Clinical Management And Detailed Step To Step Drug Therapy In Treating Systemic Hypertension
Therapeutic aim in managing systemic hypertension is to lower the blood pressure to normal or near normal levels and maintain it so throughout the day and night. Management has to be individualized, depending on the type and severity of hypertension, etiology, state of function of the target organs and the socio-economic conditions. The blood pressure has to be brought down gradually since abrupt reduction may precipitate renal failure or thrombotic strokes.
In borderline case, the blood pressure can be brought to normal even without drugs. Principles of general management include reduction of weight in obese subjects, restriction of salt intake to 4-6 g/day, provision of adequate sleep for 6-8 hours a day and avoidance of smoking. Yoga exercises, transcendental meditation and biofeedback techniques help in lowering the blood pressure further.
Main Cracking Hypertension Code
Combined Drug Therapy
Vast majority of hypertensive patients require drug therapy. The present method is to give a stepped care program for the control of blood pressure. The principle is to start treatment with a mild antihypertensive drug and add more powerful drugs if the response is not fully satisfactory. Since it is not possible to predict the response from the initial blood pressure readings, it is advisable to follow the stepped care program in all cases.
Step I: this is ideal for mild cases with blood pressure below 180/110 mm Hg. Treatment is started with a long-acting diuretic such as chlorhalidone (50-100 mg) or other diuretics such as hydrochlorothiazide (100mg) or furosemide (20mg). Patients receiving diuretics on long-term basis should be given potassium supplementation with potassium chloride 2g twice a day.
As an alternative, a beta-adrenergic blocker such as propanolol 20-40mg twice a day may be started. More cardioselective beta-adrenergic blockers such as atenelol, metaprolol and pindalol are now available for use. These, being cardioselective, do not aggravate bronchospasm which is a troublesome aide effect of the nonselective beta-adrenergic blockers.
Step II: If the blood pressure is not controlled with step I drugs, the diurectic and beta-adrenergic blocker are combined and their doses are increased. Either of them is combined with another drug such as methyl dopa, hydralazine or reserpine. Step II may be required for moderate and severe hypertension.
Step III: When step II fails, three drugs are combined. The usual combincations are:
- Diuretic + betablocker + hydralazine
- Diuretic + betablocker + prazosin, or
- Diuretic + reserpine + hydralazine. Nifedipine can be employed in addition.
Step IV: This is given to the small number of cases who do not respond even to step III. Other potent drugs such as guanethidine, bethanidine, minoxidil, captopril or nifedipine have to be added.
© 2014 Funom Theophilus Makama