ANTIHYPERTENSIVES

The current definition of hypertension (HTN) is systolic blood pressure (SBP) values of
130mmHg or more and/or diastolic blood pressure (DBP) more than 80 mmHg.
Hypertension ranks among the most common chronic medical condition characterized by a
persistent elevation in the arterial pressure. Hypertension is a significant risk factor for
coronary artery disease and stroke, a leading cause of death and disability worldwide, and a
major risk for dementia, chronic kidney disease, coronary heart disease, and heart failure. 
One of the most important steps in preventing and treating high blood pressure is a healthy
lifestyle. High blood pressure can be lowered with the following lifestyle changes:-
a) Quitting smoking
b) Losing weight if the person is overweight or obese
c) Eating a healthy diet like DASH diet. (It is low in total and saturated fat, red meat, sugar,
sugary drinks, and refined carbohydrates, but high in fruits, vegetables, whole grains, fish,
poultry, and low-fat dairy products.)
d) Doing regular aerobic exercise like brisk walking at least 30 minutes a day, several days a
week
e) Limiting alcohol two drinks a day for men, one drink a day for women
f) Do exercises like weight training or handgrip exercise
Diet modifications are also important to lower high blood pressure. They include:-
a) Avoid foods high in cholesterol or animal fat
b) Encourage greater intake of fresh fruits and vegetables (300-400 g/day), fish (at least
twice a week), low fat dairy products, dietary and soluble fibre, whole grains and protein
from plant sources, reduced saturated fat and cholesterol products.
c) Excessive consumption of coffee and other caffeine- rich products should be reduced.
d) Avoid foods which have a high salt content
e) Decrease dietary sodium
f) Increase dietary potassium
Pharmacologic intervention for this patient should be treated with two primary anti
hypertensives as the patient has a blood pressure above 150/90 mmHg. Group of anti-
hypertensives used to treat the patient includes:-
1) Calcium channel blockers and ARBs (Angiotensin receptor blockers)
Calcium channel blockers (CCBs) like dihydropyridines
(nitrendipine, nicardipine, lercanidipine) are used. CCBs binds to and block L-
type calcium channels (in myocardium and vascular smooth muscles). By blocking
these channels, CCBs cause peripheral arterial vasodilation
and myocardial depression. Its adverse effects include peripheral edema, headaches,
facial flushing, reflex tachycardia and gingival hyperplasia.

ARBs like losartan and valsartan are used. It inhibits angiotensin 11 receptor type 1. It
decreases vasoconstriction and decreases blood pressure. Secretion of aldosterone
decreases and it leads to decrease in blood pressure. Its adverse effects include
hypotension, leukopenia, angioedema, teratogenicity etc.

2) Calcium channel blockers and ACEIs (Angiotensin converting enzyme inhibitors)

ACEIs like Lisinopril, captopril are used. It inhibits the enzyme responsible for the
conversion of angiotensin 1 to angiotensin 11. Secretion of aldosterone is decreased
and it causes vasodilation. Its adverse effects include dry cough, angioedema,
hyperkalemia and they are teratogenic.

3) Calcium channel blockers and beta blockers

Beta blockers like propranolol, metoprolol are used. It inhibits the sympathetic
activation of beta adrenergic receptors. Its side effects includes increased
triglycerides, blunted effects of hypoglycemia and bronchoconstriction with non-
cardio selective beta blockers.

WORK CITED
First‐line drugs for hypertension. PubMed Central (PMC). Accessed February 7, 2021.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513559/

Hypertension and lifestyle modification: how useful are the guidelines? PubMed Central
(PMC). Accessed February 7, 2021.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991739/

AMBOSS login. Anmelden bei AMBOSS. Accessed February 7, 2021.

https://next.amboss.com/us/article/Xh09cf?q=Antihypertensive
%20therapy#Z738b7c7d2418eed3a468132c08565518