Question

A 5’ 8”, 240 lb., 52-year-old project manager went in for a physical exam. His blood pressure was <180/115 on three separate days. Further examination showed normal to low plasma renin activity, elevated total peripheral resistance (TPR), cardiac output (CO) of 7.2 L/min., X-ray evidence of left ventricular hypertrophy, retinal hemorrhages, and mild polyuria. Recommended therapy included weight reduction to his ideal level, a low-salt diet (<2gm/day sodium), prudent exercise, and a reduction in alcohol consumption (<3 oz whiskey/day). This change in lifestyle did little to change the condition. Medication was initiated in the form of an oral diuretic and progressed to a beta-blocker. Eventually a vasodilator was included to reduce the blood pressure to <140/90

1. Outline the usual steps on the medical treatment of hypertension.

Answer 1

Answer : Hypertension is defined as blood pressure above 140/90 ,and is considered severe if the pressure is above 180/120mmhg. Here I explain the usual steps on the medical treatment of hypertension. After checking the blood pressure, doctors start antihypertensives drugs according to the severity . 1) Thiazide diuretics : These medications act on kidneys to help the body to eliminate sodium and water and reduces blood volume. Thiazide diuretics are often the first ,but not the only choice in high blood pressure treatment .He : chlorthalidone, hydrochlorothiazide . 2) Angiotension -converting enzyme inhibitors (ACE inhibitors ) :It helps to relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels . Eg : captopril ,benazepril ,lisinopril . 3) Angiotension 2 receptor blockers : These medications help relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels .Eg : losartan ,candesarten and others. 4) calcium channel blockers : These medications including amlodipine, diltiazem and others help to relax the muscles of blood vessels. Some slow your heart rate. Additional medications sometime used to treat high blood pressure are :- 1) Alpha blockers : This medications reduce nerve impulses to blood vessels and reducing the effects of natural chemicals that narrow blood vessels . 2) Alpha - Beta blockers : This medications slow the heart beat to reduce the amount of blood that must be pumped through the vessels in addition with reducing nerve impulses to blood vessels .Eg - carvedilol ,labetalol . 3) Beta blockers : This medication reduce the work load on your heart and open your blood vessels ,causing heart to beat slower and with less force . 4) Aldosterone antagonists : These drugs blocks the effect of natural chemical that can lead to salt and fluid retention ,which can contribute to high blood pressure. Eg : aldactone ,eplerenone and others . 5) Vasodilators : These medications work on the muscles in the walls of your arteries and preventing the muscles from tightening and arteries from narrowing . 6) central acting agents : These medications prevent brain from signaling your nervous system to increase your hear rate and narrow blood vessels . 7) Renin inhibitors : This medications slow down the production of renin, an enzyme produced by your kidneys that starts a chain of chemica steps that increases blood pressure . In addition to above medications, doctors advise 1) proper blood pressure monitoring 2)lifestyle changes for preventing obesity and control alcohol and smoking 3)Proper diet with less salt 4) exercise. 5) avoid stress.