December 30, 2014
High Blood Pressure (hypertension)
HIGH BLOOD PRESSURE is also known as Hypertension, and it is caused by increased resistance to blood flow in your arteries, and a large propulsive flow originating in your heart. Untreated hypertension causes strain on the heart and arteries, this can lead to heart failure, heart attacks, kidney failure, stroke, blindness, and impotence. Since treatments for blood pressure are usually easy to use and take, it is very important to treat your high blood pressure. If you are healthy, your pressure should not be more than 140 mmHg systolic (upper value) and/or above 90 mmHg diastolic (lower value). If you have certain diseases (kidney, Diabetes, and others) these numbers may be lower.
Primary hypertension (high blood pressure) does not have a known underlying cause, but many physicians believe that this process may be related to arterial hardening which occurs with age. There is hope that by decreasing certain phenomena, this process can be delayed or stopped. Secondary high blood pressure is caused by an underlying disease ( such as diseases of the thyroid, and/or genital glands). The treatment of secondary causes of high blood pressure is directed towards the underlying disease which causes that type of hypertension. This article concerns the treatment of primary hypertension.
LIFESTYLE CHANGES — Also referred to as conservative management, is very important in the treatment of high blood pressure. Frequently lowering sodium (NaCl or salt) as well as moderating alcohol intake, can decrease high blood pressure. Weight reduction in those not at their ideal body weight, and regular aerobic exercise can decrease high blood pressure. Stopping smoking is essential to the control of high blood pressure. Many physicians suggest that sodium intake should be less than 2.3 grams (2300 milligrams [mg]) per day, which equals 6 grams or less of table salt. Other conservative measures can include decreasing stress and anxiety, limiting caffeine, and engaging in certain techniques such as meditation and tai chi.
MEDICATIONS — There are various classes of medications which are used to treat high blood pressure. All medications, including “natural” medications have side effects, and not all medications work for all people. Many medications have secondary benefits or secondary side effects which make them desirable or undesirable for certain groups of people. Dr Kline can help guide you through the appropriate classes and members of political pressure medicines which might be appropriate for you.
Diuretics in high blood pressure
Diuretics — Diuretics lower blood pressure mainly by causing the kidneys to excrete more sodium and water, and also by lightning (vaso-dilating ) blood vessels. This reduces resistance to blood flow which in turn reduces blood pressure.
The diuretics used to treat high blood pressure are thiazides (chlorthalidone, hydrochlorothiazide, and indapamide). In some cases, a potassium supplement or a potassium-sparing diuretic (amiloride, spironolactone, or triamterene) are given in combination with a thiazide diuretic because the thiazides can cause potassium deficiency since increased amounts of potassium are excreted in the urine.
Side effects — can certainly concur with thiazide diuretics. Weakness, fatigue, muscle cramps, worsening of gout, and even impotence, can result from this treatment as well is worsening of cholesterol. These side effects are thought to be reversible upon discontinuation of this medication.
Another class of diuretics include the “loop” diuretics such as furosemide or Lasix. These medications have any other potential treatments and side effects than the Thiazide diuretics, however in more severe cases of cardiac disease they are frequently utilized. They frequently cause electrolytes ( mineral) abnormalities and must be used with caution. They can also affect the function, and excretion of the medications.
diuretics should not be used in pregnancy or breast feeding in most cases.
ACE inhibitors in high blood pressure
ACE inhibitors — Angiotensin-converting enzyme (ACE) inhibitors block production of the hormone, angiotensin II; this molecule produces blood vessel constriction, which in turn leads to increased blood pressure. By reducing production of angiotensin II, ACE inhibitors cause blood vessel dilation, reducing resistance to blood flow. In turn this results in the lowering of blood pressure and improvement of cardiac output.
The available ACE inhibitors include benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril.
Side effects — In 10 to 15% of patients, ACE inhibitors may cause a persistent almost seizure like dry hacking cough. This cough disappears upon the discontinuation of this class of medication. Less common side effects include dry mouth, nausea, rash, muscle pain, or occasionally, kidney dysfunction and elevated blood potassium. This class of medication can not be used during pregnancy as it has a high rate of causing fetal abnormalities. For this reason women who could become pregnant should never use this medication. Ace inhibitors can also cause angioedema (very early) however this is a potentially life-threatening problem, which within minutes can result in swelling of the lips, mouth, and throat, and this can result in asphyxiation. Although this is rare, it is a medical emergency, and it should be treated as such.
Angiotensin II receptor blockers — The angiotensin II receptor blockers (ARBs) block the effects of angiotensin II at the level of the cell membrane, these membranes are on the heart and blood vessels. Arbs’s have the same effect as ace inhibitors in terms of their physiological ability to prove blood pressure and cardiac output.
The available ARBs include azilsartan, candesartan, irbesartan, losartan, olmesartan, telmisartan, and valsartan.
Side effects — Arbs are not as strong as ace inhibitors, and frequently they are more expensive. Their Main advantage is that they do not produce the cost which some people experience from ace inhibitors. ARBs can produce headache, nausea, dry mouth (xerostoma) , and abdominal pain in addition to the side effects of ace inhibitors. Angioedema is less common than with ACE inhibitors.
Calcium channel blockers in high blood pressure
Calcium channel blockers — Muscle cells require calcium to contract, and this class of medication decreases the amount of calcium flowing into the muscles of the arteries. This decrease flow of calcium into arterial muscle cells decreases vaso constriction of the arteries, which thereby increases blood flow and decreases resistance of the arteries. This reduces blood pressure. Some calcium channel blockers also decreased cardiac rate, and cardiac contractility. Although this may sound undesirable, in many circumstances this is a very important message for these medications to both decrease blood pressure and help preserve impaired cardiac function.
There are two major categories of calcium channel blockers:
●Dihydropyridines, which includes the medications: amlodipine, felodipine, isradipine, nicardipine, nifedipine, and nisoldipine
●Nondihydropyridines, which includes the two medications diltiazem and verapamil. It is these medications which most decrease cardiac rate, and cardiac contractility.
Side effects — The side effects of calcium channel blockers vary lightly with the specific medication which is used. Patients who take dihydropyridines may develop headache, flushing, nausea, overgrowth of the gum tissue (gingival hyperplasia), or swelling of the extremities (peripheral edema).
Nondihydropyridines can occasionally cause the heart rate to slow too much, headaches and nausea and constipation. Although these side effects do not occur with each medication, they can occur with this class of medications.
calcium channel blockers should not be used in pregnancy or breast feeding.
Beta blockers — These medications work at cell membranes and prevent a limb of the autonomic nervous system from stimulating the heart to beat rapidly and contract vigorously, they also have direct effects on the arterial system of blood vessels. By blocking the “accelerator” of the peripheral nervous system, beta blockers help to lower blood pressure by decreasing resistance and by decreasing cardiac output. These medications, like the calcium channel blockers and the ace inhibitors, can help certain cardiac diseases, and harm other diseases.
The available beta blockers include acebutolol, atenolol, betaxolol, bisoprolol, metoprolol, nadolol, nebivolol, pindolol, propranolol, and timolol.
Some beta blockers have combined activity, blocking both the beta and alpha receptors (see next section). These include labetalol and carvedilol.
Side effects — Beta blockers may worsen symptoms of asthma, and emphysema. They can harm blood vessels that are outside of the heart if they are diseased, and worsened per-existing peripheral vascular disease. These medications are frequently not prescribed to patients with claudication for this reason. Beta blockers may mask symptoms of low blood sugar (hypoglycemia) in people with diabetes. especially those who are treated with insulin (but also people who are treated with other medications which can increase the effects war increase production of insulin) . Beta blockers can cause fatigue, insomnia, nightmares, and cause or exacerbate depression. They can cause a limitation of the ability to exercise by decreasing cardiac output and slowing heart rate. This can be a mixed blessing, helping some patients but actually worsening the lifestyle for others. These medications can worsen the cold hands and feet in people who suffer from this problem. In most cases these medicines should not be used in pregnancy or breast feeding
Alpha blockers — Alpha blockers decrease the nervous systems ability to cause the muscles in the arteries to cause artery constriction. This also results in vasodilatation, decreasing resistance the blood flow, and therefore decreasing the pressure in the arteries. The available alpha blockers include doxazosin, prazosin, and terazosin.
Side effects — Alpha blockers can cause a lowering of blood pressure upon standing, this can cause falls. This is most common upon initiation of these medications are increasing dose. For this reason these medicines are frequently taken at bedtime, and care must be used when exiting the bed especially when the dose of this medication is increased when the medication is initiated. This medication can also cause dizziness Alpha blockers may increase the risk of hard failure. Since these medications can help with benign prostatic hypertrophy symptoms, they are frequently used in men with this problem. These medications should not be used in pregnancy or breast feeding.
Direct vasodilators — These medications directly reduce muscle tension in the arteries and cause vasodilatation. There our two commercially available medications in this class available in the United States, they are hydralazine and minoxidil. Minoxidil is typically used in only severe or resistant high blood pressure, although it is frequently used topically on the scalp to produce hair growth.
Side effects — Side effects associated with direct vasodilators include headache, constipation, swelling in the lower legs, and rapid heartbeat. These effects are usually minimized by combining the vasodilator with a beta blocker. Minoxidil also may cause excessive hair growth. Rogaine, which is used to treat baldness, is a form of minoxidil that is applied to the skin.
Certain antihypertensive drugs are specifically recommended for the treatment of particular conditions. In fact, many times these medications can help certain conditions even in the absence of high blood pressure. Here are a few examples:
●An angiotensin-converting enzyme (ACE) inhibitor or ARB can help people with diabetes mellitus to decrease kidney damage and protein in the urine (proteinuria). These medications can also help with heart failure, and are useful in people who have had a prior heart attack to prevent a recurrent heart attack.
●Beta blockers can decrease the symptoms and even progression of congestive heart failure, but they must be used extremely carefully than they can also precipitate heart failure. These medications can help prevent a repeat heart attack in people who have had this problem.
●Beta blockers or calcium channel blockers can help decrease the mismatch blood flow in people who have angina.
Combination drug therapy — Combinations the medications are used for people who have very high blood pressure (usually more than 160/100 mmHg upon presentation), were one single agents proved ineffective to adequately control high blood pressure. Adding blood pressure medications together increases the effectiveness of treatment that may also increase potential side effects.
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