Definition
We speak of hypertension when the minimum (diastolic) blood pressure values exceed 90 mmHg and the maximum (systolic) blood pressure values exceed 140 mmHg; this definition is not completely correct, given that, to define himself as “hypertensive”, a subject must maintain this alteration of blood pressure constantly.
Causes
In essential arterial hypertension, the precise causes that are at the origin of the hypertensive picture are not well defined; rather, it is possible to hypothesize only predisposing factors: unbalanced diet, old age, genetic predisposition, sedentary lifestyle, stress, etc. , occlusion of a "renal artery, Cushing's syndrome.
- Risk factors: alcohol and smoking abuse, old age, obesity / overweight, sedentary lifestyle, stress
Symptoms
In most cases, hypertension does not begin with any definite and precise symptoms, therefore the disorder tends to be diagnosed late; however, the possible symptoms can result in: impaired vision, confusion, acute headache, nausea , ringing in the ears (tinnitus), nosebleeds, dizziness, vomiting.
Diet and Nutrition
Natural Cures
The information on Hypertension - Medicines for the Treatment of Hypertension is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Hypertension - Medicines for the Treatment of Hypertension.
Medicines
The key objective of antihypertensive treatment is to reduce blood pressure to reduce the risk of complications; lifestyle changes, dietary precautions and the implementation of some simple physical exercises help to keep blood pressure within the range of levels physiological.
General guidelines for blood pressure control:
Follow a healthy and regular diet, rich in potassium and fiber, and low in salt and saturated fat
Drink a lot of water
Not smoking
Get at least 30 minutes of exercise a day
Don't drink alcohol
Reduce Stress
In case of overweight / obesity, follow a low calorie diet
If these simple dietary and behavioral precautions are not sufficient to balance blood pressure values, the patient will have to follow a pharmacological pathway aimed at treating hypertension. Very often, the hypertensive person must take drugs for life.
Medicines used in therapy for the treatment of hypertension are diuretics, calcium antagonists, sympatholytics, beta blockers, angiotensin II antagonists, ACE inhibitors.
The following are the classes of drugs most used in the therapy against hypertension, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:
Thiazide diuretics: these drugs act at the level of the nephron, increasing the amount of ultrafiltrate, which is excreted in the urine; in other words, diuretics block the mechanisms of reabsorption of water and sodium, acting at the level of the distal tubule. Consequently, the volume of blood reaching the heart decreases, as does cardiac output, peripheral resistance and blood pressure.
Thiazides are widely used in therapy for the treatment of hypertension.
Thiazide diuretics cause an electrolyte imbalance, especially in terms of potassium; in this case, an integration of this important mineral is recommended.
- Hydrochlorothiazide (eg. Rasitrio, Esidrex): start therapy for hypertension by taking a drug dose of 25 mg, once a day. Maintenance dose: it is possible to increase the dosage by 50 mg, to be taken orally, also divided into two doses Consult your doctor.
- Amiloride hydrochloride + Hydrochlorothiazide (eg Moduretic): Amiloride is often formulated in combination with potassium-sparing drugs (Hydrochlorothiazide). Indicated to treat edema caused by heart and liver disorders and for the treatment of hypertension. It is recommended to take 1-2 tablets of the drug per day (1 tablet: 5mg of amiloride + 50mg of hydrochlorothiazide); do not exceed 4 tablets per day.
Loop diuretics: as the word itself suggests, the site of action of these drugs is the loop of Henle: the active ingredients carry out their therapeutic activity by preventing the transport of chlorine and sodium in the ascending part of the loop, so it is no longer water reabsorption. These drugs increase the excretion of calcium, magnesium and potassium. They are indicated in case of hypertensive crisis and edema.
- Ethacrynic acid (eg Reomax): in general, the drug is prescribed to treat diseases characterized by an evident increase in water retention, cirrhosis, ascites, chronic renal failure and hypertension. Indicatively, it is recommended to take the drug at a dosage of 50 mg, once a day, after a meal. Consult your doctor.
Potassium-sparing diuretics: represent the only type of diuretics capable of avoiding the loss of potassium (hypokalaemia). These drugs carry out their therapeutic activity at the level of the collecting duct: by antagonizing the function of aldosterone, they decrease the absorption of sodium and water, promoting diuresis.
- Amiloride (eg Moduretic, associated with hydrochlorothiazide): tablets formulated with 5mg of amiloride + 50mg of hydrochlorothiazide are available: it is recommended to take 1-2 tablets a day for the treatment of hypertension. Do not exceed 4 tablets per day.
- Furosemide (eg. Lasix, Spirofur, Fluss): for the treatment of hypertension, it is recommended to take 1- 3 tablets of 25 mg per day, depending on the severity of the condition.
- Spironolactone (eg Aldactone, Uractone, Spirolang): the dosage for the treatment of hypertension is very variable (50-200 mg per day) and must be established by the doctor on the basis of the patient's blood pressure.
Diuretics inhibitors of carbonic anhydrase: carbonic anhydrase is an enzyme localized in the kidney and in the eye which, when inhibited, prevents the reabsorption of bicarbonate in the proximal convoluted tubule.
- Acetazolamide (eg.Diamox): the dose for the treatment of "hypertension must" be accurately established by the doctor on the basis of the patient's state of health.
Osmotic diuretics: they increase the volume of urine excreted by acting in every point of the renal tubule: by recalling water, they decrease its reabsorption. Also indicated for the treatment of intraocular hypertension.
- Mannitol (eg Osmohale, Man10% BIN, Isotol): indicatively, mannitol should be taken at a dose ranging from 50 to 200 g per day. It is generally administered intravenously; before proceeding with the posology just described, the patient is usually subjected to a dose-test of drug, in which 200 mg / kg of active are administered by slow intravenous infusion. The precise dose depends on the severity of the condition and the patient's general health status.
Beta-blockers: decrease sympathetic tone by blocking beta receptors in the heart. In other words, these active ingredients are indicated for the treatment of hypertension, reducing both the force of contraction and the heart rate.
- Atenolol (eg. Atenol, Tenoretic, Tenormin): for the treatment of arterial hypertension of renal origin, it is recommended to take 100 mg of active ingredient per day. After 15 days of treatment, the patient should begin to reap the first benefits; if this is not the case, it is possible to associate a diuretic drug with the beta blocker.
- Acebutolol hydrochloride (eg Prent, Sectral): for the treatment of arterial hypertension take 1 tablet of 200 mg of the drug, preferably before breakfast. It is possible to gradually increase the dosage up to a maximum of 400 mg per day.
- Timolol maleate (eg Blocadren, Cusimolol, Ialutim): indicatively, for the treatment of arterial hypertension, take 10mg of active ingredient twice a day.
- Nebivolol (eg Lobivon, Nebilox, Lobidiur): to treat hypertension, take 5 mg of active daily, at approximately the same time. Consult your doctor.
- Propanolol hydrochloride (eg Inderal): for the long-term treatment of hypertension, it is recommended to take 40 mg of active, twice a day.
- Bisoprolol hemifumarate (eg Concor): for the treatment of hypertension and angina pectoris, it is recommended to take 5-10 mg of active ingredient per day. The dose can be adjusted according to the severity of the disease and the patient's response. Consult your doctor.
- Metoprolol tartrate (eg. Seloken, Lopresor, Metoprolol AGE): take 1-2 tablets of 100 mg, 1-2 times a day. The dosage just described is approximate: consult your doctor.
- Carvedilol (eg. Colver): take two tablets a day (for a total of 12.5 mg) during the first two days of treatment for hypertension; subsequently, take 25 mg of active, in a single dose, up to a maximum of 50 mg (divided into two doses). Consult your doctor.
- Pindolol (eg Visken): indicatively, take ½ or 1 tablet, three times a day, up to a maximum of 4 tablets a day. Each tablet consists of 5 mg of active.
ACE Inhibitors: These drugs work by inhibiting the Angiotensin I-converting enzyme (ACE), which converts angiotensin 1 into its active form (angiotensin 2), responsible for the release of aldosterone, vasoconstriction and stimulation of the sympathetic system.
ACE inhibitors are potent antihypertensives:
- Ramipril (eg Triatec, Unipril, Eclipse): take two tablets (for a total of 2.5 mg) per day; thereafter, the dose can be increased slowly (usually every 2 weeks) up to a maximum of 10 mg / day.
- Lisinopril (eg. Zestril, Ensor, Nosilix): for the treatment of hypertension, it is recommended to take 5-10 mg per day; after 2-3 weeks of treatment, it is possible to double the dose. It is recommended to take the tablet every day, about always the same time.
- Enalapril maleate (eg. Converten): for the treatment of hypertension, this drug is often used in combination with other antihypertensive drugs (eg hydrochlorothiazide); for this purpose, it is recommended to take the drug at a dosage of 5-20 mg, formulated in tablets In any case, it is the duty of the physician to establish the most suitable dosage for the patient.
- Fosinopril in sodium salt (eg Eliten, Fosicombi, Tensozide): in addition to the treatment of hypertension, this drug is sometimes prescribed for the treatment of heart failure. For arterial hypertension, it is recommended to take a drug dose of 20 mg / day (2 tablets), in a single dose. In general, it is recommended to start therapy with a single tablet and then eventually increase the dose.
ACE inhibitors can cause more or less serious side effects: dry cough, angioneurotic edema, fetopathy and skin rash.
Sartans or AT-1 antagonists: these are inhibitors of angiotensin 2 receptors, responsible for vasoconstriction, release of aldosterone and hypertrophy. Do not administer during pregnancy.
- Candesartan (eg Blopress, Atacand PLUS, Blopressid): start therapy for hypertension by taking 8 mg of the drug once a day; the dose can be increased every 4 weeks, up to a maximum of 32 mg per day. maintenance involves taking 8 mg, once a day.
- Eprosartan (eg. Tevetenz, Tiartan): it is recommended to take 600 mg of the drug once a day. It is possible to increase the dose, after 2-3 weeks of treatment, up to 800 mg, once a day.
- Irbesartan (eg. Karvea, Karvezide, Coaprovel, Irbesartan winthrop): initiate hypertension therapy with a drug dose of 50-150 mg, to be taken once daily. Continue therapy with a dose of 150-300. mg, once a day.
Unlike ACE inhibitors, Sartans do not cause dry cough and decrease angioedema.
Calcium antagonists: these drugs for the treatment of hypertension act at the level of vascular smooth muscle: they decrease the entry of calcium ions into the cells of smooth and cardiac muscles, consequently there is a relaxation of the muscles and a decrease in peripheral resistance ; in this way, blood pressure decreases.
- Nitrendipine (eg Baypress): particularly suitable for treating arterial hypertension. It is recommended to start the treatment with 20 mg of the drug per day, in the morning after breakfast; it is also possible to take half a tablet, twice a day.
- Lercanidipine hydrochloride (eg Cardiovasc, Lisitens, Zanedip): for the treatment of mild or moderate hypertension, it is recommended to take one 10 mg tablet per day. It is possible to increase the dose up to a maximum of 20 mg per day. .
- Felodipine (eg. Prevex, Feloday, Plendil): for the treatment of arterial hypertension, it is recommended to take a drug dose of 10 mg per day, orally. If the drug has a good therapeutic effect, it is possible halve the dosage Consult your doctor.
- Amlodipine besilate (eg Norvasc): the dose of 5 mg per day seems to be the most effective in reducing symptoms related to arterial hypertension. Do not exceed 10 mg per day.
