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Learn More...What are the first line medications for hypertension?
- Normal blood pressure (BP): systolic BP is less than 120, and diastolic BP is less than 80.
- Elevated BP: systolic BP 120 to 130 and diastolic BP is less than 80.
- Stage 1 HTN: systolic BP 130 to 139 or diastolic BP 80 to 89.
- Stage 2 HTN: systolic BP at least 140 or diastolic at least 90.
What are the guidelines for Stage 1 hypertension?
- Values are mean ± SD or n (%). P ‐values from ANOVA for continuous variables.
- Normal: <120/80 mm Hg; Elevated: 120‐129/<80 mm Hg; Stage 1:130‐139/80‐89 mm Hg; Stage 2: ≥140/90 mm Hg or accepted anti‐hypertensive treatment.
- a vs normal P < .05.
- b vs elevated P < .05.
- c vs stage 1 P < .05.
- d vs stage 2 P < .05.
How to manage Stage 1 hypertension or mild hypertension?
Try to:
- Change your expectations. For example, plan your day and focus on your priorities. ...
- Focus on issues you can control and make plans to solve them. If you are having an issue at work, try talking to your manager. ...
- Avoid stress triggers. Try to avoid triggers when you can. ...
- Make time to relax and to do activities you enjoy. ...
- Practice gratitude. ...
What is the first line drug for hypertension?
Thiazide and thiazide-like diuretics are usually the first-line of treatment for hypertension; in JNC8 guidelines, the thiazide diuretics can be used as the first-line treatment for HTN (either alone or in combination with other antihypertensives) in all age groups regardless of race unless the patient has evidence of chronic kidney disease where angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker is indicated.
What is the best treatment for hypertension?
Lifestyle and home remediesEat healthy foods. Eat a heart-healthy diet. ... Decrease the salt in your diet. Aim to limit sodium to less than 2,300 milligrams (mg) a day or less. ... Maintain a healthy weight. ... Increase physical activity. ... Limit alcohol. ... Don't smoke. ... Manage stress. ... Monitor your blood pressure at home.More items...•
What should be the first blood pressure medication?
Angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), and beta blockers are recommended as first-choice medications in some younger adults with high blood pressure. They are all effective at lowering blood pressure, but differ in the ways they work.
Why are ACE inhibitors first line for hypertension?
Introduction. ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers (ARBs) effectively lower blood pressure (BP) through inhibition of the renin-angiotensin system and are equally recommended as first-line medications in the treatment of hypertension.
What is first line drug?
a drug that is the first choice for treating a particular condition because it is considered a very effective treatment for that condition with the least likelihood of causing side effects. A first-line medication may be a class of drugs (e.g., SSRIs for depression) as well as a single drug.
How to manage high blood pressure?
High blood pressure should initially be managed with changing life style — eating a healthy diet with less salt, exercising regularly, quitting smoking, and maintaining a healthy weight. When these life‐style changes are not enough, treatment with antihypertensive drugs is recommended. Several different classes of medications are available to reduce blood pressure. The six main drug classes, included in this review, are thiazide diuretics, beta‐blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, calcium channel blockers, and alpha blockers.
What are the different types of antihypertensive drugs?
To quantify the mortality and morbidity effects from different first‐line antihypertensive drug classes: thiazides (low‐dose and high‐dose), beta‐blockers, calcium channel blockers, ACE inhibitors, angiotensin II receptor blockers (ARB), and alpha‐blockers, compared to placebo or no treatment.
How does thiazide affect blood pressure?
The mechanism of these effects is uncertain, as it may involve effects on the whole body, renal autoregulation, or direct vasodilator actions (Hughes 2004). Thiazides act on the kidney to inhibit reab sorption of sodium (Na+) and chloride (Cl‐) ions from the distal convoluted tubules in the kidneys, by blocking the thiazide‐sensitive sodium‐chloride symporter (Duarte 2010). They also increase calcium reabsorption at the distal tubule, and increase the reabsorption of calcium ions (Ca2+), by a mechanism involving the reabsorption of sodium and calcium in the proximal tubule in response to sodium depletion.
What is elevated blood pressure?
Elevated blood pressure (hypertension) is a chronic condition in which the blood pressure in the arteries is persistently elevated. It has been divided into three categories, based on resting blood pressures, measured in a standard way: mild hypertension (140 to 159/90‐99 mmHg), moderate hypertension (160 to 179/100 to 109 mmHg), and severe hypertension (180/110 mmHg or higher). Most people with high blood pressure have no signs or symptoms, even if blood pressure readings are very high. For most adults with primary or essential hypertension, there is no identifiable cause for the high blood pressure. Some people have high blood pressure, called secondary hypertension, caused by underlying conditions such as adrenal gland tumours, kidney problems, thyroid problems, excessive alcohol intake, or use of certain medications, such as birth control pills. Isolated systolic hypertension is a condition in which the diastolic pressure is normal (less than 90 mmHg), but systolic pressure is high (160 mmHg or greater). This is a common type of high blood pressure among older people.
What is a beta blocker?
Beta‐blockers: Beta‐blockers are competitive antagonists that block the receptor sites for epinephrine (adrenaline) and norepinephrine on adrenergic beta‐receptors. Some block activation of all types of beta‐adrenergic receptors (β1, β2, and β3), and others are selective for one of the three types of beta receptors (Frishman 2005).
Do thiazides reduce stroke?
We concluded that most of the evidence demonstrated that first‐line low‐dose thiazides reduced mortality, stroke, and heart attack. No other drug class improved health outcomes better than low‐dose thiazides. Beta‐blockers and high‐dose thiazides were inferior.
Does blood pressure increase with age?
Blood pressure tends to increase with age. High blood pressure is more common in men in early middle age, more common in women after age 65, and more common in Blacks compared to Caucasians. The risk of high blood pressure is increased when there is a family history of high blood pressure, in the presence of obesity, or when physically inactive. High blood pressure is associated with smoking, too much salt in the diet, drinking excessive amounts of alcohol, high levels of stress, and chronic conditions such as diabetes, kidney disease, and sleep apnea.
Who mentioned patients who may have other preexisting medical conditions that need to be treated along with hypertension?
Dr. Tomey mentioned patients who may have other preexisting medical conditions that need to be treated along with hypertension. He concluded: “We need to be sensitive to the fact that certain specific groups of patients may yet get superior benefits from one drug over the other.”
What is the effect of ACE inhibitors on blood pressure?
ACE inhibitors block an enzyme that triggers the production of angiotensin, which therefore reduces blood pressure.
Why are there disagreements between studies as to whether ACE inhibitors should be the preferred form of treatment?
In addition, disagreement exists between studies as to whether ACE inhibitors, due to their longer history of use , should be the preferred form of treatment.
Is ACE a first line medication?
ACE inhibitors and ARBs are equally recommended as first-line medications in the treatment of high blood pressure.
What are the five drugs that are considered first line treatment?
In hypertension all the five major drug classes (low-dose thiazides, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists ) are efficacious in reducing blood pressure and cardiovascular events.
How to reduce blood pressure?
Once a decision has been taken to intervene, and provided that urgent reduction of the blood pressure is not needed, a period of non-drug treatment is recommended. Reducing excess weight, salt and alcohol intake coupled with increased exercise all reduce blood pressure. However, few studies have shown prolonged effectiveness of these interventions and study design has often been poor. 3 In a majority of patients medication will also be needed to reach their target blood pressure.
Why do people with essential hypertension stop taking calcium channel blockers?
Patients with essential hypertension taking calcium channel blockers stop their medication because of adverse effects more frequently than those patients taking diuretics. 2. Thiazide diuretics are no longer first-line treatment for uncomplicated hypertension.
What is the goal of uncomplicated hypertension?
Summary. The goal of therapy in uncomplicated hypertension is to reduce cardiovascular risk by lowering the patient's blood pressure. If non-drug treatment is ineffective, the choice of drug treatment is determined by its safety and efficacy. When safety and efficacy are equal the lowest cost drug should be prescribed.
What is the World Health Organization's guide to good prescribing?
The World Health Organization program, the 'Guide to good prescribing', emphasises comparative safety, convenience and cost as well as efficacy as important discriminators in making choices. 6.
What is the cut off for blood pressure?
While there is no absolute cut-off between normal and elevated blood pressure, current guidelines advise treatment for patients whose systolic pressure is 160 mmHg or greater, or whose diastolic pressure is 95-100 mmHg or greater. If other risk factors for cardiovascular disease are present, such as hyperlipidaemia, smoking, obesity or a family history, treatment should be started at 140/90-95 mmHg. 1 The patient's predicted cardiovascular risk, which can be calculated from available tables, 2 should determine the time for intervention. The higher the risk, the sooner treatment should start.
Is the National Heart Foundation's recommendation for antihypertensive therapy correct?
While the conclusion of the National Heart Foundation guidelines (2004) 5 that 'Drugs from any of the five major classes are suitable for initiation and maintenance of antihypertensive therapy' is correct, this is true only if efficacy is considered alone. Other considerations also have a place in the choice of first-line drugs. The World Health Organization program, the 'Guide to good prescribing', emphasises comparative safety, convenience and cost as well as efficacy as important discriminators in making choices. 6
How to control 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.
What tests are done to confirm if you have high blood pressure?
Ambulatory monitoring. This 24-hour blood pressure monitoring test is used to confirm if you have 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 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.
Why do doctors ask you to record your blood pressure?
Your doctor may ask you to record your blood pressure at home to provide additional information and confirm if you have high blood pressure.
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.
How to manage hypertension?
Every adult with hypertension should have a clear, detailed, and current evidence-based plan of care that ensures the achievement of treatment and self-management goals; effective management of comorbid conditions; timely follow-up with the healthcare team; and adheres to CVD evidence-based guidelines. Effective behavioral and motivational strategies are recommended to promote lifestyle modification. A structured team-based approach including a physician, nurse, and pharmacist collaborative model is recommended, along with integrating home-based monitoring and telehealth interventions. Outcome may be improved with quality improvement strategies at the health system, provider, and patient level. Financial incentives paid to providers can be useful.
How to treat asymptomatic aortic stenosis with hypertension?
Valvular heart disease: Asymptomatic aortic stenosis with hypertension should be treated with pharmacotherapy, starting at a low dose, and gradually titrated upward as needed. In patients with chronic aortic insufficiency, treatment of systolic hypertension is reasonable with agents that do not slow the heart rate (e.g., avoid beta-blockers).
What is the best diuretic for CVD?
Principles of drug therapy: Chlorthalidone (12.5-25 mg) is the preferred diuretic because of long half-life and proven reduction of CVD risk. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), and direct renin inhibitors should not be used in combination. ACE inhibitors and ARBs increase the risk of hyperkalemia in CKD and with supplemental K + or K + -sparing drugs. ACE inhibitors and ARBs should be discontinued during pregnancy. Calcium channel blocker (CCB) dihydropyridines cause edema. Non-dihydropyridine CCBs are associated with bradycardia and heart block and should be avoided in HFrEF. Loop diuretics are preferred in HF and when glomerular filtration rate (GFR) is <30 ml/min. Amiloride and triamterene can be used with thiazides in adults with low serum K +, but should be avoided with GFR <45 ml/min.#N#Spironolactone or eplerenone is preferred for the treatment of primary aldosteronism and in resistant hypertension. Beta-blockers are not first-line therapy except in CAD and HFrEF. Abrupt cessation of beta-blockers should be avoided. Bisoprolol and metoprolol succinate are preferred in hypertension with HFrEF and bisoprolol when needed for hypertension in the setting of bronchospastic airway disease. Beta-blockers with both alpha- and beta-receptor activity such as carvedilol are preferred in HFrEF.#N#Alpha-1 blockers are associated with orthostatic hypotension; this drug class may be considered in men with symptoms of benign prostatic hyperplasia. Central acting alpha 2 -agonists should be avoided, and are reserved as last-line due to side effects and the need to avoid sudden discontinuation. Direct-acting vasodilators are associated with sodium and water retention and must be used with a diuretic and beta-blocker.
What is the BP for diabetes mellitus?
Diabetes mellitus (DM) and hypertension: Antihypertensive drug treatment should be initiated at a BP ≥130/80 mm Hg with a treatment goal of <130/80 mm Hg. In adults with DM and hypertension, all first-line classes of antihypertensive agents (i.e., diuretics, ACE inhibitors, ARBs, and CCBs) are useful and effective. ACE inhibitors or ARBs may be considered in the presence of albuminuria.
What is the best treatment for DM?
Race/ethnicity: In African American adults with hypertension but without HF or CKD, including those with DM, initial antihypertensive treatment should include a thiazide-type diuretic or CCB. Two or more antihypertensive medications are recommended to achieve a BP target of <130/80 mm Hg in most adults, especially in African American adults, with hypertension.
What is the BP goal for CKD?
CKD: BP goal should be <130/80 mm Hg. In those with stage 3 or higher CKD or stage 1 or 2 CKD with albuminuria (>300 mg/day), treatment with an ACE inhibitor is reasonable to slow progression of kidney disease. An ARB is reasonable if an ACE inhibitor is not tolerated.
Is Chlorthalidone effective for metabolic syndrome?
The optimal antihypertensive drug therapy for patients with hypertension in the setting of the metabolic syndrome has not been clearly defined. Chlorthalidone was at least as effective for reducing CV events as the other antihypertensive agents in the ALLHAT study . Traditional beta-blockers should be avoided unless used for ischemic heart disease.
What is the HTN stage?
The 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of HTN stages is: Normal blood pressure (BP): systolic BP is less than 120, and diastolic BP is less than 80. Elevated BP: systolic BP 120 to 130 ...
What is the target BP for kidney disease?
In patients with chronic kidney disease, the target BP is 130/80. For patients with type 2 diabetes mellitus (T2DM), it is recommended to start on antihypertensive medications if BP is more than 130/80 with a goal of BP lower than 130/80.
How does ACE inhibitor affect blood pressure?
ACE inhibitors decrease the blood pressure by inhibiting the angiotensin-converting enzyme; this causes a decline in the production of angiotensin II and increases the bradykinin level by inhibiting its degeneration, which leads to vasodilation. [31]
What is the BP of a systolic BP?
Elevated BP: systolic BP 120 to 130 and diastolic BP is less than 80.
Is chlorthalidone better than hydrochlorothiazide?
They are better at decreasing the risk of cardiovascular disease comparing to hydrochlorothiazide. [4][5] Chlorthalidone is the drug of choice to start as monotherapy for hypertension. Studies show it to be the best diuretic to control blood pressure and to prevent mortality and morbidity.
Which diuretic acts on the principal cells in the late distal tubule and the collecting duct?
Potassium Sparing Diuretics: Act on the principal cells in the late distal tubule and the collecting duct; they inhibit the sodium reabsorption at this level in association with decreased excretion of potassium and hydrogen ions. Spironolactone and eplerenone are considered mineralocorticoid receptor antagonists, and they inhibit the mineralocorticoid receptor.
Is hypertension a cardiovascular disease?
It highlights the studies done to compare different classes of antihypertensive medications and indications for each class. Hypertension (HTN) is considered one of the leading causes of increased cardiovascular disease. Lowering blood pressure does reduce cardiovascular risks; maintaining systolic blood pressure less than 130 mm Hg demonstrably ...
