Initial management of a newly diagnosed Hypertension is with:
Ans: a (Life style modification)Ref: Thripathi, 5th ed. Pg. 514If risk assessed is low, only non pharmacological measures and BP monitoring are recommended for 3-6 months.Pharmacological therapy is recommended for BP greater than or equal to 140/90.Blood pressure classificationSystolic mmHgDiastolic mmHgNormalPrehypertension Stage 1 hypertension Stage 2 hypertension Isolated systolic hypertension<120 120-139140-159 or = 160 or =140 and< 80 Or 80-8990-99 100 <90Drug therapy is recommended for individuals with blood pressures >140/90 mmHg.Drugs used in hypertension are:1. Diuretics -Low-dose thiazide diuretics are often used as first-line agents, alone or in combination with other antihypertensive drugs, e.g., hydrochlorthiazide, chlorthalidone.2. ACE-inhibitors and angiotensin receptor blockers ACE inhibitors decrease the production of angiotensin II, increase bradykinin levels, and reduce sympathetic nervous system activity. Angiotensin II receptor blockers provide selective blockade of AT 1 receptors.3. Beta blockers - beta adrenergic receptor blockers lower blood pressure by decreasing cardiac output, due to a reduction of heart rate and contractility. Other actions include renin inhibition.4. Calcium channel blockers - Calcium channel antagonists reduce vascular resistance through L-channel blockade, which reduces intracellular calcium and blunts vasoconstriction.5. Aldosterone antagonists - It may be a particularly effective agent in patients with low-renin essential hypertension, resistant hypertension, and primary aldosteronism.The newer agent, eplerenone, which is a selective aldosterone antagonist have lesser side effects than spironolactone.6. Alpha adrenergic blockers - They lower blood pressure by decreasing peripheral vascular resistance.7. Sympatholytic agents - Centrally acting a 2 agonists lower blood pressure by inhibiting sympathetic outflow and thereby decreasing peripheral resistance, e.g., clonidine.8. Direct vasodilators - These agents decrease peripheral resistance. Hydralazine is a potent direct vasodilator. S/e: lupus-like syndrome.9. Adrenergic neuron-blocking agents - These drugs lower blood pressure by preventing normal physiological release of nor epinephrine from postganglionic sympathetic neurons, e.g., Guanethidine, reserpineNewer drugsRenin Inhibitors The orally active renin inhibitor aliskiren is now available for the treatment of hypertension.Drugs used in management of hypertensive emergenciesThe drug most commonly used to treat hypertensive emergencies is the vasodilator sodium nitroprusside.Other parenteral drugs that may be effective include fenoldopam, nitroglycerine, labetalol, enalaprilat, calcium channel blockers (IV nicardipine), diazoxide, and hydralazine.Esmolol is often used to manage intra operative and postoperative hypertension.Fenoldopam is a peripheral arteriolar dilator used for hypertensive emergencies and postoperative hypertension. It acts primarily as an agonist of dopamine D1 receptors, resulting in dilation of peripheral arteries and natriuresis.
Life style modification
ACE inhibitors
B- blockers
Diuretics
C.V.S