1 / 15

Chapter 47

Chapter 47. Drugs for Hypertension. Classification of Blood Pressure (BP). Four BP categories (defined by JNC 7): Normal Systolic BP below 120 mm Hg and diastolic BP below 80 mm Hg Prehypertension Systolic BP 120–139 mm Hg or diastolic BP 80–89 mm Hg Hypertension

sirvat
Télécharger la présentation

Chapter 47

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 47 Drugs for Hypertension

  2. Classification of Blood Pressure (BP) • Four BP categories (defined by JNC 7): • Normal • Systolic BP below 120 mm Hg and diastolic BP below 80 mm Hg • Prehypertension • Systolic BP 120–139 mm Hg or diastolic BP 80–89 mm Hg • Hypertension • Systolic BP above 140 mm Hg or diastolic BP above 90 mm Hg • Stage 2 hypertension: systolic BP and diastolic BP in different categories (eg, 160/92 mm Hg)

  3. Types of Hypertension • Two broad categories of hypertension • Primary (essential) hypertension • No identifiable cause • Chronic, progressive disorder • Population: older adults, African Americans, Mexican Americans, postmenopausal women • Treated but not cured (lifelong condition) • Referred to as “essential hypertension” • Secondary hypertension • Identifiable primary cause • Possible to treat the cause directly • Some individuals can actually be cured

  4. Consequences of Hypertension • Heart disease • Myocardial infarction (MI) • Heart failure • Angina pectoris • Kidney disease • Stroke

  5. Basic Considerations • Benefits of lowering blood pressure • Patient evaluation • Hypertension with a treatable cause • Factors that increase cardiovascular risk • Diagnostic tests • Treatment goals • Therapeutic interventions

  6. Lifestyle Modifications • Sodium restriction • DASH (Dietary Approaches to Stop Hypertension) eating plan • Alcohol restriction • Aerobic exercise • Smoking cessation • Maintenance of potassium and calcium intake

  7. Pharmacologic Therapy • Review of blood pressure control • Principal determinants of blood pressure • Arterial pressure = Cardiac output × Peripheral resistance • Cardiac output • Heart rate • Myocardial contractility • Blood volume • Venous return • Systems that help regulate blood pressure • Sympathetic baroreceptor reflex • Renin-angiotensin-aldosterone system • Renal regulation of blood pressure

  8. Pharmacologic Therapy • Antihypertensive mechanisms: sites of drug action • Brainstem • Sympathetic ganglia • Terminals of adrenergic nerves • Beta1-adrenergic receptors on the heart • Alpha1-adrenergic receptors on blood vessels • Vascular smooth muscle • Renal tubules • Beta1 receptors on juxtaglomerular cells • Angiotensin-converting enzyme • Angiotensin II receptors • Aldosterone receptors

  9. Pharmacologic Therapy • Classes of antihypertensive drugs • Diuretics • Thiazide diuretics • High-ceiling (loop) diuretics • Potassium-sparing diuretics • Sympatholytics (antiadrenergic drugs) • Beta-adrenergic blockers • Alpha1 blockers • Alpha/beta blockers: carvedilol and labetalol • Centrally acting alpha1 agonists • Adrenergic neuron blockers

  10. Pharmacologic Therapy • Sympatholytics (antiadrenergic drugs) (cont’d) • Direct-acting vasodilators: hydralazine and minoxidil • Calcium channel blockers • Drugs that suppress RAAS • ACE inhibitors • Angiotensin II receptor blockers • Aldosterone antagonists • Direct renin inhibitors ACE = angiotensin-converting enzyme; RAAS = renin-angiotensin-aldosterone system.

  11. Pharmacologic Therapy • Fundamentals of hypertension drug therapy • Treatment algorithm • Initial drug selection • Patients WITHOUT compelling indications • Patients WITH compelling indications • Adding drugs to the regimen • Rationale for drug selection • Benefits of multidrug therapy • Dosing • Step-down therapy

  12. Pharmacologic Therapy • Individualizing therapy • Patients with comorbid conditions • Renal disease • Diabetes • Patients in special populations • African Americans • Children and adolescents • The elderly

  13. Pharmacologic Therapy • Minimizing adverse effects • Promoting adherence • Why adherence can be difficult to achieve • Ways to promote adherence • Educate the patient • Teach self-monitoring • Minimize side effects • Establish a collaborative relationship • Simplify the regimen • Other measures

  14. Drugs for Hypertensive Emergencies • Sodium nitroprusside • Fenoldopam • Labetalol • Diazoxide • Clevidipine

  15. Drugs for Hypertensive Disorders of Pregnancy • Chronic hypertension and pregnancy • ACE inhibitors, ARBs, and DRIs are contraindicated during pregnancy • Most other antihypertensives can be continued during pregnancy • Preeclampsia and eclampsia • Hydralazine • Magnesium sulfate (anticonvulsant) ARB = angiotensin receptor blocker; DRI = direct renin inhibitor.

More Related