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High Blood Pressure - Information

Hypertension (HTN) or high blood pressure, sometimes arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed (diastole) between beats. Normal blood pressure is at or below 120/80 mmHg. High blood pressure is said to be present if it is persistently at or above 140/90 mmHg.

Hypertension is classified as either primary (essential) hypertension or secondary hypertension; about 90–95% of cases are categorized as "primary hypertension" which means high blood pressure with no obvious underlying medical cause. The remaining 5–10% of cases (secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart or endocrine system.

Hypertension is a major risk factor for stroke, myocardial infarction (heart attacks), heart failure, aneurysms of the arteries (e.g. aortic aneurysm), peripheral arterial disease and is a cause of chronic kidney disease. Even moderate elevation of arterial blood pressure is associated with a shortened life expectancy. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment is often necessary in patients for whom lifestyle changes prove ineffective or insufficient.

Medications

Several classes of medications, collectively referred to as antihypertensive drugs, are currently available for treating hypertension. Reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischaemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease. The aim of treatment should be to reduce blood pressure to less than 140/90 mmHg for most individuals, and lower for individuals with diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg). If the blood pressure goal is not met, a change in treatment should be made as therapeutic inertia is a clear impediment to blood pressure control. Comorbidity also plays a role in determining target blood pressure, with lower BP targets applying to patients with end-organ damage or proteinuria.

Often multiple medications are needed to be combined to achieve the goal blood pressure. Guidelines on the choice of first line agent and how to best to step up treatment with multiple agents for various subgroups of patients have changed over time and differ between countries.

In the UK low dose thiazide-based diuretic were previously thought the best first line agent, but latest guidelines emphasise calcium channel blockers (CCB) in preference for patients over the age of 55 years or if of African or Caribbean family origin, with angiotensin converting enzyme inhibitors (ACE-I) used first line for younger patients. Preferred dual therapy is generally CCB with an ACE-I, and triple therapy with addition of a thiazide-like diuretic. If a fourth agent is needed then additional diuretics of spironolactone or a higher-dose of a thiazide-like diuretics. Additional agents that may be considered are alpha blockers or beta blockers. Angiotensin II receptor antagonists are suggested as preferable to ACE-I for black people of African or Caribbean family origin, and are an alternative for patients who are unable to tolerate ACE-I. Beta-blockers may be also be considered in younger people, particularly those with an intolerance or contraindication to ACE-I and angiotensin II receptor antagonists, or women of child-bearing potential, or people with evidence of increased sympathetic drive.

High Blood Pressure - Medication Information

Hydrochlorothiazide

Hydrochlorothiazide, abbreviated HCTZ, HCT, or HZT, is a first-line diuretic drug of the thiazide class that acts by inhibiting the kidneys' ability to retain water. This reduces the volume of the blood, decreasing blood return to the heart and thus cardiac output and, by other mechanisms, is believed to lower peripheral vascular resistance. Hydrochlorothiazide is a calcium-sparing diuretic, meaning it can help the body get rid of excess water while still keeping calcium.

Hydrochlorothiazide is frequently used for the treatment of hypertension, congestive heart failure, symptomatic edema, diabetes insipidus, renal tubular acidosis, and the prevention of kidney stones.

Lisinopril

Lisinopril is a drug of the angiotensin-converting enzyme (ACE) inhibitor class that is primarily used in treatment of hypertension, congestive heart failure, and heart attacks and also in preventing renal and retinal complications of diabetes. Its indications, contraindications and side effects are as those for all ACE inhibitors. It has been compared with omapatrilat, which is of similar function.

Historically, lisinopril was the third ACE inhibitor (after captopril and enalapril) and was introduced into therapy in the early 1990s. Lisinopril has a number of properties that distinguish it from other ACE inhibitors: It is hydrophilic, has a long half-life and tissue penetration, and is not metabolized by the liver.