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The difficult treatment of hypertension

  1. Gastroepato
  2. Cardiology
  3. The difficult treatmrent of hypertension
  4. Hypertension
  5. What about the ESH-ESC guidelines
  6. Arterial hypertension and organ damage
  7. Hypertrophic heart disease
  8. Focus on arterial hypertension
  9. Complications in hypertension

notes by dr. Claudio Italiano

Ideas and concepts of a doctor  to prescribe a cure for hypertension.

If you are hypertensive, talk to your doctor right away. This article is just a reading. Your doctor will prescribe an ideal cure for hypertension.

But if despite the advice of the doctor, the diet and losing weight we have failed our goal of reducing blood pressure, then we just have to put in place a right therapy. If we have failed on life-style, and diet,  moving and / or playing sports, if we are subjected to conflictual conditions, mobbing (because our superior enslaves us!) and  stressed,  so what is the cure for high blood pressure? And then, is it always easy to choose a medication for pressure? What criteria does your doctor use to treat you? The matter seems easy, but what are the contraindications and indications? And again, if I have a hypertrophic heart, better to take a diuretic or a sartan, or an old ace inhibitor?

And if I'm a diabetic, is the old furosemide the same or does my blood sugar rise?

If I have heart failure, I do lasix or I take an antialdosterone, for example good kanrenol?

Or both?

We try to understand what care is possible and why. In the list to follow on the left column is the disease and on the right the most suitable anti-hypertensive drug types.

For example, if I have an enlarged heart (hypertrophic heart), ace-inhibitors (ACEI acronym), calcium antagonists (CA), and angiotensin-blocking (ARB) or angiotensin blockers (ARB) will be more suitable, for example the old ramiprilate, respectively. (triatec, ramipril, etc.), calcium antagonists (the old norvasc or amilodipine, diltiazem, lercadipine etc.), the sartans, (for example the lortaan, irbesartan and so on)

IDEAL DRUGS TO BE USED IN HYPERTENSION ACCORDING TO ORGAN PATHOLOGY AND / OR COMPLICANCE
Key for drugs: ACEI = ACE INIBITORI, CA = CALCIOANTAGONIST, ARB = ANGIOTENSIN RECEPTOR BLOCKERS; BB = BETA BLOCCANTI

DRUGS NOT TO BE USED ACCORDING TO THE PATHOLOGICAL CONDITIONS
  ABSOLUTE CONTRAINDICATIONS
Diuretics
thiazide:
Gout		 Metabolic syndrome
Glucose intolerance
Pregnancy
 
Beta-blocker: asthma, AV block of 2nd or 3rd degree, in acute heart failure
 

Peripheral arterial disease
Metabolic syndrome
Glucose intolerance
Athletes and active patients
COPD
Calcium antagonists and dihydropyridines Tachyarrhythmias heart failure
Calcium antagonists (verapamil, diltiazem):
Block 2nd or 3rd, heart failure		  
ACE inhibitors: pregnancy, angioneurotic edema, hyperkalemia
bilateral stenosis of the renal arteries		  
Angiotensin receptor antagonists:
pregnancy, hyperkalemia, bilateral stenosis, renal artery stenosis
 

  
Antialdosteronic diuretics: renal failure, hyperkalemia

  

Diseases and antihypertensive treatment more indicated

Subclinical organ damage
Left ventricular hypertrophy: ACEI, CA, ARB,
Atherosclerosis: CA, ACEI
microalbuminuria: ACEI, ARB
renal dysfunction: ACEI, ARB

Clinical event

Past ictale event: any
Past cardiac infarct: BB, ACEI, ARB
Angina pectoris: BB, CA
Heart failure: DIURETICS, BB, ACEI, ARB,
Atrial fibrillation: ANTIALDOSTERONICS
recurrent atrial fibrillation: ARB, ACEI
Permanent atrial fibrillation: BB, CA
Tachyarrhythmia: NON DIIDROPYDYRINES
End stage renal disease / proteinuria: BB
Peripheral arterial disease: ACEI, ARB,
Left ventricular dysfunction: DIURETICS ANSA, CA, ACEI

Clinical condition

Isolated systolic hypertension: DIURETICS, CA
Metabolic syndrome: ACEI, ARB, CA
Diabetes mellitus: ACEI, ARB
Pregnancy: CA, ALFA-METILDOPA,
Black population: BB
Glaucoma: DIURETICS, CA
ACEI-induced cough: BB or ARB

And if this is not enough, do you know that there are absolute and relative contraindications about the use of antihypertensive drugs? In fact, if I am in front of a patient with acute decompensation, so to speak in pulmonary edema, I do not prescribe a beta-blocker cardioselective: I take time. So I do not use antialdosterones if the potassium is high (hyperkalemia) Let's see them in the table.
Therefore, this being the case, if I am confronted with a patient with myocardial decompensation, I will employ loop diuretics and anti-dyadones; if I have the patient with stroke I will use ace inhibitors; so in myocardial hypertrophy I prefer beta-blockers, better if I have arrhythmia, and even if I have a chronic decompensation; I use the sartanico immediately in the young patient so as not to give impotence to the erection and not to disturb his physical performance; in the nephropathy I will prefer, again the calcium antagonists and in the angina the diltiazem.

In short, prescribing antihypertensive therapies is not a trivial matter!

 

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