{"id":9636,"date":"2021-12-28T17:54:54","date_gmt":"2021-12-28T15:54:54","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/treatment-of-hypertension\/"},"modified":"2022-01-03T23:22:31","modified_gmt":"2022-01-03T21:22:31","slug":"treatment-of-hypertension","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/treatment-of-hypertension\/","title":{"rendered":"Treatment of hypertension"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\" id=\"block-e4cec820-8b31-4fa7-8793-c1f2e3b4a8c4\"><br>In patients below 60 years of age, the target BP is below 140\/85mmHg, and below 150\/90mmHg in patients above 60 years old.<\/p>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" id=\"block-ca355875-e78e-4ade-9e2f-648fbfa097a7\" class=\"wp-block-heading\" id=\"block-ca355875-e78e-4ade-9e2f-648fbfa097a7\" class=\"title_collection \">Non-pharmaceutical<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\" id=\"block-1995f4aa-a6c7-4440-bfa6-bf3a088f8fe4\">Lifestyle changes, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\" id=\"block-cbed4b47-f267-4ca5-9bdd-552cabe727ad\"><li>Weight loss in obese patients<\/li><li>A diet rich in fruits and vegetables, and low in saturated fat, and salt<\/li><li>Exercise<\/li><li>Avoid alcohol, caffeine, and smoking<\/li><li>Stress management<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" id=\"block-7a1ba153-2689-4b0b-a765-89f0e1f53ac5\" class=\"wp-block-heading\" id=\"block-7a1ba153-2689-4b0b-a765-89f0e1f53ac5\" class=\"title_collection \">Pharmaceutical<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">The NICE treatment protocol includes 5 steps:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>In case of DM of any age or race <strong>OR<\/strong> in case of &lt;55 years old, non-Black<ul><li>Step 1: CCB<\/li><li>Step 2: ACEi\/ARB\/thiazide diuretic<\/li><\/ul><\/li><li>In case of >55 years old of any race <strong>OR<\/strong> in case of Blacks<ul><li>Step 1: ACEi\/ARB<\/li><li>Step 2: CCB\/thiazide diuretic<\/li><\/ul><\/li><li>Step 3: ACEi\/ARB + CCB + thiazide diuretic<\/li><li>Step 4: BB or alpha 1 blockers<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">In details<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\" id=\"block-401a6dc0-ca11-4ef1-b0ed-d9298f421803\"><li><strong>Thiazide diuretics<\/strong><ul><li>Chlorothiazide, chlorthalidone, hydrochlorothiazide<\/li><li>Inhibit the sodium\/chloride cotransporter located in the distal convoluted tubule of a nephron<\/li><li>Can cause hypokalemia, dyslipidemia, acidosis<\/li><\/ul><\/li><li><strong>ACE-inhibitors<\/strong> (ACEi)<ul><li>-pril: Captopril, enalapril, lisinopril, ramipril, <strong>perindopril<\/strong><\/li><li>Inhibit the angiotensin-cleaving enzyme, preventing the formation of angiotensin-II<\/li><li>Has a protective effect on the kidneys, good in diabetics<\/li><\/ul><\/li><li><strong>Angiotensin II receptor blockers<\/strong> (ARBs)<ul><li>-sartan: candesartan, irbesartan, losartan, <strong>telmisartan<\/strong>, valsartan<\/li><li>Cannot be used in conjunction with ACEi<\/li><\/ul><\/li><li><strong>Calcium channel blockers<\/strong><ul><li>DHP (dihydropyridine) type<ul><li>Amlodipine, felodipine, lacidipine, nifedipine<\/li><li>More specific for blood-vessels<\/li><\/ul><\/li><li>Non-DHP type<ul><li>Diltiazem and verapamil &nbsp;<\/li><\/ul><\/li><\/ul><\/li><li><strong>\u03b2-Blockers<\/strong><ul><li>-olol: atenolol, bisoprolol, metoprolol, nebivolol<\/li><li>Reduce the CO<\/li><\/ul><\/li><li>\u03b11-Blockers<ul><li>Not a first-line treatment, used in patients who also have BPH<\/li><\/ul><\/li><li>\u03b12-Agonists (imidazoline receptor agonists )<ul><li>Clondine<\/li><li>Reduce sympathetic outflow<\/li><\/ul><\/li><li>Vasodilators (hydralazine and minoxidil)<ul><li>Not commonly used<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" id=\"block-dc401d7c-4308-4485-aa4f-a67331b06b7e\" class=\"wp-block-heading\" id=\"block-dc401d7c-4308-4485-aa4f-a67331b06b7e\" class=\"title_collection \">Combined drugs<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\" id=\"block-8c8066b1-495a-40c6-a0b4-d9b2ebe5638f\">There are many combinations of 2, 3 and more drugs in a single pill, combining their effects. This often is more cost-effective and convenient for patients that are required to use several drugs together.<\/p>\n\n\n\n<ul class=\"wp-block-list\" id=\"block-62ae6512-484e-4440-8dae-ce7dcffc41ab\"><li>ACEi with calcium-channel blockers<\/li><li>ARBs with thiazides<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" id=\"block-cb884264-1a97-4de6-a1a9-f0215c953b09\" class=\"wp-block-heading\" id=\"block-cb884264-1a97-4de6-a1a9-f0215c953b09\" class=\"title_collection \">Rules of drug therapy<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\" id=\"block-a623b91b-b4e0-4164-9a02-c53ac3828d45\">Generally, a single drug reduces about 10mmHg of BP; the target is achieved by calculating the desired BP.<\/p>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" id=\"block-ca355875-e78e-4ade-9e2f-648fbfa097a7\" class=\"wp-block-heading\" id=\"block-ca355875-e78e-4ade-9e2f-648fbfa097a7\">Non-pharmaceutical<\/h4><h4 class=\"wp-block-heading\" id=\"block-7a1ba153-2689-4b0b-a765-89f0e1f53ac5\" class=\"wp-block-heading\" id=\"block-7a1ba153-2689-4b0b-a765-89f0e1f53ac5\">Pharmaceutical<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">In details<\/h4><h4 class=\"wp-block-heading\" id=\"block-dc401d7c-4308-4485-aa4f-a67331b06b7e\" class=\"wp-block-heading\" id=\"block-dc401d7c-4308-4485-aa4f-a67331b06b7e\">Combined drugs<\/h4><h4 class=\"wp-block-heading\" id=\"block-cb884264-1a97-4de6-a1a9-f0215c953b09\" class=\"wp-block-heading\" id=\"block-cb884264-1a97-4de6-a1a9-f0215c953b09\">Rules of drug therapy<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>In patients below 60 years of age, the target BP is below 140\/85mmHg, and below 150\/90mmHg in patients above 60 years old. Non-pharmaceutical Lifestyle changes, including: Weight loss in obese patients A diet rich in fruits and vegetables, and low in saturated fat, and salt Exercise Avoid alcohol, caffeine, and smoking Stress management Pharmaceutical The [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":21,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9636","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Treatment of hypertension &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/treatment-of-hypertension\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/treatment-of-hypertension\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/treatment-of-hypertension\\\/\",\"name\":\"Treatment of hypertension &#8211; 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