Antihypertensive drug
Antihypertensives are a class of drugs that are used to treat hypertension. Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischaemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, …
What are antihypertensives and why are they important?
Antihypertensives are a broad group of medications, and health care workers are recommended to have special caution in monitoring adherence and possible adverse reactions of these medications.
What are the drug recommendations for the treatment of hypertension (high blood pressure)?
Recommendations are to start them as first-line treatment for hypertension. Multiple studies have shown that thiazide-like diuretics (chlorthalidone and indapamide) are more potent than hydrochlorothiazide in hypertension treatment. They are better at decreasing the risk of cardiovascular disease comparing to hydrochlorothiazide. [4] [5]
How do I take antihypertensive drugs?
Most people take antihypertensive drugs in the form of a pill you swallow every day, but your provider can give you some antihypertensive medications through an IV in your arm during a hospital stay. Cleveland Clinic is a non-profit academic medical center.
How is resistant hypertension (high blood pressure) treated?
Treating resistant hypertension may involve many steps, including: Reviewing all the medications you take, including those that you take for other conditions or buy without a prescription Monitoring your blood pressure at home to see if going to the doctor causes your blood pressure to increase (white coat hypertension)
When are antihypertensives indicated?
The first recommendation is that of initiating antihypertensive drug treatment when systolic blood pressure is at least 140 or diastolic blood pressure at least 90 mmHg in patients with grade 1 hypertension and low or moderate total cardiovascular risk, and even when blood pressure is in the high normal range in ...
What are antihypertensive drugs used to treat?
Many blood pressure medications, known as antihypertensives, are available by prescription to lower high blood pressure (HBP or hypertension). There are a variety of classes of high blood pressure medications and they include a number of different drugs.
What is the role of antihypertensive drugs on the action of the heart?
Some antihypertensive drugs, most notably beta-blockers, depress heart rate and contractility (this decreases stroke volume) by blocking the influence of sympathetic nerves on the heart.
How you might select antihypertensive therapy for a patient?
The choice should be made on the basis of sound scientific data and from the patient's perspective and needs. The drug should be taken once a day, should have proven efficacy in hypertension control and cardiovascular morbidity and mortality reduction, and should have as few side effects as possible.
What is antihypertensive therapy?
Antihypertensive therapy aims to reduce the risk of severe hypertension and cerebrovascular accidents, cardiovascular strain, and renal injury. The target blood pressure for women with chronic hypertension may differ in pregnancy compared with prepregnancy.
What is the BP of a 60 year old?
There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mmHg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mmHg.
Why is veratrum called Brooklyn treatment?
Also, for many years, use of veratrum was called the “Brooklyn treatment,” noted here because Chesley spent most of his career on the faculty of the State University of New York in Brooklyn. There are several reasons for the paucity of information on antihypertensive treatment in the original Chesley monograph.
What to do if a CCB is unsuitable?
if a CCB is unsuitable, or if there is evidence or a high risk of heart failure, offer a thiazide-like diuretic. For black people of African or Caribbean family origin, consider an ARB in preference to an ACEI, in combination with a CCB.
Does antihypertensive therapy reduce LV mass?
Antihypertensive therapy is effective in reducing LV mass . In fact, Mosterd et al.46 analyzed data from 10,333 participants in the Framingham Heart Study and reported that the increasing use of effective antihypertensive therapy has caused a decrease in the prevalence of both high blood pressure and LVH in the general population. A large number trials and meta-analyses have attempted to compare the effects of different antihypertensive agents on LV mass, but flawed study designs and methodologic problems have limited the utility of these studies. Nevertheless, a recent meta-analysis by Kingbeil et al. 47 —including 80 double-blind randomized controlled trials with 146 active treatment arms (n=3767 patients) and 17 placebo arms (n=346 patients)—showed that after adjustment for treatment duration and change in diastolic blood pressure there was a significant difference ( p =0.004) among medication classes. In fact, the decrease in LV mass indexed by surface area induced by the different classes was as follows: angiotensin II receptor antagonists > calcium antagonists > ACE inhibitors > diuretics > beta blockers ( Table 50-2 ). In pairwise comparisons, angiotensin II receptor antagonists, calcium antagonists, and ACE inhibitors were more effective at reducing LV mass than were beta blockers and diuretics (all p <0.05 with Bonferroni correction).
How can hypertension be modulated?
Hypertension and its complications can be modulated by changing lifestyle (see Table 5.8) through: relaxation, weight loss, a high-fibre diet, reduction in salt intake, restriction of alcohol consumption, restriction of caffeine intake, smoking cessation and greater amounts of exercise.
Is ARB an antihypertensive?
The antihypertensive treatment of choice is an ACE inhibitor or ARB because of the potential beneficial effects on the progression of proteinuria and renal failure and because of the reported increments in plasma renin activity. However, the risk for hyperkalemia is increased.
Overview
Antihypertensives are medicines that bring your blood pressure down in various ways. Some antihypertensives make your blood vessels widen so blood gets through more easily. Others remove extra fluids from your blood or slow down your heartbeat.
Recovery and Outlook
Many people are successful in controlling their blood pressure with antihypertensive drugs. This helps prevent serious cardiovascular and kidney problems. People who keep their blood pressure in a normal range keep taking their medicine at the same time every day without missing doses.
When to Call the Doctor
Tell your provider if you’re having problems with antihypertensive side effects. They can order a different antihypertensive medication or give you a different amount (dose) of what you’re taking. Also, if your blood pressure readings get too high or too low on your home blood pressure monitor, tell your provider.
Frequently Asked Questions
You can take methyldopa, labetalol or nifedipine during pregnancy, but check with your provider for their recommendation. Many other antihypertensives are not safe for a developing fetus, so be sure to let your provider know when you plan to become pregnant.
In Favor of the Position That Blood Pressure Lowering Is Responsible for All the Benefit That Can Be Attributed to Antihypertensive Agents
The association of arterial hypertension with cardiovascular and renal disease was established a long time ago.
The Problem of Systolic BP Control
Systolic BP (SBP) is the most important BP parameter generating cardiovascular risk in hypertensive patients, particularly after 60 years of age. 10 The benefit of reducing BP in the elderly with isolated systolic hypertension has been recently subject of a meta-analysis.
The Case of Diabetes Mellitus, a Condition With Particular Sensitivity to BP Elevation
The UK Prospective Diabetes Study (UKPDS) 14 and the HOT study 12 have favored considering a goal BP of <130/80 mm Hg for diabetic patients. When compared with placebo, all drug classes, with the exception of β-blockers, have been particularly effective in diabetics.
Renal Disease, Another Condition Particularly Sensitive to BP Levels
Recently published guidelines 8,9 have established that goal BP in the presence of renal failure should be <130/85 mm Hg, or even lower (<125/75 mm Hg) if proteinuria >1g/day is found. Strict BP control has to be achieved to protect the kidney from the consequences of arterial hypertension.
Evidence in Favor of Drug-Specific Effects Beyond BP Control
Since their introduction, ACEIs and CCBs have been widely used in clinical practice to treat all stages of essential hypertension. In many countries, ACEIs are the most commonly used drugs, either as monotherapy or in association with other antihypertensive agents.
Conclusion
The issue of whether some drugs are better than others in prevention of events remains unresolved because of the small numbers of events in each group in trials performed so far comparing different classes of agents, 54 as well as other limitations that have been mentioned in this review, some of which are summarized in Table 1.
Footnotes
Correspondence Luis M Ruilope, Unidad de Hipertensión, Hospital 12 de Octubre, 28041 Madrid, Spain. E-mail [email protected]
Sources of Funding
Preparation of this manuscript was made possible by funds made available to Istituto Auxologico Italiano for current research of the Ministry of Health of Italy.
Disclosures
The authors declare no conflict of interest for this manuscript, but Dr Zanchetti declares lecture honoraria from Menarini International and Recordati SpA, and Dr Thomopoulos declares consultancy fees from AstraZeneca and lecture honoraria from Sanofi and Servier.
Footnotes
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
How to stop high blood pressure?
Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains, poultry, fish and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and trans fat. Decrease the salt in your diet.
Why do doctors take blood pressure readings?
Because blood pressure normally varies during the day and may increase during a doctor visit (white coat hypertension), your doctor will likely take several blood pressure readings at three or more separate appointments before diagnosing you with high blood pressure.
What is elevated blood pressure?
Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below (not above) 80 mm Hg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure. Elevated blood pressure may also be called prehypertension. Stage 1 hypertension.
What to do if you have chest pain?
If you also have chest pain, vision problems, numbness or weakness, breathing difficulty, or any other signs and symptoms of a stroke or heart attack, call 911 or your local emergency medical number. Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more important.
What are Alpha blockers?
Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others. Alpha-beta blockers. Alpha-beta blockers block nerve signals to blood vessels and slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
What does blood pressure measure?
A blood pressure reading, as shown in the blood pressure monitor in the image, measures the pressure in your arteries when your heart beats (systolic pressure) in the first number, and the pressure in your arteries between heartbeats (diastolic pressure) in the second number.
What happens if your blood pressure is high?
If your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which usually should be a diuretic, you may have resistant hypertension.
What is the purpose of antihypertensive drugs?
Antihypertensive drug. Antihypertensives are a class of drugs that are used to treat hypertension (high blood pressure). Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk ...
What is the goal of treatment for hypertension?
The fundamental goal of treatment should be the prevention of the important endpoints of hypertension, such as heart attack, stroke and heart failure. Patient age, associated clinical conditions and end-organ damage also play a part in determining dosage and type of medication administered.
What are the most common medications used to lower blood pressure?
Among the most important and most widely used medications are thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists (ARBs), and beta blockers .
What is the first line of treatment for calcium channel blockers?
The 8th Joint National Committee (JNC-8) recommends calcium channel blockers to be a first-line treatment either as monotherapy or in combination with thiazide -type diuretics, ACE inhibitors, or angiotensin II receptor antagonists for all patients regardless of age or race.
How old do you have to be to start taking antihypertensive?
Examples include: Age can affect the choice of medications. Current UK guidelines suggest starting patients over the age of 55 years first on calcium channel blockers or thiazide diuretics.
Why do we need a vasodilator?
Vasodilators act directly on the smooth muscle of arteries to relax their walls so blood can move more easily through them; they are only used in hypertensive emergencies or when other drugs have failed, and even so are rarely given alone.
What is nitroprusside used for?
Sodium nitroprusside, a very potent, short-acting vasodilator, is most commonly used for the quick, temporary reduction of blood pressure in emergencies (such as malignant hypertension or aortic dissection ).
The Problem of Systolic Bp Control
- Systolic BP (SBP) is the most important BP parameter generating cardiovascular risk in hypertensive patients, particularly after 60 years of age.10 The benefit of reducing BP in the elderly with isolated systolic hypertension has been recently subject of a meta-analysis.11 A difference of 10.4 mm Hg in SBP and 4.1 mm Hg in diastolic BP (DBP) between active therapy a…
Renal Disease, Another Condition particularly Sensitive to Bp Levels
- Recently published guidelines8,9 have established that goal BP in the presence of renal failure should be <130/85 mm Hg, or even lower (<125/75 mm Hg) if proteinuria >1g/day is found. Strict BP control has to be achieved to protect the kidney from the consequences of arterial hypertension. Does it matter how this control is obtained? During the last decade, a series of stu…
Evidence in Favor of Drug-Specific Effects Beyond Bp Control
- Since their introduction, ACEIs and CCBs have been widely used in clinical practice to treat all stages of essential hypertension. In many countries, ACEIs are the most commonly used drugs, either as monotherapy or in association with other antihypertensive agents. Their clinical use has been based on efficacy (which is not different from diuretics...
Conclusion
- The issue of whether some drugs are better than others in prevention of events remains unresolved because of the small numbers of events in each group in trials performed so far comparing different classes of agents,54 as well as other limitations that have been mentioned in this review, some of which are summarized in Table 1. However, there is good reason to believe …