Theory causes
- Stress
- Baroreceptor Reset
General Guidelines of Hypertension treatment (HTN Renal Artery Stenosis) Y
Treatment of hypertension
Studies have demonstrated clear benefits of treatment of hypertension even grade 1.
- Treatment goal <140/90 for most patients.
Therapeutics:
- Hypertensive Emergency
- Hypertensive urgency
- Resistant Hypertension
- Oral versus parenteral therapy Y
- Antihypertensive special situations
Treatments Includes
A-Non-pharmacologic therapy (Life style interventions):
- Avoid stress.
- Smoking cessation: smoking accounts for 30% of all cardiovascular deaths.
- Weight reduction: BMI should be < 25 Kgm/m2
- Diet: low salt :< 6gm/day , adequate
- potassium: increase fruit and vegetable consumption, adequate calcium, low saturated fat diet.
- Exercise: moderate exercise 30-40 minutes most days of the week is
- beneficial in lowering BP in hypertensive patients.
- Limited alcohol consumption.
B- Antihypertensives
Aim: to reduce the risk of complications.
The Ideal Antihypertensive: –Maintain adequate BP –Maintain perfusion –Reduce workload of heart –No undesirable effects –Allow for long term administration
►First choice groups Drug therapy (antihypertensive drugs): (commonly used drugs): ABCD
- Angiotensins-converting enzyme inhibitors (CHF) (ACEIs) and ARBs.
- Beta blockers. olols (IHD)
- CCBs ;verapamil, diltiazem, -dipines ((Zem-amil / Ipine’s)) (IHD)
- Diuretics specially (thiazides). (HF)
►Second choice groups:
- α1-adrenergic blockers: e.g. Prazosin and doxasosin.
- *Combined α and β-blockers: *e.g. labetalol. 3rd gen
- Adrenergic neuron blockers: e.g. α-methyldopa and Reserpine.
- Direct vasodilators: e.g. Hydralazine and diazoxide. Z
- Central α2 stimulants: e.g. clonidine and guanfacine.
- Dopamine (D1 receptor agonists): e.g. fenoldopam.