Hypertension

is the term used to describe high

blood pressure. Blood pressure is a measurement of the force against the walls of the arteries as the heart pumps blood throughout the body. BP = CO X PVR BP is measured in mm of mercury (Hg).

Factors that affect blood pressure: How much water and salt present in the body The condition of kidneys, nervous system, or blood vessels The levels of different body hormones Some causes of higher risk of hypertension are: Obesity Stressed or anxious Too much salt intake Family history Diabetes Smoke

The most important and most widely used classes of antihypertensive drugs are: 1) Diuretics 2) Adrenergic receptor antagonists 3) Calcium channel blockers 4) Renin Inhibitors 5) ACE inhibitors 6) Vasodilators

Diuretic drugsinhibit the reabsorption of sodium at different segments of the renal tubular system kidney excretes more sodium increase urine output (i.e., promote diuresis) reduce blood volume lower blood pressure. Types of diuretics are: -Loop diuretics -Thiazide diuretics -Potassium sparing diuretics -Carbonic anhydrase inhibitors -Osmotic diuretics

Loop diuretics:

Thiazide diuretics:

Carbonic anhydrase inhibitors:

Potassium sparing diuretics:

increase

diuresis by interfering with the sodiumpotassium exchange in the distal convoluted tubule in the kidneys inhibit the Na+/K+ pump by reducing Na+ entry across the luminal membrane

Osmotic diuretics:
mostly in the proximal tubule Nonabsorbable, producing an osmotic effect Pull water into renal tubules from the surrounding tissues creates a back-flow of sodium back into the tubule increase in water and sodium excretion and urine production blood viscosity is decreased lowering blood pressure
Work

Side-effects of diuretic include: increased urination feeling thirsty, dizzy, weak, lethargic or sick muscle cramps skin rash

Adrenergic receptors areclass of G protein-coupled receptors targets of the catecholamines, especially noradrenaline (norepinephrine) and adrenaline (epinephrine). Types of adrenergic receptors: receptors have the subtypes 1 and 2. receptors have the subtypes 1, 2 and 3.

Adrenergic antagonists acts to inhibit the action of the adrenergic receptors. divided into: -alpha blockers or -adrenergic-antagonists -beta blockers or beta-adrenergicantagonists

ALPHA BLOCKERS: Types are: 1-blockers or antagonists and 2-blockers or antagonists.

bind

with the -adrenergic receptors and blocks noradrenaline (norepinephrine) or adrenaline (epinephrine) from binding with the receptors. decreases arterial and venous vasoconstriction and consequently decrease of peripheral resistance and lowering of arterial pressure decreases platelet aggregation facilitates bladder evacuation.

BETA BLOCKERS: drugs that competitively block beta-adrenergic substances (endogenous catecholamines eg. adrenaline) to bind with the beta receptors of the involuntary nervous system (autononomic nervous system).

Figure: Mechanism of action of Beta blockers

Hence beta-blockersslow down the heart beat, reduce the force of the heart muscle's contractions, and decrease blood vessel contraction in the heart, brain, and the rest of the body.

Table: some medications available in Bangladesh

Renin inhibitors antihypertensive drugs that inhibit the first step of the renin-angiotensin-aldosterone system (RAAS). bind to the active site of renin inhibit the binding of renin to angiotensinogen prevent the formation of Ang I and Ang II. prevents water and salt retention and arteriolar vasoconstriction. lowers blood pressure. Aliskiren, the first drug in this class, received a marketing approval in 2007. It is the only renin inhibitor on the market.

ACE inhibitors lower blood pressure by blocking certain specific step in the renin-angiotensin-aldosterone system (RAAS).

Angiotensin-converting enzyme, secreted by pulmonary and renal endothelial cells, catalyzes the conversion of angiotensin-I to angiotensin II.

ACE inhibitors block the action of the angiotensinconverting enzyme so that angiotensin I is not converted into angiotensin II. Henceblood vessels dilate. amount of water put back into the blood by the kidneys decreases. blood pressure is reduced.

Side Effects: - hypotension - cough - headache - dizziness - fatigue - nausea - renal impairment.

Table: some medications available in Bangladesh

CCBs causesdecrease in intracellular calcium less contraction of vascular smooth muscle Vasodilation blood pressure drops

Side effects: Dizziness or lightheadedness. Low blood pressure. Heart rhythm problems particularly. Dry mouth. Edema (swelling of ankles, feet, or lower legs). Headache. Nausea. Fatigue. Skin rash. Constipation or diarrhea.

Table: some medications available in Bangladesh

Vasodilators relax or reduce the tone of vascular smooth muscles resulting in decreased peripheral resistance and decreased blood pressure. Commonly used vasodilators Hydralazine Sodium nitroprusside Minoxidil

Figure: Mechanism of action of Minoxidil

Vasodilators are strong medications and are generally used only as a last resort for controlling blood pressure. Side effects include: Chest pain Rapid heartbeat (tachycardia) Fluid retention (edema) Nausea Vomiting Dizziness Flushing Headache Nasal congestion

Change in lifestyle can help to lower blood pressure in some cases like losing weight if one is overweight regular physical activity a healthy diet cutting back if one drinks a lot of alcohol stopping smoking a low salt and caffeine intake.

Blood pressure vaccinations are now being trialed and may become a treatment option for high blood pressure in the future.