patients, Chronic
obstructive pulmonary disease (except for vasodilator beta-blockers).
Diuretics:
·
Spironolactone
has been found to have beneficial effects in heart failure,and, although never
tested in RCTs on hypertension, can be used as a third or fourth line drug and
helps in effectively treating undetected cases of primary aldosteronism
·
Eplerenone
has also shown a protective effect in heart failure and can be used as an
alternative to spironolactone.
·
Thiazide diuretics :
o Compelling
CI : gout
o Possible
CI : Metabolic
syndrome, Glucose intolerance, Pregnancy,
Hypercalcaemiaand Hypokalemia.
Calcium Antagonists:
·
Calcium
antagonists have shown a greater effectiveness than beta-blockers in slowing
down progression of carotid atherosclerosis and in reducing LV hypertrophy in
several controlled studies.
·
In
the largest available meta-analysis, calcium antagonists reduced new-onset
heart failure by about 20% compared with placebo but, when compared with
diuretics, beta-blockers and ACE inhibitors were inferior by about 20% (which
means a 19% rather than 24% reduction).
·
Dihydropyridines:
o Possible
CI: Tachyarrhythmia, Heart failure.
·
Non Dihydropyridines (
verapamil, diltiazem ) :
o Compelling
CI: A–V block
(grade 2 or 3, trifascicular block , Severe LV dysfunction, Heart failure.
Angiotensin-converting enzyme inhibitors and angiotensin receptor
blockers:
·
The
well-known ancillary properties of ACE inhibitors and ARBs, are their peculiar
effectiveness in reducing proteinuria
and improving outcomes in chronic heart failure
·
As
for the cancer signal that has recently been attached to ARBs, the committee unequivocally stated that such a
risk has been disproven. The US Food and Drug Administration and a review by the European Medicines Agency have both concluded that no such a cancer risk
exists with ARBs.
·
Compelling CI:Pregnancy, Hyperkalemia,Bilateral renal artery
stenosis &Angioneurotic oedema (ACE inhibitor only).
·
Possible CI :Women with child bearing potential
Renin Inhibitors :
·
Aliskiren,
a direct inhibitor of renin at the site of its activation, is available for
treating hypertensive patients, both as monotherapy and when combined with
other antihypertensive agents.
·
No
beneficial effect on mortality and hospitalization has recently been shown by
adding aliskiren to standard treatment in heart failure.
Other Antihypertensive Agents:
·
Centrally
active agents and alpha-receptor blockers are also effective antihypertensive
agents. Nowadays, they are most often used in multiple drug combinations.
Source:
Dr.Qurat-ul-Ain Hafeez, Pharm-D, RPh.
Ambulatory Care Pharmacist, Aga khan University Hospital, Karachi , Pakistan
Facebook: Qurat Hafeez
Written by Unknown
OpenDoor aims to provide Health Awareness. l OpenDoor is a platform used to Learn and Coach.
0 comments:
Post a Comment