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Treatment of Hypertension

MODERATOR: Dr. Kabilis

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Group Members

1. Ejimah Becky I. -BHU/17/01/O1/0260

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2. Efuntoye Elizabeth -BHU/17/01/O1/0263

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3. Dashe Nanfe M. - BHU/17/01/O1/0099

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4. Ngu Mark A. -BHU/22/01/O1/0106

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Table of Contents

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Introduction

Goals of Treatment

Principles of Treatment

Mechanisms Of Drug Action

-Factors to consider

-Anti Hypertensive Therapy

-Types

-Special Groups

-Terminology

-Epidemiology

-Classification

-Types of HTN

-Risk Factors

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Conclusion

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Terminolgy

-Hypertension: Systolic blood pressure of 140mmHg or greater, diastolic blood pressure of 90mmHg or greater, or taking antihypertensive medication.

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-Hypertensive emergency: Severe elevation in BP with progressive end organ damage (systolic 180mmHg or diastolic 120mmHg).

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-Hypertensive Urgency: Severe elevation of blood pressure without progressive end organ damage.

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Terminolgy

-Malignant hypertension: It is the abrupt elevation in blood pressure in patients with chronic hypertension with diastolic blood pressure greater than 130mmHg.

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-Resistant hypertension: Blood pressure of >140/90mmHg despite treatment with 3 antihypertensive agents of different classes.

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-White coat hypertension: Persistent elevated blood pressure in clinic while blood pressure is normal outside the clinic.

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-Masked hypertension: Normal blood pressure in the clinic and abnormally elevated blood pressure outside clinic.

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Epidemiology

According to the WHO(March 2023)

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  • An estimated 1.28 billion adults aged 30–79 years worldwide have hypertension, most (two-thirds) living in low- and middle-income countries.

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  • An estimated 46% of adults with hypertension are unaware that they have the condition.

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  • Less than half of adults (42%) with hypertension are diagnosed and treated.

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  • Approximately 1 in 5 adults (21%) with hypertension have it under control.

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Epidemiology

In a study done in Nigeria(2017), it was found that:

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  • The prevalence of hypertension was higher in men than women

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  • Higher amongst Urban dwellers than rural dwellers

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  • The highest prevalence was found in the South East region and lowest in the North Central region

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Classification of HTN�(JNC VII)�

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SBP(mmHg)

DBP(mmHg)

Normal

Less than 120

Less than 80

Prehypertension

120-139

80-99

Stage 1

140-159

90-99

Stage 2

Equal or >160

Equal or >100

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Types of HTN

1. Essential Hypertension(Primary hypertension)

2. Secondary Hypertension:

-Renal causes

-Cardiovascular Causes

-Endocrine Causes

-Pre-eclampsia and eclampsia

-Sleep apnea

-Drug induced.

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Risk Factors

  • NONMODIAFIABLE:

-Age>60.

-Sex( Men and Postmenopausal).

-Family hx. of cardiovascular disease.

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  • MODIFIABLE

-Smoking.

-High cholesterol diet.

-Diabetes

-Obesity

-Hyperlipidemia.

-High intake of alcohol.

-Sedentary lifestyle.

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Goals of Treatment

Prevent.

Reduce.

Manage.

To prevent or arrest cardiovascular damage.

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To prevent end organ damage.

To reduce vascular complications of hypertension.

Develop a plan to manage important lifestyle factors.

BP Control.

Correct.

Achieve a level of appropriate BP control relative to cause, with targeted antihypertensive medication treatment, and generic antihypertensive treatment.

Correct correctable or secondary causes of hypertension.

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Factors to consider before treatment

  • The cardiovascular risk profile.

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  • Presence of co-morbidities.

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  • Target organ damage.

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  • Interaction with other drugs used for concomitant conditions.

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  • Tolerability of the drug.

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  • Cost of treatment.

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Principles of treatment of Hypertension.

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  • The main objectives of chronic drug treatment in essential hypertension are to decrease blood pressure, improve prognosis, reduce the number and severity of adverse effects to a minimum, and use simple treatment schedules.

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  • Simple treatment schedules may be easily maintained with monotherapy. If monotherapy is insufficiently effective, antihypertensive drugs can be combined.

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The Seven core principles (SeCP) for treatment

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Individual and racial therapy

Integrated traditional Chinese and Western medicine.

Early identification, early diagnosis, early and life-long treatment.

Application of long-acting and slow-released anti-hypertension drugs to control blood pressure smoothly

Use low dosage and combined therapy

Life style improvement.

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Enhancing compliance.

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Anti Hypertensive Combination therapy.

  • Antihypertensive combinations are agents that control blood pressure. One pill or dose form contains more than one class of drug, which is indicated to treat hypertension.

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  • Having a combination of drugs in one pill with synergistic effect, may better control hypertension by improving compliance.

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Types of Antihypertensive combinations.

1) ACE-Inhibitors with calcium channel blocking agents.

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2) ACE inhibitors with thiazides.

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3) Angiotensin II inhibitors with calcium channel blockers.�

4) Angiotensin II inhibitors with thiazides.�

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Types of Antihypertensive combinations.

5) Antiadrenergic agents (central) with thiazides.�

6) Beta blockers with thiazides.

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7) Miscellaneous antihypertensive combinations, potassium sparing diuretics with thiazides.

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Mechanisms Of Drug Action- Calcium Channel Blockers

  • CCBs inhibit the entry of calcium into smooth muscle cells, causing vasodilation and reducing peripheral resistance.
  • Used as an alternative in patients who cannot tolerate ACE inhibitors or ARBs.

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  • Examples: Amlodipine, Nifedipine, Verapamil

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Mechanisms Of Drug Action- Calcium Channel Blockers

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Mechanisms Of Drug Action- Angiotensin-Converting Enzyme Inhibitors:

  • ACE inhibitors block the enzyme ACE, which reduces the production of angiotensin II, a hormone that causes vasoconstriction and promotes sodium and water retention.
  • Prescribed for patients with hypertension-comorbid conditions such as heart failure failure
  • Examples: Lisinopril, Enalapril, Ramipril.

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Mechanisms Of Drug Action- Angiotensin-Converting Enzyme Inhibitors:

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Mechanisms Of Drug Action- Angiotensin II Receptor Blockers

  • ARBs block the angiotensin II receptors, preventing the vasoconstrictive and sodium-retaining effects of angiotensin II.
  • For those who cannot tolerate ACE inhibitors due to side effects such as cough.
  • Examples: Losartan, Valsartan, Olmesartan.

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Mechanisms Of Drug Action- Angiotensin II Receptor Blockers

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Mechanisms Of Drug Action- Beta-Blockers

  • Beta-blockers block beta-adrenergic receptors, reducing the effects of the sympathetic nervous system, including heart rate and cardiac output.
  • For those with concomitant conditions such as angina, heart failure, previous heart attack
  • Examples: Metoprolol, Atenolol.

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Mechanisms Of Drug Action- Beta-Blockers

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Mechanisms Of Drug Action- Aldosterone Antagonists

  • This group block the action of the hormone aldosterone.
  • They increase the excretion of sodium and water by the kidneys and lower blood pressure.
  • Prescribed as part of combination therapy for patients with resistant hypertension, which refers to high blood pressure that remains uncontrolled despite the use of multiple antihypertensive medications.
  • Examples: Spironolactone, Eplerenone.

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Mechanisms Of Drug Action- Aldosterone Antagonists

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Mechanisms Of Drug Action- Diuretics

  • Diuretics increase the excretion of sodium and water from the body, reducing blood volume and lowering blood pressure.
  • Commonly used as first-line therapy for hypertension.

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  • Examples: Hydrochlorothiazide, Chlorthalidone, Furosemide.

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Mechanisms Of Drug Action- Diuretics

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Mechanisms Of Drug Action- Vasodilators

  • Vasodilators directly relax the smooth muscle in blood vessels, causing vasodilation and reduced peripheral resistance.
  • Used in Pts. with severe HTN or resistant HTN who have not responded to other antihypertensive medications. For Pts. who require aggressive blood pressure lowering.
  • Examples: Hydralazine, Minoxidil, Nitroglycerin.

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Mechanisms Of Drug Action- Vasodilators

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Conclusion

The choice of treatment depends on various factors, including the patient's specific needs, medical history, and response to treatment, and should be determined by a healthcare professional.

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References

Matthew R, Alexander(2022). Hypertension. http://emedicine.medscape.com

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Dr Payal Kohli(2019). Types and stages of hypertension.www.healthline.com

Google Images

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Thanks!

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CREDITS: This presentation template was created by Slidesgo, and includes icons by Flaticon, and infographics & images by Freepik

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