Our cardiology professor always insists us that significant part is not to prescribe drugs to the patient but to make sure he has a contribution from his part. Patients’ part is to straighten up things possible by diet and physical activity.
Part played by the patient to take control of the hypertension
1. Gather all possible information about hypertension. One does not have to master himself on hypertension. But make sure you know the cause, prevention and the treatment modalities i.e. combination of diet, physical activity + drugs prescribed by your doctor.
2. Be certain about what you eat. Do no gobble up everything. You must be aware of your diet. What do your breakfast, lunch and dinner mean to your body? Does it just fill your stomach or does it really have a positive impact on your health. When you eat healthy, your body will feel it. Read the contents of the food you buy. How much is added carbohydrate, Fat, Protein etc. Decrease the salt intake. Avoid junk food, fried food, refined food, salt and sugar. Add olives to your meal. Make simple changes in your cooking style. Use not much oil. Include fruits, vegetables, fish & nuts. There are many websites that give you in detail about what to eat and what not to eat. Make sure you don’t eat food that increases your blood cholesterol.
3. Physical Activity plays a major role. It will keep you fit and your weight in control. There are many physiological regulations that are controlled by physical activity which provides a life saving support for the human body. There are many miracles that physical exercise could do but these are not proven scientifically but you will feel the change in your body when you do it.
4. Sleep deprivation and stress has a great influence in increasing the blood pressure. It is sensible not to disturb your sleep. Sleep and stress acts in a vicious circle. If one has sleep disturbances, the next day he is going to be snappy and will end up with a stressful day. In other case if someone is stressed due to some problem, he will not get good sleep. So better to avoid both. Try some yoga, walk in fresh air, listen to good music, read good books, make your time worthwhile, try to help someone in real need which would really ease your aches.
There is no scientific evidence about the above mentioned but I can assure you it will have a dramatic change in the progression of the disease.
Following are the elements that determine the prognosis of hypertension
· Level of blood pressure
· Target organ damage
· Presence of other disease such as diabetes mellitus, cardiovascular disease, hyperlipidaemia, smoking, male sex)
· Age
· Life style which includes how good you are in maintaining relationships, your diet, activities etc.
Part played by medicine prescribed by the doctor:
Every country has its own Blood pressure threshold, to start the drug therapy. For example some countries starts therapy when the blood pressure is >160mmHg systolic and diastolic >100mmHg and in some treatment is started with systolic >140mmHg and diastolic >90mmHg. But it is best when the treatment is started at the earliest 140/90mmHg.
The aim of drug therapy is to decrease the complication of increased blood pressure and to prevent further progression.
There is no first line therapy as every individual have different drugs suitable for one self.
Diuretics:
This group consists of number of sub groups depending on the place of action in the kidney.
Thiazides:
It consists of
Bendroflumethazide
Cyclopenthiazide
Side Effects: Increases serum cholesterol, impairs glucose tolerance, Increases uric acid and hypokalemia (decreases potassium).
Loop diuretics:
Furosemides
Ethacrynic acid
Side Effects: Increases serum cholesterol, impairs glucose tolerance, increases uric acid and hypokalemia
Aldosterone Antagonists:
Spiranolactone
Epelerenone
Side Effects: Hyperkalemia (increases potassium), kidney failure.
Indication: Hyperaldosteronism
Potassium Retaining:
Amiloride
Side Effects: Renal failure, Hyperkalemia
All the above mentioned is indicated during heart failure and renal failure. The mechanism is organised through increased release of sodium in urine.
Beta Blockers:
Cardioselective
Atenolol
Metaprolol
Non selective
Propranolol
Combined alpha/beta
Labetalol
Carvedilol
Side effects: Asthma, COPD, 2nd or 3rd degree heart block, sick-sinus syndrome.
Indication: Effective in patient with tachycardia
These drugs are activated by acting on sympathetic nervous system and the rennin-angiotensin system. It decreases cardiac output, heart rate and cardiac contractility.
Alpha antagonist
Selective
Prazosin
Doxazosin
Terazosin
Non-selective
Phenoxybenzamine- used in phaeochromocytoma
Angiotensin-converting enzyme inihibitors:
Captopril
Lisinopril
Ramipril
Side Effects: dry cough, angiodema
Indication: Heart Failure, Diabetic nephropathy
These ACE inhibitors block the angiotension converting enzyme which results in decreased production of aldosterone which in turn results in increased excretion of sodium in urine.
Angiotensin II receptor antagonist
Losartan
Valsartan
Candesartan
Irbesartan
Indication: Heart failure, Diabetic nephropathy, cough (side effect of ACE inhibitors)
The above mentioned drugs work by acting on the Renin-Angiotensin-Aldosterone system .
Calcium Channel blockers
Dihydropyridines
Nifedipine
Side Effect: Flushing, Headache, sweating, swelling of ankles, palpitation
Indication: Angina
Non-dihydropyridines
Diltiazem Verapamil
Side Effect: Flushing, Headache, sweating, swelling of ankles, palpitation
Indication: Angina, Post myocardial Infarction, supraventricular tachycardia
These drugs acts causes decrease in blood pressure by causing dilation of vessels and reduce the force of heart contraction. This blocks the calcium channel which causes constriction of blood vessels.
There are other centrally acting drugs such as reserpine, methyldopa and clonidine.
There are also other vasodilators such as hydralazine and minoxidil which helps in case when the patient is resistant to other forms of drugs. Hydralazine may be involved with tachycardia, fluid retention and a systemic lupus erythematosus-like syndrome.
Sodium nitroprusside is also a potent arterial and venous dilator. It is used in hypertensive crisis.
Every treatment must have a goal. Here the aim is to maintain a systolic blood pressure <140mmhg>
Malignant hypertension:
This is characterised by elevated blood pressure (diastolic>140mmHg) along with damage of organs like kidney, eyes, brain and heart. In this case the drug of choice is intravenous nitroprusside and the blood pressure must be reduced very slowly.
Hypertension is the foot of many other disorders. The key to control is not far from us, but just next to us. Will see you in the next post with another interesting disease.
