Treatment Of Hypertension

The main purpose of antihypertensive therapy is to reduce morbidity and mortality due to cardiovascular and kidney diseases. Successful control of hypertension is not simply to achieve normal blood pressure, but to eliminate or control any other risk factors which can affect, and appropriate treatment of associated clinical disease.

New European guidelines for the treatment of arterial hypertension in 2003  guidelines were adopted that year, defined as achieving a target blood pressure of 140/90 mmHg or below low blood pressure, which is tolerated. In diabetes and kidney disease recommend lowering blood pressure below 130/80 mmHg in patients with proteinuria greater than 1 g / 24 hours, and below 125/75 mmHg.

Pharmacology of anti-hypertensive drugs:

Thiazide diuretics: inhibit cotransport sodium and chlorine from the distal lumen of the initial work of twisted channel. As more and more remains of sodium and chlorine remains the more water is excreted in the urine. The volume of extracellular fluid and plasma is reduced. Followed by decreased venous return and reducing cardiac output. Blood pressure is lowered, peripheral vascular resistance increases. Later, self-regulation of extracellular fluid volume increased peripheral vascular resistance is reduced, blood pressure, but continues to be reduced. Thus, at baseline low blood pressure due to dehydration, and subsequently to reduce peripheral resistance. Side effects: hypokalemia, hypomagnesaemia, hyperuricaemia, but rarely hypercalcaemia.

Beta blockers: are among the drugs that block the renin-angiotensin system, while inhibiting the activity of the sympathetic nervous system. Reduced blood pressure by reducing cardiac output, renin secretion, central sympathetic activity and peripheral vascular resistance. Beta-blockers differ depending on the solubility in fats. Those that are soluble and is rapidly metabolized in the liver, so that their effect is shorter. Slightly soluble in fats are excreted through the kidneys slowly and therefore their operation is prolonged.

ACE inhibitors: inhibit an important enzyme in the renin-angiotensin-aldosterone system.

Calcium channel antagonists: reduce the entry of calcium into cells of conducting system, and therefore its concentration in them is reduced. Smooth-muscle cells in the walls of arteries are therefore less reduced, which caused the spread of blood vessels. Resistance is lower in the artery, blood pressure decreases. Do not disturb the metabolism of sugar, fat and cause hypokalemia.