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» Home » CAD » Cardiology » Atherosclerosis and Risk factors » Hypertension
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» Home » CAD » Cardiology » Atherosclerosis and Risk factors » Hypertension
Background
Hypertension is characterized by a systolic blood pressure of 130 mmHg or a diastolic blood pressure of 80 mmHg. One of the most prevalent chronic conditions, hypertension, is defined by a continuous rise in arterial pressure.
One of the most significant comorbidities influencing the emergence of stroke, myocardial infarction, heart failure, and renal failure, hypertension has been one of the most researched subjects of the past century.
There is consensus that persistent blood pressure readings of 140/90mmHg or above should be treated with the conventional therapeutic aim of 130/80mmHg or less. The definition and classifications of hypertension have been developing throughout time.
Epidemiology
Around the world, more than a billion adults have hypertension, which impacts up to 45% of the adult population. All socioeconomic classes have significant rates of hypertension, which increase with age, reaching up to 60% over the age of 60.
Hypertension causes more cardiovascular disease-related deaths in the US than any other modifiable risk factor.
It is the second-leading preventable cause of death worldwide after cigarette smoking. Recent estimates suggest by 2025, there may be up to 1.5 billion people worldwide with hypertension, an increase of up to 15% or 20%.
Anatomy
Pathophysiology
An essential regulator of blood volume is sodium (Na+). High serum Na+ levels promote water retention, increasing blood volume and pressure. In normotensive adults, compensatory hemodynamic adjustments stabilize blood pressure as dietary Na+ increases. Nitric oxide generation from the endothelium increased, while renal and peripheral vascular resistance reduced.
However, blood pressure increases if nitric oxide’s impact is diminished or nonexistent. Endothelial dysfunction is a risk factor for the emergence of salt sensitivity and hypertension. Salt sensitivity is characterized by an increase in systolic blood pressure of at least 10 mmHg within a few hours of intake. It is defined as a considerable increase in blood pressure after a Na+ load of less than 5 g.
Renin- Angiotensin-Aldosterone System [RAAS]
RAAS is found in multiple organs at the cellular level. However, its most essential function is to assist in regulating pressure-volume balance in the kidney, where it maintains perfusion in states of volume depletion and is inhibited in circumstances of fluid excess. The juxtaglomerular cells of the kidney produce and store renin and its precursor, pro-renin, which are then released in response to various stimuli. Renin’s primary function is to break down angiotensinogen to create angiotensin I.
The pathogenetic significance of RAAS in hypertension is centered on how the angiotensin-converting enzyme (ACE) converts angiotensin I into angiotensin II. By enhancing the function of the sodium-hydrogen exchanger, sodium-bicarbonate exchanger, and sodium-potassium ATPase, as well as promoting aldosterone production and release from the adrenal glomerulosa, angiotensin II improves Na+ reabsorption in the proximal tubule.
Angiotensin II is also associated with endothelial dysfunction and causes renal, cardiac, and vascular damage. These effects are pro-fibrotic and pro-inflammatory and are mediated mainly by increased oxidative stress. Angiotensin II is strongly aligned to target organ damage in hypertension through these processes. Aldosterone plays a significant role in hypertension by binding to the mineralocorticoid receptor and inducing non-genomic effects.
These effects include activating the amiloride-sensitive sodium channel, also known as the epithelial sodium channel, which stimulates renal Na+ reabsorption in the cortical collecting duct. Additionally, aldosterone has a wide range of non-epithelial actions that support hypertension, vasoconstriction, and endothelial dysfunction. These include vascular fibrosis, extracellular matrix deposition, vascular remodeling, vascular smooth muscle cell proliferation, and elevated oxidative stress.
Etiology
Idiopathic or essential hypertension is the most common type of hypertension. It has been hypothesized that consuming more salt increases the potential risk of hypertension.
The patient’s genetic ability for a salt response is identified as one of the elements contributing to the development of hypertension. Salt sensitivity affects 50 to 60 % of the patients, who are more likely to develop hypertension.
Genetics
Prognostic Factors
The prognosis depends on blood pressure control and is positive if blood pressure is well controlled; nevertheless, as hypertension is a progressive condition, complications may occur in a few patients.
Adequate lifestyle and management measures accomplish little more to delay the onset and progression of complications like chronic kidney disease and renal failure.
Clinical History
Physical Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The treatment paradigm for hypertension (high blood pressure) typically involves a combination of lifestyle modifications and pharmaceutical interventions. Here is an overview of the treatment paradigm for hypertension:
Lifestyle Modifications:
Dietary changes: Encourage a balanced diet rich in fruits, vegetables, whole grains, and low-fat dairy products. Emphasize the importance of reducing sodium (salt) intake and limiting alcohol consumption.
Regular exercise: Recommend at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with muscle-strengthening activities at least twice a week.
Weight management: Promote weight loss for overweight or obese individuals to achieve a healthy body weight, as excess weight contributes to increased blood pressure.
Sodium restriction: Encourage reducing sodium intake to less than 2,300 milligrams per day (and even lower for certain populations, such as those with diabetes or kidney disease).
Limit alcohol consumption: Advise moderate alcohol consumption (up to one drink per day for women and up to two drinks per day for men) or complete abstinence if recommended by a healthcare provider.
Pharmaceutical Interventions:
Stepwise medication approach: Initiate antihypertensive medication based on the individual’s blood pressure levels, comorbidities, and risk factors.
First-line medications: Typically, thiazide diuretics (e.g., hydrochlorothiazide) or ACE inhibitors (e.g., lisinopril) are recommended as initial therapy due to their effectiveness, safety profile, and cost.
Combination therapy: If blood pressure goals are not achieved with a single medication, combination therapy with two or more antihypertensive agents from different drug classes may be prescribed.
Medication adherence: Emphasize the importance of taking medications as prescribed and educate patients about potential side effects and drug interactions.
Regular blood pressure monitoring: Encourage patients to monitor their blood pressure regularly at home and provide feedback to their healthcare provider.
Ongoing Management and Monitoring:
Follow-up visits: Schedule regular follow-up visits to monitor blood pressure, assess medication effectiveness and potential side effects, and adjust treatment as necessary.
Risk factor management: Address and manage other cardiovascular risk factors, such as diabetes, dyslipidemia (abnormal lipid levels), and smoking cessation.
Patient education: Provide comprehensive education on hypertension, its risks, and the importance of lifestyle modifications and medication adherence.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
Healthy Food Environments
Promote healthier food choices: Collaborate with food manufacturers, restaurants, and cafeterias to provide and promote low-sodium options, reduce the availability of high-sodium processed foods, and clearly label nutritional information.
Smoke-Free Environments
Creating smoke-free environments is crucial for individuals with hypertension, as exposure to tobacco smoke can significantly increase the risk of cardiovascular problems. Here are some speciality-wise suggestions for establishing smoke-free environments:
Healthcare facilities: Implement strict no-smoking policies in hospitals, clinics, and other healthcare settings. Provide designated outdoor smoking areas away from entrances and windows.
Public spaces: Advocate for smoke-free policies in public areas such as parks, playgrounds, and outdoor recreational areas to protect individuals, especially children, from secondhand smoke.
Educational campaigns: Collaborate with schools, community centers, and workplaces to raise awareness about the dangers of smoking and the importance of smoke-free environments.
Smoking cessation programs: Offer comprehensive smoking cessation programs that include counseling, support groups, and access to medication to assist individuals in quitting smoking.
Patient education: Educate patients about the risks of smoking and secondhand smoke, emphasizing the importance of maintaining a smoke-free home and car.
Nicotine replacement therapy (NRT): Provide access to NRT products, such as nicotine patches, gum, or lozenges, to assist individuals in quitting smoking and reducing withdrawal symptoms.
ACE inhibitors in management of Hypertension
ACE inhibitors (Angiotensin-Converting Enzyme inhibitors) are a class of pharmaceutical agents commonly used for the treatment of hypertension. They work by blocking the enzyme responsible for converting angiotensin I into angiotensin II, a hormone that constricts blood vessels and increases blood pressure. By inhibiting this enzyme, ACE inhibitors help relax and widen the blood vessels, reducing blood pressure and improving blood flow.
Here are some key points about ACE inhibitors for hypertension:
Calcium channel blockers used for Hypertension
Calcium channel blockers (CCBs) are a class of medications commonly used for the management of hypertension (high blood pressure). These medications work by blocking calcium channels in the smooth muscle cells of blood vessels, leading to relaxation and dilation of the vessels, which helps to lower blood pressure. Here are some important points regarding the use of CCBs for hypertension:
Types of Calcium Channel Blockers:
Use of Diuretics for Hypertension
Diuretics are commonly prescribed medications for the treatment of hypertension (high blood pressure). They work by increasing the excretion of sodium and water from the body, reducing the volume of fluid in the blood vessels, and thereby lowering blood pressure. Here are some important points to know about diuretics for hypertension:
Use of Renin-angiotensin-aldosterone system (RAAS) inhibitors for Hypertensive Chronic Kidney Disease
Use of Glucocorticoid Receptor Antagonists for Secondary Hypertension
Glucocorticoid receptor antagonists, also known as glucocorticoid antagonists or glucocorticoid receptor blockers, are a class of medications that can be used in the management of secondary hypertension. Secondary hypertension refers to high blood pressure caused by an underlying medical condition or medication. Here are some examples of glucocorticoid receptor antagonists that may be used in the treatment of secondary hypertension:
Mifepristone: mifepristone is primarily known as a medication used for pregnancy termination and in the management of certain hormonal disorders. However, it also acts as a glucocorticoid receptor antagonist and can be effective in treating hypertension caused by excess cortisol production (Cushing’s syndrome).
Spironolactone: spironolactone is a potassium-sparing diuretic that is commonly used to treat conditions like primary hyperaldosteronism (Conn’s syndrome), which can lead to secondary hypertension. It also acts as a glucocorticoid receptor antagonist, providing additional benefit in certain cases.
Medication
IR tablets
Initial dose:
100
mg
Orally
once a day
Maintenance dose: 100-450 mg orally once a day
ER tablets:
Initial dose: 25-100 mg orally once a day
Maintenance dose: 100-400 mg orally once a day
Initial:
1
mg
Orally
8 - 12
hrs
Maintenance: 6-15 mg once a day or divided 2 to 3 times a day alternatively
1
mg
Orally
once a day
; the dose can be titrated to double the dose up to 16 mg qDay based on blood pressure response
ER: not recommended for HTN
10 - 20
mg
Orally
every 12 hrs
Maintenance: 20-40 mg once a day
Do not exceed 60 mg per day
40 - 320
mg
Tablet
Orally
once a day
Initial:
1
mg
Orally
once a day
Maintenance: 1-5 mg per day for every 12hrsand can increase upto less than 20 mg per day
Dose Adjustments
Dosing considerations
To prevent syncope first dose and subsequent dose preferred at bedtime and can be taken with food
100
mg
Orally
every 12 hrs
initially; increased up to100 mg for 12hrs every 2-3 days Usual dosage range: 200-400 mg orally every 12hrs Do not exceed 2400 mg per day
Nonblack patients:
1
mg
orally
every day
black patients: 2 mg orally every day
Maintenance dose
2-4 mg orally every day or divided in every 12 hours
2.5
mg
Orally
twice a day
; increase to 2.5 mg for at least 2 days
Extended-release capsules:
Initial dose: 120-240mg orally once a day, increasing the dose as needed
Maintenance dose: 120 to 540mg orally once every day
Maximum dose:540mg/day
Extended-release coated capsules
Initial dose: 120-180mg orally once a day; increase the dose as needed
Maintenance dose: 240 to 360mg orally every day
Maximum dose: 480mg/day
Extended-release tablets
Initial dose: 180 to 240mg orally once a day; increase the dose as needed
Maintenance dose: 540mg orally every day
400 - 1200
mg/day
Capsule
Orally
every 12 hours
off-label:
1
mg
Intravenous (IV)
loading dose, followed by 0.5-2 mg/day oral divided every 12 hours.
Initial dose: Initiate with 40mg/5mg or 80mg/5mg orally every day. Do not exceed 80mg/10mg every day
Maximum dose: Telmisartan 80mg-amlodipine 10mg orally every day
Dose Adjustments
Hepatic impairment
Start with a lower dose of 2.5 mg amlodipine and increase the amount gradually
Renal impairment
Dosage adjustment is not required
Initial dose-12.5mg/150mg or 25mg/150mg orally every day; can increase the dose if needed after 2-4 weeks. Do not exceed 300mg/25mg
Maintenance dose-25mg/300mg orally every day
Dose Adjustments
Renal impairment
CrCl<30ml/min: caution is needed for the use. When CrCl is below 30 mL/min, hydrochlorothiazide is typically ineffective and contraindicated in anuric individuals; aliskiren has the potential to cause hyperkalemia and progressive renal failure
CrCl>30ml/min: No dosage adjustment is needed
Hepatic impairment
No dosage adjustment needed
Initial dose:5mg/20mg orally once a day, can increase the dose after 1-2 weeks
Maintenance dose-10mg/40mg orally once a day
lisinopril/hydrochlorothiazide
Initial dose-10 to 80mg/6.25 to 50mg orally once a day. May increase the dose after 2 to 3 weeks. Do not exceed 80mg/50mg per day
eprosartan/hydrochlorothiazide
600mg/12.5mg to 600mg/25mg orally everyday
Initial dose: 1 tablet (80-160mg valsartan/12.5-25mg hydrochlorothiazide) per day orally
Maintenance dose: May increase the dose after 1-2 weeks to a maximum dose of 320mg valsartan/25mg hydrochlorothiazide daily
Dose Adjustments
Renal impairment
CrCl less than 30 mL/min: Because hydrochlorothiazide is not anticipated to be filtered into the renal tubule, which is where it acts when the glomerular filtration rate is less than 30 mL/min, hydrochlorothiazide-valsartan is not advised
methyldopa/hydrochlorothiazide
methyldopa 500mg/hydrochlorothiazide 30 to 50mg orally every day
methyldopa 250mg/hydrochlorothiazide 25mg orally twice a day or
methyldopa 250mg/hydrochlorothiazide 15mg orally twice or thrice a day
Do not exceed 50mg of hydrochlorothiazide every day
Dose Adjustments
Renal impairment
In patients with creatinine clearance (CrCl) of less than 30 mL/min, valsartan/hydrochlorothiazide should be avoided due to the potential for azotemia (elevated blood urea nitrogen and creatinine levels)
moexipril 7.5mg to 15mg/hydrochlorothiazide 12.5 to 25mg orally before a meal once a day
If hydrochlorothiazide 25 mg once a day monotherapy is effective in controlling blood pressure, but considerable potassium loss still occurs, hydrochlorothiazide 6.25 mg-moexipril 3.75 mg may be used to manage blood pressure without causing electrolyte disturbances (one-half of a hydrochlorothiazide 12.5-moexipril 7.5 mg tablet)
25 - 15
mg-- captopril/hydrochlorothiazide
Orally
every day
Do not exceed 150 mg/50 mg captopril/hydrochlorothiazide
0.1 - 0.3
mg/15 mg
Orally
every day or divided into 2 times a day
Do not exceed 0.6 mg/30 mg per day
30 - 60
mg
Tablets (extended release)
Orally
once a day
7 - 14
days
when required<
should not exceed more than 120 mg/day (Procardia XL) or 90 mg/day (Adalat CC)
(10 mg/12.5 mg) or (20 mg/12.5 mg) orally each day Increase the dose from either of the drug components based on the clinical response Do not increase the hydrochlorothiazide part more than every 2-3 weeks
Dose Adjustments
Renal impairment- When CrCl ≥30 mL/min; no dose modification is required When CrCl <30 mL/min/1.73 m² or the serum creatinine ≥3 mg/dL, the drug is not recommended
metoprolol/hydrochlorothiazide
Renal impairment-
In case of renal impairment, use the medication with caution
Thiazides may develop a cumulative effect if given in the impaired renal function
:
Lopressor HCT: 50-100 mg metoprolol tartrate and 25-50 mg hydrochlorothiazide orally each day as single or divided doses
Dutoprol: 25-100mg metoprolol succinate and 12.5 mg hydrochlorothiazide orally each day as a single dose
The drug is not indicated for initial therapy
candesartan/hydrochlorothiazide
16-32 mg candesartan and 12.5-25 mg hydrochlorothiazide orally each day; the therapeutic effect is expected within 4 weeks
propranolol/hydrochlorothiazide
1 tablet (40/25 mg) orally every 12 hours. If the propranolol dose is more than 160 mg, do not use the combination of the two drugs
Dose Adjustments
Renal impairment-
In case of renal impairment, use the dose with caution
Hepatic impairment-
Adjust the dose in case of severe hepatic impairment
1 tablet (2.5/10 mg) orally each day. Titrate an appropriate dose to control the blood pressure.
Do not increase the dose to more than 10/80 mg per day
1 tablet (2.5/10 mg) orally each day. Titrate an appropriate dose to control the blood pressure.
Do not increase the dose to more than 10/80 mg per day
Dose Adjustments
Renal impairment-
In case of renal impairment, when CrCl<30 ml/min, decrease the dose
In case of severe renal impairment, co-administer the dose with a diuretic
Hepatic impairment-
2.5 mg based on the initial dose of amlodipine
1 tablet (2.5/10 mg) orally each day. Titrate an appropriate dose to control the blood pressure.
Do not increase the dose to more than 10/80 mg per day
Dose Adjustments
Renal impairment-
In case of renal impairment, when CrCl<30 ml/min, decrease the dose
In case of severe renal impairment, co-administer the dose with a diuretic
Hepatic impairment-
2.5 mg based on the initial dose of amlodipine
1 tablet (2.5/10 mg) orally each day. Titrate an appropriate dose to control the blood pressure.
Do not increase the dose to more than 10/80 mg per day
Dose Adjustments
Renal impairment-
In case of renal impairment, when CrCl<30 ml/min, decrease the dose
In case of severe renal impairment, co-administer the dose with a diuretic
Hepatic impairment-
2.5 mg based on the initial dose of amlodipine
benazepril/hydrochlorothiazide
1 tablet (2.5/10 mg) orally each day. Titrate an appropriate dose to control the blood pressure.
Do not increase the dose to more than 10/80 mg per day
Initially, 5 mg/160 mg orally each day
Titrate an appropriate dose to control the blood pressure.
Increase the dose after 2 weeks. Do not exceed the dose of more than 10 mg/day for amlodipine and 320 mg/day for valsartan
Dose Adjustments
Renal impairment-
In case of moderate renal impairment, dose adjustment is not required
In severe renal impairment (CrCl>30 ml/min), dose adjustment is not studied
Hepatic impairment-
Increase the dose in case of hepatic impairment
5
mg
Orally
twice a day; may increase up to 10 mg
3 - 4
week
amlodipine/valsartan/hydrochlorothiazide
12.5-25mg hydrochlorothiazide/
5-10mg amlodipine/160-320 mg valsartan/ every Day
if needed May increase dose after 2 weeks
But should not exceed more than 10 mg/320 mg/25 mg orally once daily
Dose Adjustments
Renal & Hepatic Impairment
Renal impairment
Dose adjustment is not necessary with mild to moderate
Safety and efficacy not established with severe
Hepatic impairment
amlodipine: half-life is increased to 56 hr with an impaired hepatic function and metabolised by liver
valsartan: dose adjustment not necessary with mild to severe hepatic impairment
hydrochlorothiazide: alterations of fluid and electrolyte balance in patients with impaired hepatic function may lead to hepatic coma
Herb or crude fruit in the form of tea
10g/day
Begin with 1.25 mg orally every morning then the dose can be raised every 4 weeks to a maximum of 5 mg every morning
Initial dose: Administer 4mg orally twice a day, with the possibility of dose increases of 4 to 8 mg/day every 1 to 2 weeks.
Maintenance dose: Administer 4 to 16mg orally twice a day
Do not exceed 32mg orally twice a day
1 tablet orally every day
Dosage Modifications
Hepatic impairment
Mild: dose modification not required
Moderate: Not suggested
Severe: not suggested
Renal impairment
Mild or moderate: dose modification not required
Moderate and severe: study not performed
Initial dose: Administer 2.5mg/3.5mg orally with or without the food every day
Wait 7–14 days between titration stages and adjust dosage in accordance with blood pressure objectives.
Do not exceed 10mg/14mg every day
Dose Adjustments
Renal impairment
CrCl 30 to 80ml/min: No to exceed 5/7mg
CrCl<30ml/min: Not suggested
Hepatic impairment
Dosing suggestions are unsupported
fosinopril/hydrochlorothiazide
Initial oral dose: 10 mg/12.5 mg every day
Dosage range: 10-80 mg/12.5-50 mg orally every day
Combination treatment recommended for individuals who have insufficiently controlled blood pressure with either fosinopril or hydrochlorothiazide as standalone therapies
4 - 8
mg
every day
or divided 2 times a day; increase up to 16 mg/day
Diuretic may be added
20
mg/day
Orally
; increased to 40 mg after 2 weeks
Following may be Diuretic added
spironolactone and hydrochlorothiazide
1-2 tablets/day orally (hydrochlorothiazide 50 mg/ spironolactone 50 mg)
2-4 tablets/day orally (hydrochlorothiazide 25 mg/ spironolactone 25 mg)
Dose Adjustments
Renal Impairment
hydrochlorothiazide efficacy decreased when CrCL <30 mL/min
Hepatic Impairment
Contraindicated in Acute or severe hepatic failure
Take a dose of 10 mg orally every 6 hours for 2 to 4 days; also take a dose of 25 mg every 6 hours daily for the initial week
Then raise dose up to 50 mg every 6 hour from next week
Administer a dose of 20 to 40 mg intramuscularly or intravenously and repeat as required
Take 20 to 40 mg orally every 8 hours
Administer dose of 5 mg/hr intravenously by slow infusion initially and it may be raised by 2.5 mg/hr every 15 minutes
Not more than 15 mg/hr
Indicated for Hypertension
Initial Dose:600mg orally every day
Maintenance Dose:400-800mg orally every day or in divided doses two times a day.
Renal Impairment
The patient should be carefully monitored. The maximum daily dosage should not exceed 600 mg
Hepatic Impairment
The patient should be carefully monitored. The maximum daily dosage should not exceed 600 mg
cilazapril/hydrochlorothiazide
Take dose of cilazapril 2.5 to 10 mg with hydrochlorothiazide 6.25 to 25 mg daily
Dosage modification
Renal Impairment
CrCl ≥10 ml/minute: reduced dose of cilazapril
CrCl <10 ml/minute: not suggested
Hepatic Impairment
Reduced dose of cilazapril
Take an initial dose of 2.5 mg one time a day
Maximum dose not more than 10 mg one time a day
Dosing modifications
Renal Impairment
For Heart failure
CrCl >40 ml/minute: take initial dose of 0.5 mg one time a day
CrCl 10 to 40 ml/minute: take initial dose of 0.25 to 0.5 mg one time a day
CrCl <10 ml/minute: Use not suggested
For Hypertension
CrCl >40 ml/minute: take initial dose of 1 mg one time a day
CrCl 10 to 40 ml/minute: take initial dose of 0.5 mg one time a day
CrCl <10 ml/minute: Use not suggested
Hepatic Impairment
For Hypertension
Take initial dose of ≤0.5 mg one time a day and use cautiously
Oral
Initial dose: 2.5 to 5 mg orally every day
Maintenance dose: 10 to 40 mg orally every day or divided every 2 times a day
Intravenous
1.25 mg/dose Intravenous over 5 minutes every 4 times a day; doses till 5 mg/dose Intravenous every 4 times a day can be administered
Initially, 50 mg/12.5 mg orally each day
If the dose is upwardly titrated, do not exceed the last titration of more than 100 mg/25mg orally each day
Initially, if the volume is decreased, reduce the losartan to 25 mg orally each day
Hypertension with Left Ventricular Hypertrophy
Firstly, give monotherapy of losartan
If the blood pressure is reduced inadequately, start with losartan/hydrochlorothiazide
Initially, 50 mg/12.5 mg orally each day
Increase to 100 mg/12.5 mg orally each day and then simultaneously to 100 mg/25 mg if required to control blood pressure
The starting oral dose is 50 mg one time daily
If necessary and well-tolerated, the dose may be gradually increased to orally intake of 100 mg daily for maintenance dose
Indicated for Hypertension
Initial dose: 7.5 mg orally every day, one day before the meal
Or
3.75 mg orally every day if on the thiazide diuretic
Maintenance dose: 7.5 mg-30 mg orally every day or divided two times a day
Administer the dose one hour prior to the meal
Renal Impairment
Sr.CrCl <40 ml/min:
Initial dose: 3.75 mg orally every day
It should not exceed 15 mg in a day
and Osteoarthritis
:
For each dose strength, 200 mg celecoxib only used once a day.
Initial dose: 5mg amlodipine /200mg celecoxib orally daily, or 2.5 mg/200 mg in tiny, fragile, elderly, or patients with moderate hepatic impairment
Take 2.5mg amlodipine /200mg celecoxib when used with other antihypertensive medications
Adjust amlodipine component dosage based on goals of blood pressure; in general, wait 1-2 weeks between the titration steps; when more rapid titration is clinically indicated, closely monitor
should not exceed more than 10mg amlodipine /200mg celecoxib
Dose Adjustments
Dosage Modifications
Renal impairment
Mild - moderate: dose adjustment is not necessary
Severe (CrCl less than 30 mL/min): Not advised (NSAIDs are not advised in severe renal impairment)
Hepatic impairment
Mild (Child Pugh score A): Start with a lower dosage of 2.5mg amlodipine /200mg celecoxib
Moderate (Child-Pugh B): Not recommended; in patients with moderate hepatic impairment, the daily recommended dose of celecoxib should be reduced by 50%; however, because the combination provides a single dose strength of 200 mg celecoxib, it is not advised
Severe (Child Pugh score C): Not advised
Take a dose of 1 mg orally in a day
If required, after 1 month, the dose may be raised to 2 mg daily given in divided doses
25-50 mg orally given two times a day after the meals
Patients who don't have volume depletion
80-160 mg orally daily
maximum dose is 320 mg orally daily
If further antihypertensive impact is necessary, the dose may be increased to a maximum of 320 mg daily or a diuretic may be added
The majority of the antihypertensive impact is felt within the first two weeks, and the maximum decrease is often reached after four weeks
Higher impact than dosage increases of more than 80 mg is the addition of a diuretic
Initiate treatment with an oral dose of 5 mg per day
The dosage can be raised by 2.5 mg per day every 7 to 14 days if necessary
However, the maximum recommended daily dose should not exceed 10 mg
For maintenance, a daily dosage range of 5 to 10 mg is typically advised
Begin with a daily oral dose of 50 mg
This can be raised to a maximum of 100 mg per day if needed
For patients who might have low fluid volume within blood vessels or are taking diuretics (medications that promote urination), start with 25 mg taken orally once a day
Invivo data suggests the starting dosage for the medication involves oral administration of 20 mg every day and increased by twofold every fourth day until the desired outcome is achieved
40 mg of a loading dosage may be utilized when a quicker response is required
Administer 5 mg orally twice daily, with the option to escalate the dosage to 20 to 75 mg/day, divided into 2 to 4 doses as necessary
The oral dose is 10 mg to 20 mg once to twice a day
The dosage may be enhanced by 10 mg to 20 mg for each three to four days based on the seriousness of the disease
The maintenance dose is 20 mg to 120 mg a day
Dose Adjustments
Initially, 5-10 mg once daily
Increase the dose to 20 mg each based on tolerability and response
Indicated for essential hypertension
In vivo data suggests 150 mg one time orally in a day
Indicated for Severe/Refractory Hypertension
Initial dose: 5 mg orally every day; enhance the dose every three days if necessary
Maintenance dose: 2.5 mg to 80 mg one-two time a day
It should not exceed 100 mg in a day
Initial dose-administer 2mg orally in the morning. may increase the dose to 4mg/day after 3 to 4 weeks.
Do not exceed 6mg/day.
Take a dose of 80 to 160 mg orally daily in 2 or 3 divided doses
Daily dose should not be more than 320 mg
6 to 12 mg in a day
Indicated for chronic hypertension
12.5-25 mg orally once daily
Evaluate the response 2-4 weeks later and titrate the dose as required
Due to higher adverse effects, a dose of more than 25 mg/day is not recommended
Consider a combination therapy with additional BP-controlling agents
The suggested dose is 50 to 200 mg orally every day
In some instances, a daily dosage of a maximum of 300 mg may be needed for a few patients
Indicated for Essential hypertension
In the beginning, a dose of 5 mg one time a day is recommended, with the possibility of raising it to 10 mg a day if the desired level of BP control is not attained within a minimum of three weeks of treatment
The maximum allowable dosage is 20 mg in a day
Take a dose of 5 to 20 mg orally one time in a day
Take a maintenance dose of 10 to 20 mg one time in a day
50 to 100 mg orally daily
Dose Adjustments
200-400 mg orally each day in two divided doses
Take daily 1 to 4 tablets orally
Indicated for Hypertension
10 mg orally every day
If required, enhance the dose 20 mg orally every day
As a monotherapy or in the combination with antihypertensive agents: Usual daily dose: 25 to 50 mg daily. Maintenance dose: 25 to 50 mg on the alternate days
Dose Adjustments
Dosing modifications
Renal impairment: Contraindicated in severe cases
Hepatic impairment: Contraindicated in severe cases
10 to 20 mg daily
1-2 combination tablets each day in the morning
Take an initial dose of 200 mcg orally one time daily in the morning, then it may raise if required; after 3 weeks, up to 400 mcg daily as a single dose
Indicated for Hypertension
4 mg to 16 mg orally in divided two times a day
Angina pectoris
8 mg to 16 mg orally every day
Cerebrovascular disorders
2 mg to 4 mg orally two times a day
5 mg is administered once a day, up to 10 mg daily if required
ER TABLETS
Age: > 6 years old
:
Initial dose: 1 mg/kg orally once a day
Maximum dose: 2 mg/kg orally once a day
0.5 - 1
mg/kg
Orally
once a day
; do not exceed 2 mg/kg per day
Off-label:
Initial: 0.05-0.1 mg/kg orally once a day
(Off-label)
IR:
1 - 4
mg
Orally
once a day
(Off-label) :
1
mg
Orally
once a day
increase up to 20 mg per day
13
mg/kg
Orally
once a day
or divided for every 12hr
do not exceed 1200 mg per day
1.5-2mg/kg/day orally divided every 8 hours. Do not exceed 6mg/kg/day
0.25 - 0.5
mg
Tablets(extended release)
Orally
once a day
should not exceed more than 3 mg/kg/day (120 mg/day)
Age: 6-16 yrs:
Body weight 20-35 kg: 10 mg/day orally daily; increase up to 20 mg after 2 weeks if there is inadequate response
Body weight >35 kg: 20 mg/day orally daily; increase up to 40 mg after 2 weeks if there is inadequate response
do not exceed 40 mg/day
Administer dose of 1.7 to 3.5 mg/kg daily intramuscularly or intravenously divided in 4 to 6 doses
Administer dose of 0.5 to 3 mcg/kg/min intravenously
1 month to 16 yrs (oral)
Initial dose: 0.08 mg/kg/day orally or divided every 2 times a day; should not exceed more than 5 mg/day
May increase, when necessary, every two weeks according to the blood pressure should not exceed more than 0.58 mg/kg/day (40 mg/day)
1 month to 16 yrs (Intravenous)
0.01 to 0.02 mg/kg daily divided every 2 times a day by Intravenous infusion
Hypertensive Crisis
0.05 to 0.1 mg/kg by direct Intravenous injection
Renal Impairment
The GFR less than 30 mL/min/1.73 m²: usually Not recommended
Age: > 1 year
1 mg/kg orally daily
Modify dosage according on blood pressure response
Consider a larger initial dosage of 2 mg/kg in select situations if a greater drop in blood pressure is required
Age: 6-17 years
The use of doses exceeding 5 mg/day orally has not been investigated
The recommended dosage range is 2.5 to 5 mg per day
Indicated for Severe/Refractory Hypertension
Age <12 years
Initial dose: 0.1 mg/Kg to 0.2 mg/Kg orally every day; It should not exceed 5 mg in a day. Titrate it for every three days for a response
Maintenance dose: 0.25 mg/Kg to 1 mg/Kg orally one-two times a day
It should not exceed 50 mg in a day
Age >12 years
Initial dose: 5 mg orally every day; enhance the dose every three days if necessary
Maintenance dose: 2.5 mg to 80 mg one-two time a day
It should not exceed 100 mg in a day
Initially, 0.3 mg/kg once each day
Titrate up to a maximum dose of 2mg/kg each day or 50 mg each day
above 12 years: Initial Recommended dose is 1 mg/kg daily
Dose Adjustments
Dosing modifications
Renal impairment: Contraindicated in severe cases
Hepatic impairment: Severe: Contraindicated in severe cases
Initial dose: 200-400mg/day divided orally. Do not exceed 800mg/day
30 - 60
mg
Tablets (extended release)
Orally
once a day
7 - 14
days
should not exceed more than 120 mg/day (Procardia XL)
metoprolol/hydrochlorothiazide
Lopressor HCT: 50-100 mg metoprolol tartrate and 25-50 mg hydrochlorothiazide orally each day as single or divided doses
Dutoprol: 25-100mg metoprolol succinate and 12.5 mg hydrochlorothiazide orally each day as a single dose
The drug is not indicated for initial therapy
amlodipine/valsartan/hydrochlorothiazide
Initiate with 2.5 mg orally every day, if needed May increase dose after 2 weeks
But should not exceed more than 10 mg/320 mg/25 mg orally once daily
and osteoarthritis
:
For each dose strength, 200 mg celecoxib only used once a day.
Initial dose: 2.5mg amlodipine /200mg celecoxib orally daily in tiny, fragile, elderly, or patients with moderate hepatic impairment
Initiate with a daily dose of 5 mg orally in the beginning
Indicated for Hypertension
2.5 mg orally every day. Titrate it for response gradually
Indicated for Essential hypertension
At starting, Take 2.5 mg one time a day, with the option for adjustment based on BP responsiveness
The maximum dosage should not exceed 10 mg in a day
Future Trends
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477925/
www.ncbi.nlm.nih.gov/books/NBK539859/
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» Home » CAD » Cardiology » Atherosclerosis and Risk factors » Hypertension
Hypertension is characterized by a systolic blood pressure of 130 mmHg or a diastolic blood pressure of 80 mmHg. One of the most prevalent chronic conditions, hypertension, is defined by a continuous rise in arterial pressure.
One of the most significant comorbidities influencing the emergence of stroke, myocardial infarction, heart failure, and renal failure, hypertension has been one of the most researched subjects of the past century.
There is consensus that persistent blood pressure readings of 140/90mmHg or above should be treated with the conventional therapeutic aim of 130/80mmHg or less. The definition and classifications of hypertension have been developing throughout time.
Around the world, more than a billion adults have hypertension, which impacts up to 45% of the adult population. All socioeconomic classes have significant rates of hypertension, which increase with age, reaching up to 60% over the age of 60.
Hypertension causes more cardiovascular disease-related deaths in the US than any other modifiable risk factor.
It is the second-leading preventable cause of death worldwide after cigarette smoking. Recent estimates suggest by 2025, there may be up to 1.5 billion people worldwide with hypertension, an increase of up to 15% or 20%.
An essential regulator of blood volume is sodium (Na+). High serum Na+ levels promote water retention, increasing blood volume and pressure. In normotensive adults, compensatory hemodynamic adjustments stabilize blood pressure as dietary Na+ increases. Nitric oxide generation from the endothelium increased, while renal and peripheral vascular resistance reduced.
However, blood pressure increases if nitric oxide’s impact is diminished or nonexistent. Endothelial dysfunction is a risk factor for the emergence of salt sensitivity and hypertension. Salt sensitivity is characterized by an increase in systolic blood pressure of at least 10 mmHg within a few hours of intake. It is defined as a considerable increase in blood pressure after a Na+ load of less than 5 g.
Renin- Angiotensin-Aldosterone System [RAAS]
RAAS is found in multiple organs at the cellular level. However, its most essential function is to assist in regulating pressure-volume balance in the kidney, where it maintains perfusion in states of volume depletion and is inhibited in circumstances of fluid excess. The juxtaglomerular cells of the kidney produce and store renin and its precursor, pro-renin, which are then released in response to various stimuli. Renin’s primary function is to break down angiotensinogen to create angiotensin I.
The pathogenetic significance of RAAS in hypertension is centered on how the angiotensin-converting enzyme (ACE) converts angiotensin I into angiotensin II. By enhancing the function of the sodium-hydrogen exchanger, sodium-bicarbonate exchanger, and sodium-potassium ATPase, as well as promoting aldosterone production and release from the adrenal glomerulosa, angiotensin II improves Na+ reabsorption in the proximal tubule.
Angiotensin II is also associated with endothelial dysfunction and causes renal, cardiac, and vascular damage. These effects are pro-fibrotic and pro-inflammatory and are mediated mainly by increased oxidative stress. Angiotensin II is strongly aligned to target organ damage in hypertension through these processes. Aldosterone plays a significant role in hypertension by binding to the mineralocorticoid receptor and inducing non-genomic effects.
These effects include activating the amiloride-sensitive sodium channel, also known as the epithelial sodium channel, which stimulates renal Na+ reabsorption in the cortical collecting duct. Additionally, aldosterone has a wide range of non-epithelial actions that support hypertension, vasoconstriction, and endothelial dysfunction. These include vascular fibrosis, extracellular matrix deposition, vascular remodeling, vascular smooth muscle cell proliferation, and elevated oxidative stress.
Idiopathic or essential hypertension is the most common type of hypertension. It has been hypothesized that consuming more salt increases the potential risk of hypertension.
The patient’s genetic ability for a salt response is identified as one of the elements contributing to the development of hypertension. Salt sensitivity affects 50 to 60 % of the patients, who are more likely to develop hypertension.
The prognosis depends on blood pressure control and is positive if blood pressure is well controlled; nevertheless, as hypertension is a progressive condition, complications may occur in a few patients.
Adequate lifestyle and management measures accomplish little more to delay the onset and progression of complications like chronic kidney disease and renal failure.
The treatment paradigm for hypertension (high blood pressure) typically involves a combination of lifestyle modifications and pharmaceutical interventions. Here is an overview of the treatment paradigm for hypertension:
Lifestyle Modifications:
Dietary changes: Encourage a balanced diet rich in fruits, vegetables, whole grains, and low-fat dairy products. Emphasize the importance of reducing sodium (salt) intake and limiting alcohol consumption.
Regular exercise: Recommend at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with muscle-strengthening activities at least twice a week.
Weight management: Promote weight loss for overweight or obese individuals to achieve a healthy body weight, as excess weight contributes to increased blood pressure.
Sodium restriction: Encourage reducing sodium intake to less than 2,300 milligrams per day (and even lower for certain populations, such as those with diabetes or kidney disease).
Limit alcohol consumption: Advise moderate alcohol consumption (up to one drink per day for women and up to two drinks per day for men) or complete abstinence if recommended by a healthcare provider.
Pharmaceutical Interventions:
Stepwise medication approach: Initiate antihypertensive medication based on the individual’s blood pressure levels, comorbidities, and risk factors.
First-line medications: Typically, thiazide diuretics (e.g., hydrochlorothiazide) or ACE inhibitors (e.g., lisinopril) are recommended as initial therapy due to their effectiveness, safety profile, and cost.
Combination therapy: If blood pressure goals are not achieved with a single medication, combination therapy with two or more antihypertensive agents from different drug classes may be prescribed.
Medication adherence: Emphasize the importance of taking medications as prescribed and educate patients about potential side effects and drug interactions.
Regular blood pressure monitoring: Encourage patients to monitor their blood pressure regularly at home and provide feedback to their healthcare provider.
Ongoing Management and Monitoring:
Follow-up visits: Schedule regular follow-up visits to monitor blood pressure, assess medication effectiveness and potential side effects, and adjust treatment as necessary.
Risk factor management: Address and manage other cardiovascular risk factors, such as diabetes, dyslipidemia (abnormal lipid levels), and smoking cessation.
Patient education: Provide comprehensive education on hypertension, its risks, and the importance of lifestyle modifications and medication adherence.
Promote healthier food choices: Collaborate with food manufacturers, restaurants, and cafeterias to provide and promote low-sodium options, reduce the availability of high-sodium processed foods, and clearly label nutritional information.
Creating smoke-free environments is crucial for individuals with hypertension, as exposure to tobacco smoke can significantly increase the risk of cardiovascular problems. Here are some speciality-wise suggestions for establishing smoke-free environments:
Healthcare facilities: Implement strict no-smoking policies in hospitals, clinics, and other healthcare settings. Provide designated outdoor smoking areas away from entrances and windows.
Public spaces: Advocate for smoke-free policies in public areas such as parks, playgrounds, and outdoor recreational areas to protect individuals, especially children, from secondhand smoke.
Educational campaigns: Collaborate with schools, community centers, and workplaces to raise awareness about the dangers of smoking and the importance of smoke-free environments.
Smoking cessation programs: Offer comprehensive smoking cessation programs that include counseling, support groups, and access to medication to assist individuals in quitting smoking.
Patient education: Educate patients about the risks of smoking and secondhand smoke, emphasizing the importance of maintaining a smoke-free home and car.
Nicotine replacement therapy (NRT): Provide access to NRT products, such as nicotine patches, gum, or lozenges, to assist individuals in quitting smoking and reducing withdrawal symptoms.
ACE inhibitors (Angiotensin-Converting Enzyme inhibitors) are a class of pharmaceutical agents commonly used for the treatment of hypertension. They work by blocking the enzyme responsible for converting angiotensin I into angiotensin II, a hormone that constricts blood vessels and increases blood pressure. By inhibiting this enzyme, ACE inhibitors help relax and widen the blood vessels, reducing blood pressure and improving blood flow.
Here are some key points about ACE inhibitors for hypertension:
Calcium channel blockers (CCBs) are a class of medications commonly used for the management of hypertension (high blood pressure). These medications work by blocking calcium channels in the smooth muscle cells of blood vessels, leading to relaxation and dilation of the vessels, which helps to lower blood pressure. Here are some important points regarding the use of CCBs for hypertension:
Types of Calcium Channel Blockers:
Diuretics are commonly prescribed medications for the treatment of hypertension (high blood pressure). They work by increasing the excretion of sodium and water from the body, reducing the volume of fluid in the blood vessels, and thereby lowering blood pressure. Here are some important points to know about diuretics for hypertension:
Glucocorticoid receptor antagonists, also known as glucocorticoid antagonists or glucocorticoid receptor blockers, are a class of medications that can be used in the management of secondary hypertension. Secondary hypertension refers to high blood pressure caused by an underlying medical condition or medication. Here are some examples of glucocorticoid receptor antagonists that may be used in the treatment of secondary hypertension:
Mifepristone: mifepristone is primarily known as a medication used for pregnancy termination and in the management of certain hormonal disorders. However, it also acts as a glucocorticoid receptor antagonist and can be effective in treating hypertension caused by excess cortisol production (Cushing’s syndrome).
Spironolactone: spironolactone is a potassium-sparing diuretic that is commonly used to treat conditions like primary hyperaldosteronism (Conn’s syndrome), which can lead to secondary hypertension. It also acts as a glucocorticoid receptor antagonist, providing additional benefit in certain cases.
IR tablets
Initial dose:
100
mg
Orally
once a day
Maintenance dose: 100-450 mg orally once a day
ER tablets:
Initial dose: 25-100 mg orally once a day
Maintenance dose: 100-400 mg orally once a day
Initial:
1
mg
Orally
8 - 12
hrs
Maintenance: 6-15 mg once a day or divided 2 to 3 times a day alternatively
1
mg
Orally
once a day
; the dose can be titrated to double the dose up to 16 mg qDay based on blood pressure response
ER: not recommended for HTN
10 - 20
mg
Orally
every 12 hrs
Maintenance: 20-40 mg once a day
Do not exceed 60 mg per day
40 - 320
mg
Tablet
Orally
once a day
Initial:
1
mg
Orally
once a day
Maintenance: 1-5 mg per day for every 12hrsand can increase upto less than 20 mg per day
Dose Adjustments
Dosing considerations
To prevent syncope first dose and subsequent dose preferred at bedtime and can be taken with food
100
mg
Orally
every 12 hrs
initially; increased up to100 mg for 12hrs every 2-3 days Usual dosage range: 200-400 mg orally every 12hrs Do not exceed 2400 mg per day
Nonblack patients:
1
mg
orally
every day
black patients: 2 mg orally every day
Maintenance dose
2-4 mg orally every day or divided in every 12 hours
2.5
mg
Orally
twice a day
; increase to 2.5 mg for at least 2 days
Extended-release capsules:
Initial dose: 120-240mg orally once a day, increasing the dose as needed
Maintenance dose: 120 to 540mg orally once every day
Maximum dose:540mg/day
Extended-release coated capsules
Initial dose: 120-180mg orally once a day; increase the dose as needed
Maintenance dose: 240 to 360mg orally every day
Maximum dose: 480mg/day
Extended-release tablets
Initial dose: 180 to 240mg orally once a day; increase the dose as needed
Maintenance dose: 540mg orally every day
400 - 1200
mg/day
Capsule
Orally
every 12 hours
off-label:
1
mg
Intravenous (IV)
loading dose, followed by 0.5-2 mg/day oral divided every 12 hours.
Initial dose: Initiate with 40mg/5mg or 80mg/5mg orally every day. Do not exceed 80mg/10mg every day
Maximum dose: Telmisartan 80mg-amlodipine 10mg orally every day
Dose Adjustments
Hepatic impairment
Start with a lower dose of 2.5 mg amlodipine and increase the amount gradually
Renal impairment
Dosage adjustment is not required
Initial dose-12.5mg/150mg or 25mg/150mg orally every day; can increase the dose if needed after 2-4 weeks. Do not exceed 300mg/25mg
Maintenance dose-25mg/300mg orally every day
Dose Adjustments
Renal impairment
CrCl<30ml/min: caution is needed for the use. When CrCl is below 30 mL/min, hydrochlorothiazide is typically ineffective and contraindicated in anuric individuals; aliskiren has the potential to cause hyperkalemia and progressive renal failure
CrCl>30ml/min: No dosage adjustment is needed
Hepatic impairment
No dosage adjustment needed
Initial dose:5mg/20mg orally once a day, can increase the dose after 1-2 weeks
Maintenance dose-10mg/40mg orally once a day
lisinopril/hydrochlorothiazide
Initial dose-10 to 80mg/6.25 to 50mg orally once a day. May increase the dose after 2 to 3 weeks. Do not exceed 80mg/50mg per day
eprosartan/hydrochlorothiazide
600mg/12.5mg to 600mg/25mg orally everyday
Initial dose: 1 tablet (80-160mg valsartan/12.5-25mg hydrochlorothiazide) per day orally
Maintenance dose: May increase the dose after 1-2 weeks to a maximum dose of 320mg valsartan/25mg hydrochlorothiazide daily
Dose Adjustments
Renal impairment
CrCl less than 30 mL/min: Because hydrochlorothiazide is not anticipated to be filtered into the renal tubule, which is where it acts when the glomerular filtration rate is less than 30 mL/min, hydrochlorothiazide-valsartan is not advised
methyldopa/hydrochlorothiazide
methyldopa 500mg/hydrochlorothiazide 30 to 50mg orally every day
methyldopa 250mg/hydrochlorothiazide 25mg orally twice a day or
methyldopa 250mg/hydrochlorothiazide 15mg orally twice or thrice a day
Do not exceed 50mg of hydrochlorothiazide every day
Dose Adjustments
Renal impairment
In patients with creatinine clearance (CrCl) of less than 30 mL/min, valsartan/hydrochlorothiazide should be avoided due to the potential for azotemia (elevated blood urea nitrogen and creatinine levels)
moexipril 7.5mg to 15mg/hydrochlorothiazide 12.5 to 25mg orally before a meal once a day
If hydrochlorothiazide 25 mg once a day monotherapy is effective in controlling blood pressure, but considerable potassium loss still occurs, hydrochlorothiazide 6.25 mg-moexipril 3.75 mg may be used to manage blood pressure without causing electrolyte disturbances (one-half of a hydrochlorothiazide 12.5-moexipril 7.5 mg tablet)
25 - 15
mg-- captopril/hydrochlorothiazide
Orally
every day
Do not exceed 150 mg/50 mg captopril/hydrochlorothiazide
0.1 - 0.3
mg/15 mg
Orally
every day or divided into 2 times a day
Do not exceed 0.6 mg/30 mg per day
30 - 60
mg
Tablets (extended release)
Orally
once a day
7 - 14
days
when required<
should not exceed more than 120 mg/day (Procardia XL) or 90 mg/day (Adalat CC)
(10 mg/12.5 mg) or (20 mg/12.5 mg) orally each day Increase the dose from either of the drug components based on the clinical response Do not increase the hydrochlorothiazide part more than every 2-3 weeks
Dose Adjustments
Renal impairment- When CrCl ≥30 mL/min; no dose modification is required When CrCl <30 mL/min/1.73 m² or the serum creatinine ≥3 mg/dL, the drug is not recommended
metoprolol/hydrochlorothiazide
Renal impairment-
In case of renal impairment, use the medication with caution
Thiazides may develop a cumulative effect if given in the impaired renal function
:
Lopressor HCT: 50-100 mg metoprolol tartrate and 25-50 mg hydrochlorothiazide orally each day as single or divided doses
Dutoprol: 25-100mg metoprolol succinate and 12.5 mg hydrochlorothiazide orally each day as a single dose
The drug is not indicated for initial therapy
candesartan/hydrochlorothiazide
16-32 mg candesartan and 12.5-25 mg hydrochlorothiazide orally each day; the therapeutic effect is expected within 4 weeks
propranolol/hydrochlorothiazide
1 tablet (40/25 mg) orally every 12 hours. If the propranolol dose is more than 160 mg, do not use the combination of the two drugs
Dose Adjustments
Renal impairment-
In case of renal impairment, use the dose with caution
Hepatic impairment-
Adjust the dose in case of severe hepatic impairment
1 tablet (2.5/10 mg) orally each day. Titrate an appropriate dose to control the blood pressure.
Do not increase the dose to more than 10/80 mg per day
1 tablet (2.5/10 mg) orally each day. Titrate an appropriate dose to control the blood pressure.
Do not increase the dose to more than 10/80 mg per day
Dose Adjustments
Renal impairment-
In case of renal impairment, when CrCl<30 ml/min, decrease the dose
In case of severe renal impairment, co-administer the dose with a diuretic
Hepatic impairment-
2.5 mg based on the initial dose of amlodipine
1 tablet (2.5/10 mg) orally each day. Titrate an appropriate dose to control the blood pressure.
Do not increase the dose to more than 10/80 mg per day
Dose Adjustments
Renal impairment-
In case of renal impairment, when CrCl<30 ml/min, decrease the dose
In case of severe renal impairment, co-administer the dose with a diuretic
Hepatic impairment-
2.5 mg based on the initial dose of amlodipine
1 tablet (2.5/10 mg) orally each day. Titrate an appropriate dose to control the blood pressure.
Do not increase the dose to more than 10/80 mg per day
Dose Adjustments
Renal impairment-
In case of renal impairment, when CrCl<30 ml/min, decrease the dose
In case of severe renal impairment, co-administer the dose with a diuretic
Hepatic impairment-
2.5 mg based on the initial dose of amlodipine
benazepril/hydrochlorothiazide
1 tablet (2.5/10 mg) orally each day. Titrate an appropriate dose to control the blood pressure.
Do not increase the dose to more than 10/80 mg per day
Initially, 5 mg/160 mg orally each day
Titrate an appropriate dose to control the blood pressure.
Increase the dose after 2 weeks. Do not exceed the dose of more than 10 mg/day for amlodipine and 320 mg/day for valsartan
Dose Adjustments
Renal impairment-
In case of moderate renal impairment, dose adjustment is not required
In severe renal impairment (CrCl>30 ml/min), dose adjustment is not studied
Hepatic impairment-
Increase the dose in case of hepatic impairment
5
mg
Orally
twice a day; may increase up to 10 mg
3 - 4
week
amlodipine/valsartan/hydrochlorothiazide
12.5-25mg hydrochlorothiazide/
5-10mg amlodipine/160-320 mg valsartan/ every Day
if needed May increase dose after 2 weeks
But should not exceed more than 10 mg/320 mg/25 mg orally once daily
Dose Adjustments
Renal & Hepatic Impairment
Renal impairment
Dose adjustment is not necessary with mild to moderate
Safety and efficacy not established with severe
Hepatic impairment
amlodipine: half-life is increased to 56 hr with an impaired hepatic function and metabolised by liver
valsartan: dose adjustment not necessary with mild to severe hepatic impairment
hydrochlorothiazide: alterations of fluid and electrolyte balance in patients with impaired hepatic function may lead to hepatic coma
Herb or crude fruit in the form of tea
10g/day
Begin with 1.25 mg orally every morning then the dose can be raised every 4 weeks to a maximum of 5 mg every morning
Initial dose: Administer 4mg orally twice a day, with the possibility of dose increases of 4 to 8 mg/day every 1 to 2 weeks.
Maintenance dose: Administer 4 to 16mg orally twice a day
Do not exceed 32mg orally twice a day
1 tablet orally every day
Dosage Modifications
Hepatic impairment
Mild: dose modification not required
Moderate: Not suggested
Severe: not suggested
Renal impairment
Mild or moderate: dose modification not required
Moderate and severe: study not performed
Initial dose: Administer 2.5mg/3.5mg orally with or without the food every day
Wait 7–14 days between titration stages and adjust dosage in accordance with blood pressure objectives.
Do not exceed 10mg/14mg every day
Dose Adjustments
Renal impairment
CrCl 30 to 80ml/min: No to exceed 5/7mg
CrCl<30ml/min: Not suggested
Hepatic impairment
Dosing suggestions are unsupported
fosinopril/hydrochlorothiazide
Initial oral dose: 10 mg/12.5 mg every day
Dosage range: 10-80 mg/12.5-50 mg orally every day
Combination treatment recommended for individuals who have insufficiently controlled blood pressure with either fosinopril or hydrochlorothiazide as standalone therapies
4 - 8
mg
every day
or divided 2 times a day; increase up to 16 mg/day
Diuretic may be added
20
mg/day
Orally
; increased to 40 mg after 2 weeks
Following may be Diuretic added
spironolactone and hydrochlorothiazide
1-2 tablets/day orally (hydrochlorothiazide 50 mg/ spironolactone 50 mg)
2-4 tablets/day orally (hydrochlorothiazide 25 mg/ spironolactone 25 mg)
Dose Adjustments
Renal Impairment
hydrochlorothiazide efficacy decreased when CrCL <30 mL/min
Hepatic Impairment
Contraindicated in Acute or severe hepatic failure
Take a dose of 10 mg orally every 6 hours for 2 to 4 days; also take a dose of 25 mg every 6 hours daily for the initial week
Then raise dose up to 50 mg every 6 hour from next week
Administer a dose of 20 to 40 mg intramuscularly or intravenously and repeat as required
Take 20 to 40 mg orally every 8 hours
Administer dose of 5 mg/hr intravenously by slow infusion initially and it may be raised by 2.5 mg/hr every 15 minutes
Not more than 15 mg/hr
Indicated for Hypertension
Initial Dose:600mg orally every day
Maintenance Dose:400-800mg orally every day or in divided doses two times a day.
Renal Impairment
The patient should be carefully monitored. The maximum daily dosage should not exceed 600 mg
Hepatic Impairment
The patient should be carefully monitored. The maximum daily dosage should not exceed 600 mg
cilazapril/hydrochlorothiazide
Take dose of cilazapril 2.5 to 10 mg with hydrochlorothiazide 6.25 to 25 mg daily
Dosage modification
Renal Impairment
CrCl ≥10 ml/minute: reduced dose of cilazapril
CrCl <10 ml/minute: not suggested
Hepatic Impairment
Reduced dose of cilazapril
Take an initial dose of 2.5 mg one time a day
Maximum dose not more than 10 mg one time a day
Dosing modifications
Renal Impairment
For Heart failure
CrCl >40 ml/minute: take initial dose of 0.5 mg one time a day
CrCl 10 to 40 ml/minute: take initial dose of 0.25 to 0.5 mg one time a day
CrCl <10 ml/minute: Use not suggested
For Hypertension
CrCl >40 ml/minute: take initial dose of 1 mg one time a day
CrCl 10 to 40 ml/minute: take initial dose of 0.5 mg one time a day
CrCl <10 ml/minute: Use not suggested
Hepatic Impairment
For Hypertension
Take initial dose of ≤0.5 mg one time a day and use cautiously
Oral
Initial dose: 2.5 to 5 mg orally every day
Maintenance dose: 10 to 40 mg orally every day or divided every 2 times a day
Intravenous
1.25 mg/dose Intravenous over 5 minutes every 4 times a day; doses till 5 mg/dose Intravenous every 4 times a day can be administered
Initially, 50 mg/12.5 mg orally each day
If the dose is upwardly titrated, do not exceed the last titration of more than 100 mg/25mg orally each day
Initially, if the volume is decreased, reduce the losartan to 25 mg orally each day
Hypertension with Left Ventricular Hypertrophy
Firstly, give monotherapy of losartan
If the blood pressure is reduced inadequately, start with losartan/hydrochlorothiazide
Initially, 50 mg/12.5 mg orally each day
Increase to 100 mg/12.5 mg orally each day and then simultaneously to 100 mg/25 mg if required to control blood pressure
The starting oral dose is 50 mg one time daily
If necessary and well-tolerated, the dose may be gradually increased to orally intake of 100 mg daily for maintenance dose
Indicated for Hypertension
Initial dose: 7.5 mg orally every day, one day before the meal
Or
3.75 mg orally every day if on the thiazide diuretic
Maintenance dose: 7.5 mg-30 mg orally every day or divided two times a day
Administer the dose one hour prior to the meal
Renal Impairment
Sr.CrCl <40 ml/min:
Initial dose: 3.75 mg orally every day
It should not exceed 15 mg in a day
and Osteoarthritis
:
For each dose strength, 200 mg celecoxib only used once a day.
Initial dose: 5mg amlodipine /200mg celecoxib orally daily, or 2.5 mg/200 mg in tiny, fragile, elderly, or patients with moderate hepatic impairment
Take 2.5mg amlodipine /200mg celecoxib when used with other antihypertensive medications
Adjust amlodipine component dosage based on goals of blood pressure; in general, wait 1-2 weeks between the titration steps; when more rapid titration is clinically indicated, closely monitor
should not exceed more than 10mg amlodipine /200mg celecoxib
Dose Adjustments
Dosage Modifications
Renal impairment
Mild - moderate: dose adjustment is not necessary
Severe (CrCl less than 30 mL/min): Not advised (NSAIDs are not advised in severe renal impairment)
Hepatic impairment
Mild (Child Pugh score A): Start with a lower dosage of 2.5mg amlodipine /200mg celecoxib
Moderate (Child-Pugh B): Not recommended; in patients with moderate hepatic impairment, the daily recommended dose of celecoxib should be reduced by 50%; however, because the combination provides a single dose strength of 200 mg celecoxib, it is not advised
Severe (Child Pugh score C): Not advised
Take a dose of 1 mg orally in a day
If required, after 1 month, the dose may be raised to 2 mg daily given in divided doses
25-50 mg orally given two times a day after the meals
Patients who don't have volume depletion
80-160 mg orally daily
maximum dose is 320 mg orally daily
If further antihypertensive impact is necessary, the dose may be increased to a maximum of 320 mg daily or a diuretic may be added
The majority of the antihypertensive impact is felt within the first two weeks, and the maximum decrease is often reached after four weeks
Higher impact than dosage increases of more than 80 mg is the addition of a diuretic
Initiate treatment with an oral dose of 5 mg per day
The dosage can be raised by 2.5 mg per day every 7 to 14 days if necessary
However, the maximum recommended daily dose should not exceed 10 mg
For maintenance, a daily dosage range of 5 to 10 mg is typically advised
Begin with a daily oral dose of 50 mg
This can be raised to a maximum of 100 mg per day if needed
For patients who might have low fluid volume within blood vessels or are taking diuretics (medications that promote urination), start with 25 mg taken orally once a day
Invivo data suggests the starting dosage for the medication involves oral administration of 20 mg every day and increased by twofold every fourth day until the desired outcome is achieved
40 mg of a loading dosage may be utilized when a quicker response is required
Administer 5 mg orally twice daily, with the option to escalate the dosage to 20 to 75 mg/day, divided into 2 to 4 doses as necessary
The oral dose is 10 mg to 20 mg once to twice a day
The dosage may be enhanced by 10 mg to 20 mg for each three to four days based on the seriousness of the disease
The maintenance dose is 20 mg to 120 mg a day
Dose Adjustments
Initially, 5-10 mg once daily
Increase the dose to 20 mg each based on tolerability and response
Indicated for essential hypertension
In vivo data suggests 150 mg one time orally in a day
Indicated for Severe/Refractory Hypertension
Initial dose: 5 mg orally every day; enhance the dose every three days if necessary
Maintenance dose: 2.5 mg to 80 mg one-two time a day
It should not exceed 100 mg in a day
Initial dose-administer 2mg orally in the morning. may increase the dose to 4mg/day after 3 to 4 weeks.
Do not exceed 6mg/day.
Take a dose of 80 to 160 mg orally daily in 2 or 3 divided doses
Daily dose should not be more than 320 mg
6 to 12 mg in a day
Indicated for chronic hypertension
12.5-25 mg orally once daily
Evaluate the response 2-4 weeks later and titrate the dose as required
Due to higher adverse effects, a dose of more than 25 mg/day is not recommended
Consider a combination therapy with additional BP-controlling agents
The suggested dose is 50 to 200 mg orally every day
In some instances, a daily dosage of a maximum of 300 mg may be needed for a few patients
Indicated for Essential hypertension
In the beginning, a dose of 5 mg one time a day is recommended, with the possibility of raising it to 10 mg a day if the desired level of BP control is not attained within a minimum of three weeks of treatment
The maximum allowable dosage is 20 mg in a day
Take a dose of 5 to 20 mg orally one time in a day
Take a maintenance dose of 10 to 20 mg one time in a day
50 to 100 mg orally daily
Dose Adjustments
200-400 mg orally each day in two divided doses
Take daily 1 to 4 tablets orally
Indicated for Hypertension
10 mg orally every day
If required, enhance the dose 20 mg orally every day
As a monotherapy or in the combination with antihypertensive agents: Usual daily dose: 25 to 50 mg daily. Maintenance dose: 25 to 50 mg on the alternate days
Dose Adjustments
Dosing modifications
Renal impairment: Contraindicated in severe cases
Hepatic impairment: Contraindicated in severe cases
10 to 20 mg daily
1-2 combination tablets each day in the morning
Take an initial dose of 200 mcg orally one time daily in the morning, then it may raise if required; after 3 weeks, up to 400 mcg daily as a single dose
Indicated for Hypertension
4 mg to 16 mg orally in divided two times a day
Angina pectoris
8 mg to 16 mg orally every day
Cerebrovascular disorders
2 mg to 4 mg orally two times a day
5 mg is administered once a day, up to 10 mg daily if required
ER TABLETS
Age: > 6 years old
:
Initial dose: 1 mg/kg orally once a day
Maximum dose: 2 mg/kg orally once a day
0.5 - 1
mg/kg
Orally
once a day
; do not exceed 2 mg/kg per day
Off-label:
Initial: 0.05-0.1 mg/kg orally once a day
(Off-label)
IR:
1 - 4
mg
Orally
once a day
(Off-label) :
1
mg
Orally
once a day
increase up to 20 mg per day
13
mg/kg
Orally
once a day
or divided for every 12hr
do not exceed 1200 mg per day
1.5-2mg/kg/day orally divided every 8 hours. Do not exceed 6mg/kg/day
0.25 - 0.5
mg
Tablets(extended release)
Orally
once a day
should not exceed more than 3 mg/kg/day (120 mg/day)
Age: 6-16 yrs:
Body weight 20-35 kg: 10 mg/day orally daily; increase up to 20 mg after 2 weeks if there is inadequate response
Body weight >35 kg: 20 mg/day orally daily; increase up to 40 mg after 2 weeks if there is inadequate response
do not exceed 40 mg/day
Administer dose of 1.7 to 3.5 mg/kg daily intramuscularly or intravenously divided in 4 to 6 doses
Administer dose of 0.5 to 3 mcg/kg/min intravenously
1 month to 16 yrs (oral)
Initial dose: 0.08 mg/kg/day orally or divided every 2 times a day; should not exceed more than 5 mg/day
May increase, when necessary, every two weeks according to the blood pressure should not exceed more than 0.58 mg/kg/day (40 mg/day)
1 month to 16 yrs (Intravenous)
0.01 to 0.02 mg/kg daily divided every 2 times a day by Intravenous infusion
Hypertensive Crisis
0.05 to 0.1 mg/kg by direct Intravenous injection
Renal Impairment
The GFR less than 30 mL/min/1.73 m²: usually Not recommended
Age: > 1 year
1 mg/kg orally daily
Modify dosage according on blood pressure response
Consider a larger initial dosage of 2 mg/kg in select situations if a greater drop in blood pressure is required
Age: 6-17 years
The use of doses exceeding 5 mg/day orally has not been investigated
The recommended dosage range is 2.5 to 5 mg per day
Indicated for Severe/Refractory Hypertension
Age <12 years
Initial dose: 0.1 mg/Kg to 0.2 mg/Kg orally every day; It should not exceed 5 mg in a day. Titrate it for every three days for a response
Maintenance dose: 0.25 mg/Kg to 1 mg/Kg orally one-two times a day
It should not exceed 50 mg in a day
Age >12 years
Initial dose: 5 mg orally every day; enhance the dose every three days if necessary
Maintenance dose: 2.5 mg to 80 mg one-two time a day
It should not exceed 100 mg in a day
Initially, 0.3 mg/kg once each day
Titrate up to a maximum dose of 2mg/kg each day or 50 mg each day
above 12 years: Initial Recommended dose is 1 mg/kg daily
Dose Adjustments
Dosing modifications
Renal impairment: Contraindicated in severe cases
Hepatic impairment: Severe: Contraindicated in severe cases
Initial dose: 200-400mg/day divided orally. Do not exceed 800mg/day
30 - 60
mg
Tablets (extended release)
Orally
once a day
7 - 14
days
should not exceed more than 120 mg/day (Procardia XL)
metoprolol/hydrochlorothiazide
Lopressor HCT: 50-100 mg metoprolol tartrate and 25-50 mg hydrochlorothiazide orally each day as single or divided doses
Dutoprol: 25-100mg metoprolol succinate and 12.5 mg hydrochlorothiazide orally each day as a single dose
The drug is not indicated for initial therapy
amlodipine/valsartan/hydrochlorothiazide
Initiate with 2.5 mg orally every day, if needed May increase dose after 2 weeks
But should not exceed more than 10 mg/320 mg/25 mg orally once daily
and osteoarthritis
:
For each dose strength, 200 mg celecoxib only used once a day.
Initial dose: 2.5mg amlodipine /200mg celecoxib orally daily in tiny, fragile, elderly, or patients with moderate hepatic impairment
Initiate with a daily dose of 5 mg orally in the beginning
Indicated for Hypertension
2.5 mg orally every day. Titrate it for response gradually
Indicated for Essential hypertension
At starting, Take 2.5 mg one time a day, with the option for adjustment based on BP responsiveness
The maximum dosage should not exceed 10 mg in a day
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477925/
www.ncbi.nlm.nih.gov/books/NBK539859/
Hypertension is characterized by a systolic blood pressure of 130 mmHg or a diastolic blood pressure of 80 mmHg. One of the most prevalent chronic conditions, hypertension, is defined by a continuous rise in arterial pressure.
One of the most significant comorbidities influencing the emergence of stroke, myocardial infarction, heart failure, and renal failure, hypertension has been one of the most researched subjects of the past century.
There is consensus that persistent blood pressure readings of 140/90mmHg or above should be treated with the conventional therapeutic aim of 130/80mmHg or less. The definition and classifications of hypertension have been developing throughout time.
Around the world, more than a billion adults have hypertension, which impacts up to 45% of the adult population. All socioeconomic classes have significant rates of hypertension, which increase with age, reaching up to 60% over the age of 60.
Hypertension causes more cardiovascular disease-related deaths in the US than any other modifiable risk factor.
It is the second-leading preventable cause of death worldwide after cigarette smoking. Recent estimates suggest by 2025, there may be up to 1.5 billion people worldwide with hypertension, an increase of up to 15% or 20%.
An essential regulator of blood volume is sodium (Na+). High serum Na+ levels promote water retention, increasing blood volume and pressure. In normotensive adults, compensatory hemodynamic adjustments stabilize blood pressure as dietary Na+ increases. Nitric oxide generation from the endothelium increased, while renal and peripheral vascular resistance reduced.
However, blood pressure increases if nitric oxide’s impact is diminished or nonexistent. Endothelial dysfunction is a risk factor for the emergence of salt sensitivity and hypertension. Salt sensitivity is characterized by an increase in systolic blood pressure of at least 10 mmHg within a few hours of intake. It is defined as a considerable increase in blood pressure after a Na+ load of less than 5 g.
Renin- Angiotensin-Aldosterone System [RAAS]
RAAS is found in multiple organs at the cellular level. However, its most essential function is to assist in regulating pressure-volume balance in the kidney, where it maintains perfusion in states of volume depletion and is inhibited in circumstances of fluid excess. The juxtaglomerular cells of the kidney produce and store renin and its precursor, pro-renin, which are then released in response to various stimuli. Renin’s primary function is to break down angiotensinogen to create angiotensin I.
The pathogenetic significance of RAAS in hypertension is centered on how the angiotensin-converting enzyme (ACE) converts angiotensin I into angiotensin II. By enhancing the function of the sodium-hydrogen exchanger, sodium-bicarbonate exchanger, and sodium-potassium ATPase, as well as promoting aldosterone production and release from the adrenal glomerulosa, angiotensin II improves Na+ reabsorption in the proximal tubule.
Angiotensin II is also associated with endothelial dysfunction and causes renal, cardiac, and vascular damage. These effects are pro-fibrotic and pro-inflammatory and are mediated mainly by increased oxidative stress. Angiotensin II is strongly aligned to target organ damage in hypertension through these processes. Aldosterone plays a significant role in hypertension by binding to the mineralocorticoid receptor and inducing non-genomic effects.
These effects include activating the amiloride-sensitive sodium channel, also known as the epithelial sodium channel, which stimulates renal Na+ reabsorption in the cortical collecting duct. Additionally, aldosterone has a wide range of non-epithelial actions that support hypertension, vasoconstriction, and endothelial dysfunction. These include vascular fibrosis, extracellular matrix deposition, vascular remodeling, vascular smooth muscle cell proliferation, and elevated oxidative stress.
Idiopathic or essential hypertension is the most common type of hypertension. It has been hypothesized that consuming more salt increases the potential risk of hypertension.
The patient’s genetic ability for a salt response is identified as one of the elements contributing to the development of hypertension. Salt sensitivity affects 50 to 60 % of the patients, who are more likely to develop hypertension.
The prognosis depends on blood pressure control and is positive if blood pressure is well controlled; nevertheless, as hypertension is a progressive condition, complications may occur in a few patients.
Adequate lifestyle and management measures accomplish little more to delay the onset and progression of complications like chronic kidney disease and renal failure.
The treatment paradigm for hypertension (high blood pressure) typically involves a combination of lifestyle modifications and pharmaceutical interventions. Here is an overview of the treatment paradigm for hypertension:
Lifestyle Modifications:
Dietary changes: Encourage a balanced diet rich in fruits, vegetables, whole grains, and low-fat dairy products. Emphasize the importance of reducing sodium (salt) intake and limiting alcohol consumption.
Regular exercise: Recommend at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with muscle-strengthening activities at least twice a week.
Weight management: Promote weight loss for overweight or obese individuals to achieve a healthy body weight, as excess weight contributes to increased blood pressure.
Sodium restriction: Encourage reducing sodium intake to less than 2,300 milligrams per day (and even lower for certain populations, such as those with diabetes or kidney disease).
Limit alcohol consumption: Advise moderate alcohol consumption (up to one drink per day for women and up to two drinks per day for men) or complete abstinence if recommended by a healthcare provider.
Pharmaceutical Interventions:
Stepwise medication approach: Initiate antihypertensive medication based on the individual’s blood pressure levels, comorbidities, and risk factors.
First-line medications: Typically, thiazide diuretics (e.g., hydrochlorothiazide) or ACE inhibitors (e.g., lisinopril) are recommended as initial therapy due to their effectiveness, safety profile, and cost.
Combination therapy: If blood pressure goals are not achieved with a single medication, combination therapy with two or more antihypertensive agents from different drug classes may be prescribed.
Medication adherence: Emphasize the importance of taking medications as prescribed and educate patients about potential side effects and drug interactions.
Regular blood pressure monitoring: Encourage patients to monitor their blood pressure regularly at home and provide feedback to their healthcare provider.
Ongoing Management and Monitoring:
Follow-up visits: Schedule regular follow-up visits to monitor blood pressure, assess medication effectiveness and potential side effects, and adjust treatment as necessary.
Risk factor management: Address and manage other cardiovascular risk factors, such as diabetes, dyslipidemia (abnormal lipid levels), and smoking cessation.
Patient education: Provide comprehensive education on hypertension, its risks, and the importance of lifestyle modifications and medication adherence.
Cardiology, General
Endocrinology, Metabolism
Nephrology
Promote healthier food choices: Collaborate with food manufacturers, restaurants, and cafeterias to provide and promote low-sodium options, reduce the availability of high-sodium processed foods, and clearly label nutritional information.
Cardiology, General
Endocrinology, Metabolism
Creating smoke-free environments is crucial for individuals with hypertension, as exposure to tobacco smoke can significantly increase the risk of cardiovascular problems. Here are some speciality-wise suggestions for establishing smoke-free environments:
Healthcare facilities: Implement strict no-smoking policies in hospitals, clinics, and other healthcare settings. Provide designated outdoor smoking areas away from entrances and windows.
Public spaces: Advocate for smoke-free policies in public areas such as parks, playgrounds, and outdoor recreational areas to protect individuals, especially children, from secondhand smoke.
Educational campaigns: Collaborate with schools, community centers, and workplaces to raise awareness about the dangers of smoking and the importance of smoke-free environments.
Smoking cessation programs: Offer comprehensive smoking cessation programs that include counseling, support groups, and access to medication to assist individuals in quitting smoking.
Patient education: Educate patients about the risks of smoking and secondhand smoke, emphasizing the importance of maintaining a smoke-free home and car.
Nicotine replacement therapy (NRT): Provide access to NRT products, such as nicotine patches, gum, or lozenges, to assist individuals in quitting smoking and reducing withdrawal symptoms.
Cardiology, General
ACE inhibitors (Angiotensin-Converting Enzyme inhibitors) are a class of pharmaceutical agents commonly used for the treatment of hypertension. They work by blocking the enzyme responsible for converting angiotensin I into angiotensin II, a hormone that constricts blood vessels and increases blood pressure. By inhibiting this enzyme, ACE inhibitors help relax and widen the blood vessels, reducing blood pressure and improving blood flow.
Here are some key points about ACE inhibitors for hypertension:
Cardiology, General
Calcium channel blockers (CCBs) are a class of medications commonly used for the management of hypertension (high blood pressure). These medications work by blocking calcium channels in the smooth muscle cells of blood vessels, leading to relaxation and dilation of the vessels, which helps to lower blood pressure. Here are some important points regarding the use of CCBs for hypertension:
Types of Calcium Channel Blockers:
Cardiology, General
Endocrinology, Metabolism
Family Medicine
General Practice
Hospital Medicine
Internal Medicine
Diuretics are commonly prescribed medications for the treatment of hypertension (high blood pressure). They work by increasing the excretion of sodium and water from the body, reducing the volume of fluid in the blood vessels, and thereby lowering blood pressure. Here are some important points to know about diuretics for hypertension:
Nephrology
Cardiology, General
Endocrinology, Metabolism
Glucocorticoid receptor antagonists, also known as glucocorticoid antagonists or glucocorticoid receptor blockers, are a class of medications that can be used in the management of secondary hypertension. Secondary hypertension refers to high blood pressure caused by an underlying medical condition or medication. Here are some examples of glucocorticoid receptor antagonists that may be used in the treatment of secondary hypertension:
Mifepristone: mifepristone is primarily known as a medication used for pregnancy termination and in the management of certain hormonal disorders. However, it also acts as a glucocorticoid receptor antagonist and can be effective in treating hypertension caused by excess cortisol production (Cushing’s syndrome).
Spironolactone: spironolactone is a potassium-sparing diuretic that is commonly used to treat conditions like primary hyperaldosteronism (Conn’s syndrome), which can lead to secondary hypertension. It also acts as a glucocorticoid receptor antagonist, providing additional benefit in certain cases.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477925/
www.ncbi.nlm.nih.gov/books/NBK539859/
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