The Management of Hypertension, Essay Example

Hypertension

Hypertension known as high blood pressure affects one in three people in the United States and heart failure, heart attack and liver disease if untreated. It is often called the “silent killer” because if often goes undetected thus untreated because like other diseases it shows no symptoms before it strikes. With proper treatment a person with hypertension can live a long and healthy life.

The medications for hypertension treatment are called antihypersensitives. They are classified as such:

• angiotensin-converting enzyme (ACE) inhibitors
• diuretics
• calcium channel blockers
• beta blockers
• alpha blockers
• angiotensin II receptor blockers

Some of the commonly prescribed combined medications include hydrochlorothiazide and one of the following ACE inhibitors:

• lisinopril
• enalapril
• cilazapril
• quinapril

Basically these drugs can be prescribed in single form or in combination depending on how the body’s blood pressure responds to the medication.

JNC VII recommendation for hypertension management emphasizes the importance of monitoring the systolic blood pressure. “It is apparent through research that the lowering of blood pressure is more significant than addressing cardiovascular events. The report stressed that the majority of patients will require two or more medications to achieve goal blood pressure.” (Moser, 2004). “SBP 140-159 mm Hg, DPB 90-99 mg Hg recommends a thiazide type diuretic. Further, ACEI, ARB, BB or CCB by itself or in combination treatment. SBP > or = 100 mg Hg recommends a two drug combination of thiazide type diuretic and ACEI, ARB, BB or CCB.” (“Clinical Trials in Hypertension and Renal Diseases”).

Hawthorne berries and garlic is a non-medical natural remedy for hypertension that has been successful for years. Eating a high grain diet with many vegetables and fruit and a low salt content has been known to lower blood pressure. This is called the DASH diet or (Dietary Approach to Stop Hypertension). “If a patient is overweight and loses just 10 pounds studies show that they can reduce their blood pressure by 10 %.” (“Simple Steps to Help You Prevent High Blood Pressure Without Medication”). Further electric acupuncture therapy has been successful with lowering blood pressure levels.

Discussion of Patient’s Treatment

Two patients’ have been diagnosed with hypertension:

• 32 years of age, African American male with post myocardial infarction
• 86 years of age, Caucasian White female with post myocardial infarction

Describe the drug of choice you would treat each patient with and your rationale for choosing such drugs.

Choice of Drug and Rationale for Choosing

Research shows that if the blood pressure in patients with post myocardial infarction has been elevated over 10% for 10 years, the blood pressure should be lowered to 130/80 mg Hg. Further if left ventricular dysfunction is present, the blood pressure should be further lowered to 120/80 mm Hg. The Framingham risk factor analysis is used to access the risks associated. Generally it is easier to reduce the diastolic pressure in patients older than 55 years of age.

“Doctors recommend using the anti­anginals, b-blockers and calcium channel blockers, and diuretics as well as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II recep­tor blockers (ARBs). The b-blockers and calcium channel blockers would be the drugs of choice for the 86 year old Caucasian female. At the first visit, doctors would probably start with a b-blocker. Further an ARB/diuretic, a calcium channel blocker/ACE inhibitor, or an ARB/calcium channel blocker combination might also be possible choices. ACE inhibitor or ARB acutely or a nitrate would be recommended for the 32 year old African American male with post myocardial infarction as long as he is stable.” (Moser, Victor, Wright, Handler, 2008).

References

Moser, M. (2004) Update on the Management of Hypertension: Recent Clinical Trials and the JNC 7 Retrieved September 28, 2009 from, http://www.ionchannels.org/showabstract.php?pmid=15470293&redirect=yes&terms=medication+management+that+includes+JNC+VII+recommendations

Simple Steps to Help You Prevent High Blood Pressure Without Medication (2009) Retrieved September 28, 2009 from, http://www.johnshopkinshealthalerts.com/alerts/hypertension_stroke/JohnsHopkinsHealthAlertsHypertensionStroke_563-1.html

Clinical Trials in Hypertension and Renal Diseases (2009) Retrieved September 28, 2009 from, http://www.hypertensiononline.org/slides2/slide01.cfm?q=coronary+disease&dpg=3

Moser, M., Wright, J., Victor, R., Handler, J. (2008) How to Treat Hypertension in Patients With Coronary Heart Disease Retrieved September 28, 2009 from, http://www.hypertensionfoundation.org/PDInfo/JC8014-Moser.pdf