Hypertension Diagnosis, Treatment And Life Style Changes
In the UK, it is recommended that all adults have their blood pressure measured every 5 years. Persons with high normal (130–139 mmHg systolic or 85–89 mmHg diastolic) or past high readings should have annual measurement.
Blood pressure should be measured using a well-maintained sphygmomanometer of validated accuracy. Blood pressure should be measured in both arms and the arm with the highest value used for following readings. circulatory strain ought to be estimated in both the sitting and the standing positions.
An appropriate sized cuff used since one that is too small will result in an overestimation of the patient’s blood pressure. The arm must be supported level with the heart and it is main that the patient prepares not hold their arm blood pressure.
Blood pressure is measured exhausting the Korotkov sounds which perform and disappear over the brachial artery as pressure in the cuff is released.
Cuff reduction should occur at approximately 2 mmHg/s to allow accurate measurement of the systolic and diastolic blood pressures.
The fourth Korotkov phase (muffling of sound) has before been used for diastolic blood pressure measurement but is not currently recommended except Korotkov V cannot be defined.
having set up that the pulse is expanded the estimation ought to be repeated several times ended more than a few weeks, unless the initial measurement is at riskily high stages, in which case several dimensions should be made through the same clinic attendance.
The patient may have regular values and still have hypertension.
Be that as it may, some may have irregular qualities predictable with either extra cardiovascular hazard components or hypertension-related harm.
»Blood urea nitrogen (BUN)
»Fasting lipid panel
»Fasting blood glucose
OTHER DIAGNOSTIC TESTS:-
Anti hypertensive Drugs:-
Image source: Hypertension drug classification.
Usual effective doses:
»Chlorothiazide (Diuril): 250 -500 mg daily or twice daily.
»Chlorthalidone (Various): 5 -25 mg daily.
»Hydrochlorothiazide (hydrodiuril): 5 – 50 mg daily.
»Indapamide (Various): 25 – 5.0 mg daily.
»Methyclothiazide (Various): 5 – 5.0 mg daily.
»Metolazone (Zaroxolyn): 5 -5.0 mg daily.
Mechanism of Actions:- Antihypertensive effects are produced by directly dilating the arterioles and diminishing the absolute liquid volume. Thiazide diuretics increase the following:
»Urinary excretion of sodium and water by inhibiting sodium and chloride reabsorption in the distal convoluted (renal) tubules
»Urinary excretion of potassium and, to a lesser extent, bicarbonate
»The effectiveness of other antihypertensive mediators by avoiding re development of extracellular and plasma volumes.
Usual effective doses:-
»Bumetanide (Various): 5 – 2.0 mg daily
»Ethacrynic acid (Edecrin): 25 -100 mg daily
»Furosemide (Lasix): 20 -80 mg daily
»Torsemide (Demadex): 5 -10 mg daily
Mechanism of Actions:
»Furosemide (Lasix), ethacrynic acid (Edecrin), bumetanide (Various), and torsemide (Demadex) act primarily in the ascending loop of henle consequently they are called circle diuretics.
»By acting within the loop of Henley, they decrease sodium reabsorption.
»Their action is more intense but of shorter duration (1 – 4 hrs.) than that of the thiazides; loss of patent exclusivity has resulted in an increase in the availability of generic products, which had reduced the costs associated with their usage.
»Potassium-retaining diuretics have also been included in the consensus document and include the mineralocorticoid antagonists spironolactone (Aldactone) and eplerenone (Inspra), as well as the sodium transport channel antagonists, amiloride (Various) and triamterene (Dyrenium).
Mechanism of Actions:- Potassium-sparing diuretics achieve their diuretic effects differently and less potently than the thiazides and loop diuretics. Their most pertinent shared feature is that they promote potassium retention.
Angiotensin-converting enzyme inhibitors (ACEIs) and ARBs:-
Usual effective doses:-
Benazepril (Lotensin): 10-40 mg in one to two doses
Fosinopril (Various): 10-40 mg in one dose
Moexipril (Univasc): 7.5-30 mg in one dose
Perindopril (Aceon): 4-8 mg in one to two doses
Quinapril (Accupril): 10-80 mg in one dose
Ramipril (Altace): 2.5-20 mg in one dose
Trandolapril (Mavik): 1-4 mg in one dose
Mechanism of Actions:-
»These agents inhibit the conversion of angiotensin I (a weak vasoconstrictor) to angiotensin II (a potent vasoconstrictor), which decreases the availability of angiotensin II.
»ACE inhibitors indirectly inhibit fluid volume increases when interfering with angiotensin II by inhibiting angiotensin II–stimulated release of aldosterone, which promotes sodium and water retention. The net effect appears to be a decrease in fluid volume, along with peripheral vasodilation.
Mechanism of Action:- Hydralazine directly relaxes arterioles, decreasing systemic vascular resistance. It is also used intravenously or intramuscularly in managing hypertensive crisis.
The usual daily dose:- 25 -100 mg.
Mechanism of Action:- A more potent vasodilator than hydralazine, minoxidil relaxes arteriolar smooth muscle directly, decreasing peripheral resistance. It also decreases renal vascular resistance while preserving renal blood flow.
Effective in most patients, minoxidil is commonly used to treat patients with severe hypertension that has been refractory to conventional drug regimens.
The usual daily dose:- 2.5 to 80 mg.
Mechanism of Action:- A direct-acting peripheral dilator, this agent has potent effects on both the arterial and venous systems. It is used only in short-term emergency treatment of acute hypertensive crisis, when a rapid effect is required.
Onset of action is almost instantaneous and is maximal in 1 to 2 minutes. Nitroprusside is administered intravenously with continuous blood pressure monitoring.
The usual dose:-0.3 to 10 mcg/kg/min as a continuous intravenous infusion.
Angiotensin II receptor antagonists:-
Mechanism of Actions:- This class of drugs works by obstructing the official of angiotensin ii to the angiotensin ii receptors.
By blocking the receptor site, these agents inhibit the vasoconstrictor effects of angiotensin II while also preventing the release of aldosterone from the adrenal glands.
These two properties of angiotensin II have been shown to be important causes for developing hypertension. Clinically, angiotensin receptor blockers appear to be equally effective for the treatment of hypertension as ACE inhibitors.
Dosage guidelines for the available agents are as follows:
Candesartan cilexetil (Atacand): 8 – 32 mg in one to two doses
Eprosartan (Teveten): 400-800 mg in one to two doses
Irbesartan (Avapro): 150 – 300 mg in one dose
Losartan (Cozaar): 25 – 100 mg in one to two doses
Olmesartan (Benicar): 20 – 40 mg in one dose
Telmisartan (Micardis): 20 – 80 mg in one dose
Valsartan (Diovan): 80 – 320 mg in one to two doses
Azilsartan (Edarbi): 80 mg daily in one dose
Mechanism of Action:- Unlike ACE inhibitors and ARBs, which act during the later stages of the reninangiotensin system to reduce angiotensin II aliskiren works directly on the enzyme renin, to reduce the eventual production of angiotensin II.
*The usual starting dose is 150 mg daily, increased to 300 mg daily.
*Doses greater than 300 mg have not been shown to offer additional blood pressure lowering effects.
Mechanism of Action:-Proposed mechanisms of action include the following:
»Exhilaration of renin flow is blocked.
»Cardiac contractility is decreased, thus diminishing cardiac output.
»Sympathetic output is decreased centrally.
»Reduction in heart rate decreases cardiac output.
»Blocker action may combine all of the above mechanisms.
Usual effective dose:-
Propranolol (Inderal):- The usual daily dose range is 40 to 160 mg.
Metoprolol (Lopressor):- The usual daily dose is 50 to 100 mg.
Nadolol (Corgard):-The usual daily dose is 40 to 120 mg.
Atenolol (Tenormin):- The usual daily dose is 25 to 100 mg.
Timolol (Various):- The usual daily dose is 20 to 40 mg.
Pindolol (Various):- The usual daily dose is 10 to 40 mg.
Labetalol (Trandate):- The usual daily dose is 200 to 800 mg.
Acebutolol (Sectral):- The usual daily dose is 200 to 800 mg.
Esmolol (Brevibloc):- The usual dose is 150 to 300 mcg/kg/min up to 300 mcg/kg/min intravenously.
Betaxolol (Kerlone):-The usual daily dose is 5 to 20 mg.
Penbutolol (Levatol):-The usual daily dose is 10 to 20 mg.
Bisoprolol (Zebeta):-the usual daily dose is 2.5 to 10 mg.
Carvedilol (Coreg):- Usual daily doses are 12.5-50 mg daily.
Nebivolol (Bystolic):- administered in a single daily dose of 5 mg.
Centrally active Alpha(α)–agonists:-
Mechanism of Action:-Methyldopa decreases total peripheral resistance through the said mechanism while having little effect on cardiac output or heart rate (except in older patients).
The usual daily dose:- 250 mg-1 g.
Mechanism of Actions:- Clonidine stimulates α 2-receptors centrally, reducing vasomotor tone and heart rate.
The usual daily dose:- 0.1 to 0.8 mg divided in two doses.
Mechanism of Action:-Guanabenz are centrally active α2-agonists that have actions similar to clonidine.
The usual daily doses:- 4 – 8 mg in two doses.
The Postganglionic adrenergic neuron blockers:-
Mechanism of Action:- Reserpine acts centrally, as well as peripherally, by depleting catecholamine stores in the brain and in the peripheral adrenergic system.
The usual daily dose:- 0.1 – 0.25 mg.
Peripheral α1-adrenergic blockers:- Prazosin (Minipress), terazosin (Hytrin), and doxazosin (Cardura)
Mechanism of Actions:-The α1-blockers block the peripheral postsynaptic α1-adrenergic receptor, causing vasodilation of both arteries and veins.
As well, the frequency of reflex tachycardia is lesser with these agents than with the vasodilator hydralazine. These hemodynamic changes reverse the abnormalities in hypertension and preserve organ perfusion.
Recent studies have also shown that these agents have no adverse effect on serum lipids and other cardiac risk factors.
The average daily doses are:-
Prazosin (Minipress): 2 – 20 mg
Terazosin (Hytrin): 1 – 20 mg
Doxazosin (Cardura): 1 – 16 mg
Mechanism of Actions:-
»Calcium-channel blockers inhibit the influx of calcium through slow channels in vascular smooth muscle and cause relaxation. Low-renin hypertensive, black, and elderly patients respond well to these agents.
»Although the calcium-channel blockers share a similar mechanism of action, each agent produces different degrees of systemic and coronary arterial vasodilation, sinoatrial (SA) and atrioventricular (AV) nodal depression, and a decrease in myocardial contractility.
Usual effective doses:-
Amlodipine (Norvasc): 2.5 – 10 mg in one dose
Isradipine (DynaCirc): 2.5 – 10 mg in one to two doses
Felodipine (Plendil): 2.5 – 20 mg in one dose
Nicardipine (Cardene SR): 60-120 mg as an extended-release product twice daily
Nisoldipine (Sular): 10 – 40 mg in one dose
Clevidipine (Cleviprex): Intravenous administration only; as 1 to 2 mg/hr, doubled at 90-second intervals up to target blood pressure goal.
Weight reduction:- Maintain normal body weight
DASH eating plan:- Consume a diet rich in, vegetables, fruits and low-fat dairy products with a reduced content of saturated and total fat.
Dietary sodium restriction:- Reduce daily dietary sodium
Physical fitness:- physical fitness at least 30 minutes/day.
Moderate alcohol consumption:- Limit consumption to less than or equal to 2 drinks/day (1 oz or 30 mL ethanol e.g 24 oz brew 10 oz wine 3 oz 80 proof bourbon in most men and not exactly or equivalent to 1 savor day ladies and lighter weight people .
Reduce stress:-Take some time to think about watch causes you to feel stressed such as work, family, finances or illness.
Stop smoking:-Stop smoking helps your blood pressure return to normal.
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