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It is important to appreciate that we cannot cure HTN, we can only reduce symptoms
- treatment must continue lifelong, making noncompliance a significant problem
A. NORMAL
- systolic BP <120 mm Hg and diastolic BP <80 mm Hg
B. PREHYPERTENSION
- indicates increased risk of cardiovascular disease – even though outright
HTN has not yet developed
- those with pressure in the prehypertension range have a 2- to 3-fold
increased risk of cardiovascular
events
- to reduce risk, people should adopt certain health promoting lifestyle
changes
C. HYPERTENSION
- systolic BP >140 mm Hg or diastolic BP >90 mm Hg
B. SECONDARY HYPERTENSION
- elevation of BP brought on by an identifiable primary cause
- it may be possible to treat that cause directly rather than relying
on drugs for symptomatic relief
- some individuals can actually be cured
- when cure is not possible, secondary HTN can be managed with the same
drugs used for primary
HTN
A. BASIC CONSIDERATIONS
1. Benefits of Lowering Blood Pressure
- when the BP of hypertensive individuals is lowered, morbidity is
decreased and life is
prolonged
2. Patient Evaluation
a. Hypertension with a Treatable Cause – some forms of HTN
result from treatable
causes, such as Cushing’s syndrome,
pheochromocytoma, and oral
contraceptive use
- patients should be evaluated for these causes
and managed
appropriately
- direct treatment of the underlying cause can control
BP, eliminating the need
for further antihypertensive therapy
3. Treatment Goals
- ultimate goal is to reduce cardiovascular and renal morbidity and
mortality
- hopefully, this can be accomplished without decreasing
quality of life with the drugs
employed
Stage 1 or 2 HTN – maintain systolic BP<140 mm Hg and diastolic
BP<90 mm Hg
Diabetes or Chronic Kidney Disease – target BP <130/<80 mm Hg
Over 50 – reducing systolic pressure
4. Therapeutic Interventions
Blood Pressure Reductions:
- patients with prehypertension = implement healthy lifestyle
changes
- patients with HTN = treat with antihypertensive drugs
combined with healthy lifestyle
changes
B. LIFESTYLE MODIFICATIONS
- when implemented before HTN develops, healthy lifestyle changes may
actually prevent HTN
- when implemented after HTN develops, healthy lifestyles changes can
lower BP, decreasing or
eliminating the need for drugs
- can decrease other cardiovascular risk factors
3. DASH Eating Plan – diet rich in fruits, vegetables, and low-fat dairy
products, and low in total fat, saturated fats, and cholesterol
- encourages intake of whole grain products, fish, poultry, and nuts
- recommends minimal intake of red meat and sweets
A. PHARMACOLOGIC THERAPY
- many medications are used to treat chronic HTN
- all can lower BP, however, the difference is the site of the drug action
Adverse Effects:
hydralazine – syndrome resembling systemic lupus
erythematosus (SLE)
- rare at recommended doses
- if SLE-like reaction occurs, hydralazine should be
withdrawn
- 3rd drug of choice for HTN treatment
5. ACE Inhibitors
- lower BP by preventing formation of angiotensin II, preventing
angiotensin II-mediated
vasoconstriction and aldosterone-mediated volume expansion
- in diabetic patients with renal damage, these actions slow
progression of kidney injury
- less effective in African Americans than in white patients
- principal adverse effects are persistent cough, first dose
hypotension, angioedema, and
hyperkalemia (secondary to suppression of aldosterone
release)
- combined use with potassium supplements or potassium sparing
diuretics is generally avoided
- can cause fetal harm during 2nd and 3rd trimester
2. Individualizing Therapy
a. Patients with Comorbid Conditions – comorbid conditions
complicate treatment of HTN
- renal disease and diabetes are two especially
problematic conditions