TREATMENT OF HYPERTENSION Lifestyle modification

• For normal persons and prehypertensives life style modification is advised.
• For patients with compelling indications like heart fail­ure, post MI, high coronary artery disease risk, dia­betes, chronic kidney disease and recurrent strokes adequate drug treatment to keep the blood pressure < 130/80 is advisable for prehypertension, stage 1 and 2 hypertension.
• For stage 1 hypertension
  • thiazide-type diuretics, ACE inhibitors, ARB (angiotensin receptor blockers), beta blockers, calcium channel blockers or a combination of these drugs may be given.
• For stage 2 hypertension
  • -d rug combination should be given to avoid the toxicity of high dose of 1 drug.
• Thiazide-type diuretics
• Angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs)
• Calcium channel blockers Beta blockers, which are now used less often for initial therapy in the absence of a specific indication for their use

Lifestyle modification

• · Weight reduction
• · Regular exercise – Yoga, aerobics, swimming, cycling, dancing
• · Daily morning walk at least 3 kms/day at least 5 days a week on empty stomach, at a brisk pace.
• · Avoid alcohol
• · No tobacco, pan masala, smoking.
• · Low salt intake (half teaspoon or 6 gm NaCi daily)
• · Increased intake of fruits and vegetables
• · Low fat diet – use only unsaturated fats

Control of Risk factors

• · Tight control of diabetes
• · Drug treatment for obesity, if required
• · Stop smoking.
• · Lipid-lowering treatment

Drug treatment Diuretics  :

• Diuretics Thiazides Chlorthiazides,
• Hydrochlorthiazide,
• Indapamide 1.25 – 2.5 mg/oay,
• Metolazone 2.5 – 5.0 mg/day.
• ‘Potassium-sparing diuretics –
  • Amiloride,
  • Triamterene.
• Aldosterone receptor blockers –
  • Spironolactone 25 ­50 mg/day,
  • Eplerenone.
• Loop diuretics –
  • Furosemide 20 to 80 mg/day,
  • Torsemide.

ACE Inhibitors  :

• Enalapril 5/ 10/ 15 mg 1 OD / BD
• LisinoPril 5/ 10 / 20 mg 1 OD / BD
• Perindopril 2 / 4 mg aD / BD

Angiotensin ll antagonists – Angiotensin receptor blockers : ‘

• Losartan25,50 mg 1 OD / BD
• ibesartan 150/ 300 mg BD
• Telmisartan 20 / 40 mg aD LOsartan 80 2-3 mg OD

Calcium channel blockers : 

• Diltiazem 90/120/180 mgOD/BD
• Amlodipine 2.5/5 10 mg OD
• Verapamil 80/ 120 / 360 mg OD / BD
• Nedipine 10/ 20 / 30 mg OD BD

Beta blockers :

• Atenolol 25/ 50 / 100 mg aD
• Bisoprolol 2.5/ 5/ 10 mg OD
• Nebivolol 5 mg OD / BD
• Metoprolol 50/ 100 mg OD BD

Combined Alpha and Beta blockers:

• Doxazosin 1 mg / 2 mg aD
• Prazosin 1 mg / 2 mg / 5 mg aD BD / TDS
• · Carvedilol 12.5/ 25/ 50 mg OD BD
• · Labetalol 200/ 400 mg OD BD
• Terazosin 1 mg / 2 mg OD BD

Central Alpha 2 agonists and other centrally act­ing drugs:

• · Reserpine 0.05/0.25 mg OD
• · Methyldopa 250 / 500 mg / 1 gm BD
• · Clonidine 0.1 mg 1 BD / 1 TDS /2 TDS

Direct vasodilators:

• · Hydralazine
• · Minoxidil