Hypertension Treatment And Management

Hypertension Treatment And Management

Question. Outline the management of essential hypertension.
Or
Describe briefl management of hypertension.

Answer.

Management of systemic hypertension.

Nonpharmacological treatment

1. Salt restriction: Modest sodium restriction 2.4 gm sodium or 6 gm NaCl is effctive in controlling hypertension.

2. Weight reduction: In overweight persons, reduction of 1 kg may reduce 1.6 to 1.3 mm Hg of blood pressure

3. Stop smoking: Smoking raises BP. It is an independent and most important reversible coronary risk factor.

4. Diet:

Lacto­vegetarian diet and high intake of poly unsaturated fih oils have high potassium levels and lower blood pressure by:

1. Increased sodium extraction
2. Decreased sympathetic activity
3. Decreased rennin­angiotensin secretion and direct dilatation of removal of renal arteries
4. Adequate calcium and magnesium intake should be maintained in diet

5. Limit of alcohol intake is done

6. Various forms of relaxation like yoga, biofeedback and psychotherapy lower the blood pressure

7. Regular exercise, relaxation exercise.

Pharmacological therapy:

1. Diuretics: Commonly used diuretics are hydrochlorothiazide 100 mg per day, chlorthalidone 50–100 mg/day.
The reduced potassium levels in body results in hypokalemia, potassium supplements have to be given in people on long­term diuretic therapy.
Potassium sparing diuretics, i.e. spironolactone 25 mg TDS is given.

2. Beta-blockers: Propranolol was used extensively as effctive antihypertensive drug. The dose administered as 40–160 mg/day.

3. Calcium channel blockers: Nifedipine 16 to 20 mg BD is administered. Side effects are headache, dizziness, flshing.
Drug is contraindicated in acute myocardial infarction, cardiogenic shock, pregnancy and is used with caution in diabetics and edema.
Felodipine sulfate 5 to 10 mg/day is effctive in mild to moderate hypertension.
Amlodipine 5 to 10 gm is effective and is safe in hypertensives.

4. ACE inhibitors:

1. Enalapril maleate 5 mg OD is given.
2. Captopril in combination with diuretics or a betablocker. 25 gm TDS of captopril is administered. It is considered safe in asthmatics and diabetics.
3. Ramipril 2.5 mg daily is used to reduce hypertension.

5. Alpha-1 adrenergic blockers: Prazosin is commonly used drug. Dose is 0.5 mg TDS.

6. Vasodilators: Diazoxide and sodium nitroprusside are given as IV dosage.