TREATMENT OF HYPERTENSION Lifestyle modification WITH Drug treatment

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

HYPERTENSION Lifestyle modification 1

TREATMENT OF HYPERTENSION Lifestyle modification

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 Diuretic:

  • 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 –
  • 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
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