High Blood Pressure Easy or complex? University Pharmacy Edwin Elliot, Insia Hussain Pharm.D. candidates, 2011
The evolution of mankind 2.5 mn years 50 years and we wonder why our healthcare costs are going up?
What is Blood Pressure Blood Pressure is the force of blood pushing against artery walls as it courses through the body. When our blood vessels get narrowed, pressure against the artery walls increases.
What does it mean? Makes walls of your blood vessels thicker Makes the your heart work harder. Increases your risk for heart diseases and stroke and kidney failure 1 out of every 3 Americans have high blood pressure.
Why me?
Hypertension and Racial Groups African Americans: Highest Prevalence Early Onset Hispanics: Generally low prevalence Asian and Pacific Islanders: May be more responsive to treatment than other groups Native Americans: Similar prevalence to general population High prevalence of diabetes and obesity
Know your numbers! Two numbers: SBP: Systolic - as the heart beats DBP: Diastolic - as the heart relaxes
What is our? Reduce morbidity and mortality by least intrusive means possible. Achieve and maintain SBP < 140 mm Hg DBP < 90 mm Hg In Patients with Diabetes or Chronic Kidney disease SBP < 130 mm Hg DBP < 80 mm Hg
Lifestyle changes - Diet Adopt a diet rich in fruits, vegetables, and low fat dairy products with reduced content of saturated and total fat Reduce dietary sodium intake to less than 2.4 grams of sodium (less than 6 grams of Sodium Chloride)
How to read the labels? l Sodium free = 5 or less than 5 mg (milligrams) Very low sodium = 35 mg or less Fruits, vegetables, pasta Low sodium foods = 140 mg or less Bread, meat, chicken, fish, milk, margarine High sodium foods = over 140 mg. Cheese, luncheon meats, hot dogs, bacon, ketchup, mustard, soy sauce, many frozen entrees, canned soups, canned entrees, hamburger helper, many snack crackers, most chips and pizza.
Lifestyle changes Alcohol consumption Men: Limit to 2 drinks per day. Women and lighter weight persons: limit to 1 drink per day. 1 drink = ½ oz. or 15mL ethanol E.g.: 12 oz. beer, 5 oz. wine, 1.5 oz. 80- proof whiskey
Lifestyle changes Exercise! 30 minutes of moderate level activity on most days of week. Can break it up into 10 minute sessions. Use stairs instead of elevator Get off bus 2 stops early. Park your car at the far end of the lot and walk!
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Medication Therapy Classes of medication for treatment of hypertension Diuretics Beta Blockers ACE inhibitors Angiotensin Receptor Blockers (ARBs) Calcium Channel Clockers Alpha-1 Blockers Alpha-2 Agonist Direct Vasodilators
Diuretics or water pill Generic (Brand) Names: Examples: hydrochlorothiazide, indapamide, chlothalidone, or metolazone o e Decrease the amount of fluid flowing through blood vessels, thus decreasing blood pressure Usually it's the first drug prescribed for hypertension. Side effects: Urination, Dizziness, Dehydration, Changes in potassium and/or sodium.
Beta Blockers Generic (Brand) Names: 13 different types, identifiable by their "lol" suffixes. Examples: atenolol (Tenormin), metoprolol (Lopressor) Decrease the force of the heart's contractions and block effects of the nervous system on blood vessels and the heart. Recommended for heart attack survivors or people with heart failure.
cont Beta Blockers Not as effective for African-Americans. Side Effects: Drowsiness or fatigue, Weakness or Side Effects: Drowsiness or fatigue, Weakness or dizziness, Impotence.
Angiotensin Converting Enzyme Inhibitors (ACE-I) Generic (Brand) Names: 10 different types; identifiable by their "pril" suffixes. Examples: Lisinopril (Zestril), benazepril (Lotensin), Dilate blood vessels by blocking an enzyme (ACE) that constricts vessels. Protects kidneys Used in diabetics Side Effect: Dry Cough, Angioedema
Angiotensin-ii Receptor Blockers (ARB) Generic (Brand) Names: 7 different types; identifiable by their sartan" suffixes. Examples: losartan (Cozaar), candesartan (Atacand) They function like ACE inhibitors, but with fewer side effects. They are more expensive than ACE inhibitors Do not take if you are pregnant or plan to become pregnant.
Calcium Channel Blockers Generic (Brand) Names: About 20 different drugs, identifiable by their dipine" suffixes. Examples: amlodipine (Norvasc), nifedipine (Procardia) Keep calcium from entering the muscle cells of the heart and blood vessels, hence dilates blood vessels. Side Effect: Feeling Tired; Swelling of the abdomen, ankles or feet; Heartburn or upset stomach; Constipation (verapamil)
Alpha-1 Blocker Generic (Brand) Names: About 6 different drugs, identifiable by their zosin" suffixes. Examples: doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin) These medications block nerve impulses that tighten blood vessels. Side effects: Dizziness, Headache
Alpha-2 Agonist Generic (Brand) Names: About 9 different drugs Examples: clonidine (Catapres), guanabenz (Wytensin) These medications help relax and widen blood vessels by controlling nerve impulses from the brain. Do NOT discontinue abruptly Side effects: Dizziness, Constipation and Dry eyes
Vasodilators Generic (Brand) Names: Examples: hydralazine (Apresoline), minoxidil (Rogaine) Dilate blood vessels. Strong medicines that are generally used when other blood pressure drugs haven't worked Side effects: Dizziness, Hair Growth (Minoxidil)
Selection of therapy Race: African Americans respond well to diuretic therapy Caucasian respond well to ACE inhibitors Age: some adverse effects may not be tolerated well by elderly people Concomitant diseases and therapies: some agents also treat migraines, benign prostatic hyperplasia, heart failure Quality of life impact: tolerance of adverse effects Economic considerations: newer agents are very expensive
Thinking Outside the Pillbox Adherence to your hypertension medication is 49% in America Cause of 89,000 premature deaths in America annually Major factor for poor medication compliance is Patient education
U i it Ph University Pharmacy!!
Tk Take Charge! Know your numbers! Watch what you are eating and drinking Be physically active Know your medications Know the side effects
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