Anti-Hypertensive

Background


Hypertension is defined as a systolic blood pressure equal to or greater than 140 mmHg or a diastolic blood pressure greater than 90 mmHg. Systolic pressure indicates the force of the blood in the arteries as the heart beats. Diastolic pressure is the force of blood in the arteries as the heart relaxes. There are three stages of hypertension: prehypertension, stage 1 hypertension and stage 2 hypertension. Prehypertension includes individuals with a systolic blood pressure of 120 to 139 mmHg or a diastolic blood pressure of 80 to 89 mmHg. Stage 1 hypertension includes individuals with systolic blood pressure of 140 to 159 mmHg or diastolic blood pressure of 90 to 99 mmHg. Stage 2 hypertension includes individuals with systolic blood pressure of 160 mmHg or higher or diastolic blood pressure of 100 mmHg or greater.

Classes of antihypertensive medicationsMechanismExample
diureticsAct on kidneys to help the body eliminate sodium and water, then reducing blood volume. isosorbide, chlorthalidone, indapamide, torsemideazide
angiotensin-converting enzymes (ACE) inhibitorsHelp relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.lisinopril, benazepril, captopril
angiotensin receptor blockers (ARBs)Help relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels.candesartan, losartan
beta-blockersReduce the workload on heart and open blood vessels, causing heart to beat slower and with less force.acebutolol, atenolol
renin inhibitorsWork by relaxing the muscle in artery walls and by therefore reducing the force of contraction of heart muscle.aliskiren
calcium channel blockersHelp relax the muscles of blood vessels. Some slow heart rate.amlodipine, diltiazem

Hypertension is often characterized by an absence of signs and symptoms. Therefore, it is recommended that all individuals have blood pressure measurements taken at least every 2 years. For individuals at greater risk for developing hypertension, such as elderly adults, those with a familial history of hypertension or heart disease, overweight or obese individuals, and those of African-American or Hispanic heritage, blood pressure measurements should be taken at least annually. Blood pressure measurements taken at a health care visit should be obtained with proper equipment, and two or more measurements should be taken at each visit to ensure the validity and persistence of the blood pressure level.

Hypertension is a major risk factor associated with cardiovascular disease and predisposition to heart attack, heart failure, stroke, and kidney disease. High blood pressure has been consistently correlated with cardiovascular disease. The risk for cardiovascular disease doubles with each increasing increment of 20 mmHg in systolic blood pressure or 10mm Hg in diastolic blood pressure. At the same time, hypertension is a risk factor for the first, third, and ninth most common causes of death, which are heart disease, stroke, and kidney disease, respectively. Hypertension is a factor in 67% of heart attacks, 74% of heart failures, and 77% of strokes. For those over the age of 50 it is important to note that systolic blood pressure greater than 140 mmHg indicates a more significant cardiovascular risk than high diastolic blood pressure. Nevertheless, the risks for these disorders can be decreased with appropriate treatment and management of hypertension. In addition to being a risk factor for other disorders, hypertension can also affect cognitive functioning. Hypertensive individuals show poorer performance on neuropsychological tests. Hypertension has also been shown to interact with the aging process. Hypertensive older adults tend to show poorer cognitive performance than their normotensive peers.

Hypertension can often be successfully controlled through lifestyle modification and drug therapy. The lifestyle modifications include weight reduction or maintenance of normal weight, reduced sodium intake, increased physical activity, reduction in alcohol consumption, and smoking cessation. Weight reduction and normal body weight maintenance is defined as attaining and maintaining a body mass index within the normal range (18.5 to 24.9). A reduction in dietary sodium intake is the second recommendation. Both weight management and sodium reduction can be addressed by following the Dietary Approaches to Stop Hypertension (DASH) eating plan with reduced sodium intake. Physical activity is the third modification and includes at least 30 minutes of aerobic activity three times per week. The fourth recommendation, reduction of alcohol consumption, is of great importance. In many instances alcohol not only affects organ functioning, but it may also interact with many hypertensive medications. As with all cardiovascular disorders and most other health-related issues, smoking cessation is also recommended. Although smoking does not pose a risk factor for hypertension, smoking does exacerbate the negative effects of hypertension. All of these lifestyle modifications work to eliminate the risk factors for development of hypertension by decreasing blood pressure and decreasing an individual’s chances of developing other more serious related disorders.

Many hypertensive individuals are prescribed at least one antihypertension medication, and many are prescribed a two-drug combination. Nevertheless, many hypertensive and prehypertensive individuals have not made the recommended lifestyle changes nor do they adhere to the prescribed medication regime. Therefore, emphasis now focuses on a comprehensive treatment plan that includes lifestyle modification as well as medication adherence. Pharmacological treatment and life style treatments are described in more detail in the following sections. Pharmacological treatment of hypertension has shown excellent results in lowering blood pressure. There are several classes of antihypertensive medications including thiazide-type diuretics, angiotensin-converting enzymes (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, renin inhibitors, and calcium channel blockers. Of these medications, many individuals begin with one, usually a thiazide, and are often prescribed an additional medication to fully control their condition. It has been found that pharmacological intervention reduces cardiovascular risks but does not eliminate them. Although pharmacological treatment is highly successful, often medication is under prescribed, and when prescribed adherence to the medication regimen is problematic due to lack of symptomatology, cost, demands of multiple medications, and adverse side effects.

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