MedCram Lecture on Hypertension Treatment

Definition of Hypertension

• Defined by A and C seven
• Hypertension: Blood pressure > 140/90
  • Stage 1 Hypertension: 140-159 / 90-99
  • Stage 2 Hypertension: ≥ 160 / ≥ 100

Importance of Managing Hypertension

• High blood pressure leads to:
  • Stroke
  • Ischemic cardiomyopathy
  • Hypertensive heart disease
  • Coronary artery disease
• Reducing BP by 5mm Hg can:
  • Decrease stroke risk by 34%
  • Decrease ischemic heart disease risk by 21%
  • Decrease dementia, heart failure, cardiovascular mortality

Treatments for Hypertension

Lifestyle Changes

• Dietary changes (low sodium diet, DASH diet)
  • Rich in nuts, whole grains, fruits, and vegetables
• Physical exercise
• Biofeedback, relaxation, meditation

Medications

• Medications have side effects, unlike lifestyle changes which don't
• Choosing medication:
  1. Underlying diagnosis
  2. Comorbidities

Types of Blood Pressure Medications

Major Types (A, B, C, D)

1. A - ACE Inhibitors and ARBs
2. B - Beta Blockers
3. C - Calcium Channel Blockers
4. D - Diuretics

ACE Inhibitors (A)

• Useful in:
  • Diabetes (protects kidneys)
  • Congestive heart failure (improves ejection fraction)
  • Post MI (improves survival)
  • Connective tissue disease (e.g., scleroderma)
• Side Effects:
  • Angioedema, cough (30% in ACE, switch to ARB)
  • Hyperkalemia, hyponatremia
  • Increased creatinine (renal failure, especially in bilateral renal artery stenosis)

Beta Blockers (B)

• Useful in:
  • Congestive heart failure (improves survival)
  • Post MI (improves survival)
  • Young, Caucasian patients
• Specific types for CHF: Carvedilol, Metoprolol
• Side Effects:
  • Decreased heart rate and blood pressure
  • Increased lipids, cholesterol, depression
  • Bronchospasm (asthma, COPD)
  • Increased potassium

Calcium Channel Blockers (C)

• No survival improvement
• Useful in:
  • African Americans
  • Elderly
• Types:
  • Dihydropyridines: Nifedipine, Amlodipine, Felodipine (causes peripheral vasodilation)
    • Amlodipine also reduces heart rate (good for ischemic heart disease)
  • Non-Dihydropyridines: Diltiazem, Verapamil
    • Reduces contractility (useful in atrial fibrillation with rapid ventricular response)
• Side Effects:
  • Edema, constipation, potential heart failure

Diuretics (D)

• Types: Thiazides (HCTZ), Loop diuretics (Lasix)
• HCTZ:
  • Increases: Calcium, uric acid, lipids, glucose
  • Decreases: Potassium, sodium
  • Can cause renal failure (increased creatinine)
• Lasix (Furosemide):
  • Decreases: Calcium, potassium, sodium
  • Can cause renal failure (increased creatinine)

Summary for Choosing Medications

• Avoid specific medications based on patient condition (e.g., gout, kidney stones)

Next Steps

• In the following lecture, we will cover additional antihypertensive medications like alpha blockers, alpha-2 agonists, nitrates, etc.