Drugs To Manage Hypertension
Drugs To Manage Hypertension
Introduction of the problem of hypertension in America
The hypertension prevalence in America has been on an increase irrespective of increased awareness of the essence of controlling blood pressure. The increasing obesity prevalence is a main factor to the increased hypertension prevalence. The population aging is also another factor. Some of the strong predictors of hypertension are age, weight and ethnicity. The people with the highest rate is the blacks, older individuals and people with diabetes. It is only 30 percent of people with hypertension who have their BP controlled. Some of the barriers to effective control of BP have been determined; these include patient access and adherence to therapy and failure of the provider to initiate or intensify therapy (Aram et al. 2003).
JNC VII recommendations for the management of hypertension.
To manage hypertension, various things and rules ought to be followed. Health lifestyles for all individuals should be encouraged. There should be a prescription of lifestyle modification for all patients who have hypertension and prehypertension. The components of modification of lifestyle comprise of DASH eating plan, weight reduction, aerobic physical activity, dietary sodium reduction and moderation of consumption of alcohol. In weight reduction, normal body weight should be maintained (body mass index 18.5-24.9kg/m2). Dash eating plan entails the adoption of a diet that is rich in vegetables, fruits and low fat dairy products with reduced content of total and saturate fat. The dietary sodium intake should be reduced to <=100 mmol per day, which translates to 2.4g sodium or 6g sodium chloride. One should engage in regular aerobic physical activity; for example, fast walking at not less than 30 minutes every day. Men should limit themselves into taking 2 or less than 2 drinks a day while ladies and should take one or less than one drink per day. Some strategies for improving therapy adherence were stated as follows. The empathy of clinicians increases trust of patients, their motivation and adherence to therapy. Physicians ought to consider the culture believes and individual attitudes of their patients when formulating therapy.
Classes of antihypertensive agents
Adrenergic drugs
These are large groups of antihypertensive drugs. The subcategories of adrenergic drugs are: Peripherally acting dual alpha 1 and beta receptor blockers, peripherally acting alpha 1 receptor blockers, centrally acting alpha 2 receptor agonists, and centrally and peripherally acting adrenergic neuron blockers. The other one is peripherally acting beta receptor blockers (beta-blockers) comprising of cardioselective (beta 1 receptor blockers and nonselective (beta 1 and beta 2 receptor blockers).
Mechanism of action
Each of the categories of drugs is stated to have central action on the brain or peripheral action at the blood vessels and the heart. These drugs comprise of the adrenergic neuron blockers, the alpha2 receptor agonists, the alpha1 receptor, and the combination alpha1 and beta receptor blockers. The centrally acting alpha2 drugs clonidine and methyldopa act by modification of the SNS function. Since SNS simulation results to increased rate of heart and force of contraction, and release of rennin from the kidney, and the blood vessels constriction, hypertension is experienced. The centrally acting adrenergic operates by stimulating the alpha2 adrenergic receptors in the brain. The alpha2 adrenergic receptors reduce sympathetic outflow from the central nervous system. The stimulation of the alpha2adrenergic receptors also has effect to the kidneys and they reduce rennin activity.
Adverse effects
The commonest adverse effects of adrenergic drugs are dry mouth, dizziness, sedation, drowsiness, sexual dysfunction, constipation, and constipation. Other effects include nausea; sleep disturbances, rash, peripheral pooling of blood and cardiac disturbances like palpitations. Some of the drugs can also cause disruptions in blood count together with serum electrolyte and levels of a real function.
Angiotensin-coverting enzyme (ACE) inhibitors
These are a large group of antihypertensive drugs.
Mechanism of action
The ACE development was spurred by a discovery of an animal substance with useful benefits to humans. The substance was South American Viper venom that inhibits the activity of kininase. Kininase is enzyme for breaking down bradykinin, which is a potent vasodilator in the body of a human being. The ACE inhibitors have various beneficial cardiovascular effects. They inhibit the angiotensin-converting enzyme, responsible for converting AI formed through rennin action to AII. AII is a potent vasoconstrictor, and it induces secretion of aldosterone by adrenal glands. The aldosterone stimulates resorption of water and sodium that can raise blood pressure. The effects of ACE inhibitors are renal and cardiovascular. Their cardiovascular effects are as a result of their ability of reducing blood pressure by decreasing SVR. This is done by preventing the breakdown of the vasodilating substance bradykinin as well as substance P and prevention of AII formation. All these effects decrease after load or the resistance against which the left ventricle ought to pump for ejection of its volume of blood when contracting (Lilley, 2009).
Adverse effects
The main, side effects of ACE are mood changes, dizziness, fatigue, and headaches. There is also a dry and non-productive cough may take place that is reversible with therapy discontinuation of therapy. The initial dose may result to significant blood pressure decline. Other negative effects are hyperkalemia, loss of taste, agranulocytosis, thrombocytosis, neutropenia, anemia, pruritus, and rash. One uncommonly, but fatal negative effect is angioedema, which is a strong vascular reaction that involve submucosal tissues inflammation.
Vasodilators
They act directly on arteriolar and venous smooth muscle causing relaxation. They do not operate via adrenergic receptors.
Mechanism of action
The direct acting vasodilators are helpful as hypertensive drugs due to their ability to elicit peripheral vasodilation directly. This leads to SVR reduction. The most notable vasodilator effect is their hypotensive effect. Nonetheless, recently minoxidil has as well got an increased attention due to its effectiveness in restoration of hair growth. Minoxidil, hydralazine, and diazoxide work through arteriolar vasodilation, while nitroprusside contains both venous and arteriolar effects (Lilley, 2009).
Adverse effects
The negative effects of hydralazine comprise of diarrhea, anorexia, nasal congestion, edema, tachycardia, anxiety, headache and dizziness. Negative effects of diazoxide comprise of dizziness, orthostatic hypotension, headache, acute pancreatitis, vomiting, nausea, water and sodium retention, dysrhythmias, and hyperglycemia in diabetic patients. The adverse effects of minoxidil are pericardial effusion, breast tenderness, thrombocytopenia T-wave electrocardiographic changes, and rash.
Most effective drug for hypertension
Diuretics
They are extremely effective category of antihypertensive drugs. Currently they are listed as the current first line antihypertensives in the JNC VII for hypertension treatment. They may be used as monotherapy or together with other antihypertensive drugs. Their basic, therapeutic effect is decreasing of plasma and extracellular fluid volumes that result to decrease in preload. This results to a decrease in cardiac output and total peripheral resistance which decreases the heart’s workload. Thiazide diuretics are the commonly used hypertension treatment diuretics (Lilley, 2009).
Medication adherence
Poor medication adherence is common and contributes to worsening of disease, death and increased costs of healthcare. Practitioners ought to identify poor adherence and enhance adherence by putting emphasis on the value of regimen of a patient. The regimen should be made easy and customized to the lifestyle of the patient. Healthcare providers can ask patients about their behavior of taking medication, to determine poor adherence. Adherence can be augmented by a collaborative approach. Patients who fail to maintain adherence require strategies that are more intensive as compared who adhere with ease.
Does “one size fits all” apply to hypertensive agents?
Clinical trials have indicated that frequently used antihypertensive agents have different BP lowering responses in different people from different population. When choosing the antihypertensive drug to administer various factors ought to be considered, these factors include age, ethnicity, and lifestyle. It is essential for the main guideline groups to promote the heterogeneity concept in response to medications and offer treatment of blood pressure, which consider various specified conditions like age, race, and obesity (Gupta, 2010).
Hypertension management for individuals
Following her status, of being pregnant, Mrs. G should stops using lisinopril. This is because the treatment may have a negative effect to the fetus. It is recommended that Mrs. G uses labetalol that is a beta blocker, a hydralazine and sustained release nifedipine, which is a calcium channel blocker.
For patients with diabetes, clinical trials have shown the essence of tight blood control amongst patients. For instance, in Mr. X’s case, two or more antihypertensive medication are required to attain the blood pressure of less than 140/90 mm Hg or 130/80 mm
Mr. T is at considerable risk because he has a family history of hypertension, and additionally he smokes and is overweight. To control the hypertension, Mr. T should undergo exercise to ensure control the overweight condition and also desist from smoking. To ensure medication adherence the nurse can provide Mr. T with a reminder tool to ensure that he adheres to medication adherence (Berlowitz, et al, 2003).
Reference
Aram V. C. et al. (2003). Seventh Report of the Joint National Committee on Prevention,Detection, Evaluation, and Treatment of a High Blood Pressure, Hypertension, Vol. 42,p. 1206-1252; Retrieved on October 15, 2012 from,http://hyper.ahajournals.org/cgi/content/full/42/6/1206.
Berlowitz, D.R et al (2003) Hypertension management in patients with diabetes: Need for more aggressive, American diabetes association, Vol. 26, Is. 2 p. 255-259 Retrieved on October 16, 2012 from http://care.diabetesjournals.org/content/26/2/355.full.
Gupta, A.K. (2010)Racial Differences in Response to Antihypertensive Therapy: Does One Size Fits All? Vol. 1 Is. 4 p.217-219.
Lilley, (2009) Chapter 25: Antihypertensive Drugs
Osterberg, L. & Blaschke, T. (2005) Adherence to Medication: The New England Journal of Medicine, 353: 487-498. (Published in MOODLE)
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