HYPERTENSION, or high blood pressure, is described as the pressure exerted on the arterial walls when the heart pumps blood. The reading is expressed as a ratio of systolic (arterial pressure when the heart beats) over diastolic (arterial pressure when the heart rests). Generally, the ratio below 120/80 mmHg is considered normal.
Pre-hypertension, or elevated blood pressure, has a ratio up to129/89 mmHg. Stage One hypertension is up to 139/89 mmHg, whilst Stage Two is from 140/90 mmHg. A hypertensive crisis is above 180/120 mmHg. These are the four stages of hypertension.
The importance of controlling blood pressure is to reduce the risk of heart disease, heart attack and strokes. Because hypertension is asymptomatic, late diagnosis may cause diet and lifestyle modifications not to precede treatment, although such interventions would be initially desirable.
The treatment protocol would be determined not only by the stage of hypertension, but other criterion to be considered, such as the patient’s race, age, kidney function, diabetic status, and cardiovascular disease risk assessment. Review on how the patient is responding to treatment is done at a bi-monthly to monthly interval, where dosages may be adjusted upwards or downwards, or other categories of drug could be added on if not responsive to treatment.
The first line treatment, as developed by the WHO (World Health Organisation), include medications such as diuretics, ACE inhibitors, and calcium channel blockers, after which a review is done to check on response, compliance, and if any side effects are experienced.
Diuretics, also referred to as water pills, reduce the blood volume by allowing you to pass out water and salt. Examples of such are Lasix (furosemide), aldactone (spironolactone), HCTZ (hydrochlorothiazide), and Natrilix SR (indapamide). Some water pills are a combination of more than one diuretic, depending on the patient’s retention of water or kidney dysfunction, which occurs mostly in the elderly. Most serious side effects are allergic reaction, kidney failure, or irregular heartbeat. Levels of sodium and potassium in the blood should be monitored.
ACE (angiotensin converting enzyme) inhibitors are one type of vasodilators, and are best selected for the diabetic hypertensive patient, or a hypertensive patient with heart failure, since it has dual functions; protection on the kidneys, as well as the blood pressure lowering. Widely prescribed locally are captopril, Ramipril, and enalapril. However, the side effect of cough may limit its scope. In addition, other side effects such as sore throat, mouth sores, irregular heartbeat, or rarely an immediate reaction such as the swelling of neck, face and tongue may occur, and may require emergency intervention and subsequent discontinuation of this drug. Regular monitoring of the potassium levels is required. **
Calcium channel blockers are another vasodilator category of first-line antihypertensive, which are electrical signal blockers, for example Nifedipine, Amlodipine, Diltiazem, and Verapamil. They block the entry of calcium into the heart muscles and blood vessels, thus facilitating relaxation. These work best in black ethnicity, but may cause ankle swelling as a side effect.
Beta-blockers are another category of drugs which reduce the force at which the blood is pumped by the heart, thus slowing down the heart rate. Some of the popular ones locally are Atenolol, Metoprolol, and Bisoprolol. Beta blockers are contraindicated in asthmatics, COPD (chronic obstructive pulmonary disease), diabetes mellitus, and peripheral vascular disease.
Alpha blockers have a dual purpose: They are indicated for hypertension and, simultaneously, prostate hypertrophy. They relax the pressure of the blood vessels by blocking nerve signals that are sent out to tighten these vessels. Most pronounced side effects of alpha blockers are postural hypotension (dizziness or light-headedness when changing position from lying to sitting, or from sitting to standing) and headaches.
Carvedilol falls in a unique category, which has both alpha and beta blocking properties.
Alternatively, there are central acting agents which prevent the signal from the brain to reach the heart, causing the heart rate to decelerate and also not to narrow the blood vessels. These medications are Clonidine and Aldomet (methyldopa); the latter is mostly selected in gestational hypertension.
Finally, a category of vasodilators which just widens all blood vessels is hydralazine and minoxidil; the latter is also used topically for alopecia.
The European Heart Journal in 2019 suggested that taking hypertension medication just before bedtime was highly recommended to reduce illness or death due to heart and blood vessel disease, despite the fact that the body mechanism causes blood pressure to be lowest during your sleep, and raise whilst doing the daily activities. The most appropriate candidates for this practice are diabetics, the elderly, and chronic kidney disease and obese patients.
POINTS TO NOTE:
* Antihypertensives must be taken daily for life; do not stop unless instructed by your doctor.
* Diuretics are most conveniently taken during your waking hours, so that your sleep will not be interrupted for a bathroom visit.
* If you experience side effects after starting any hypertension medication, such as dry cough, ankle swelling and dizziness, then immediate feedback must be given to your healthcare provider, so that changes to the regimen can be made.
* No grapefruit and grapefruit juice should be taken concomitantly with calcium channel blockers, since it interferes with the breakdown of the drug.
* Likewise, alcohol is not recommended with calcium channel blockers, and may increase side effects of the drug.
* Synergistic use of calcium channel blockers and other antihypertensive medications may potentiate a drop in blood pressure.
For further pharmacological guidance, contact the pharmacist of Medicine Express PHARMACY located at 223 Camp Street, between Lamaha and New Market Streets. If you have any queries, comments or further information on the above topic, kindly forward them to medicine.express@gmail.com or send them to 223 Camp Street, N/burg. Tel #225-5142.