II. Approach: Young Hypertensive
- Pathophysiology
- Active
- Increased sympathetic tone
- Elevated Plasma Renin Activity (PRA)
- First choice medications
- Other medications
- Beta-alpha Antagonist
- Alpha-1 Antagonist
- Calcium Channel Blocker
- Avoid
- Beta Blockers
- Decreased HDL
- Sexual activity and Exercise affected
- Beta Blockers
III. Approach: Athletes
IV. Approach: Elderly
- See Hypertension in the Elderly
- Non-black patients over age 60 years old
V. Approach: Black
- Pathophysiology
- Low renin
- High plasma volume
- High vessel resistance
- First Choice Medications
- Diuretics (Hydrochlorothizides)
- Concurrent use improves Beta Blocker response
- Concurrent use improves ACE Inhibitor response
- Calcium Channel Blockers
- Diuretics (Hydrochlorothizides)
- Changes (Previously contraindicated)
- ACE Inhibitors
- ACE Inhibitors are effective in black patients when added to Diuretics or Calcium Channel Blockers
- Previously thought not useful with low renin status
- Use if indicated for renal protection (however, will require additional Antihypertensive)
- AASK study showed benefit with Ramipril
- Retarded renal disease progression
- Wright (2002) JAMA 288:2421-31 [PubMed]
- ACE Inhibitors
- Other Medications
- Labetalol
- Hydralazine 37.5 mg with Isordil 20 mg three times daily
- Consider in NYHA Class 3-4 Heart Failure with Reduced Ejection Fraction
- Added as adjunct to ACE Inhibitor and Beta Blocker
- See Systolic Dysfunction
VI. Approach: Obesity (even 10 pounds or 4.5 kg over Ideal Weight)
- Pathophysiology
- Modestly elevated vessel resistance
- Higher Cardiac Output
- High plasma volume
- Low renin
- First Choice Management
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Related Studies
| Definition (MEDLINEPLUS) |
High blood pressure, also called hypertension, usually has no symptoms. But it can cause serious problems such as stroke, heart failure, heart attack and kidney failure. If you cannot control your high blood pressure through lifestyle changes such as losing weight and reducing sodium in your diet, you may need medicines. Blood pressure medicines work in different ways to lower blood pressure. Some remove extra fluid and salt from the body. Others slow down the heartbeat or relax and widen blood vessels. Often, two or more medicines work better than one. NIH: National Heart, Lung, and Blood Institute |
| Definition (NCI) | Any substance used in the treatment of acute or chronic hypertension regardless of pharmacological mechanism. Antihypertensive agents include diuretics, alpha-adrenergic and beta-adrenergic antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, ganglionic blockers, and vasodilator agents. |
| Definition (CSP) | agent that reduces high blood pressure. |
| Definition (MSH) | Drugs used in the treatment of acute or chronic vascular HYPERTENSION regardless of pharmacological mechanism. Among the antihypertensive agents are DIURETICS; (especially DIURETICS, THIAZIDE); ADRENERGIC BETA-ANTAGONISTS; ADRENERGIC ALPHA-ANTAGONISTS; ANGIOTENSIN-CONVERTING ENZYME INHIBITORS; CALCIUM CHANNEL BLOCKERS; GANGLIONIC BLOCKERS; and VASODILATOR AGENTS. |
| Concepts | Pharmacologic Substance (T121) |
| MSH | D000959 |
| SnomedCT | 1182007, 372586001 |
| LNC | LP31453-1 |
| English | Agents, Antihypertensive, antihypertensive agent, Antihypertensive Drugs, Agents, Anti-Hypertensive, Anti Hypertensive Agents, Anti Hypertensive Drugs, Anti Hypertensives, Anti-Hypertensive Agents, Anti-Hypertensive Drugs, Anti-Hypertensives, Antihypertensives, Drugs, Anti-Hypertensive, Drugs, Antihypertensive, antihypertensives (medication), antihypertensives, anti hypertensive, antihypertensives drugs, anti hypertensive drug, anti-hypertensive drugs, hypotensive agent, antihypertensive drug, antihypertensive drugs, anti hypertensives, antihypertensive, antihypertensive agents, hypotensive agents, anti-hypertensives, anti hypertensive drugs, blood pressure lowering drug, Antihypertensive Agents, Antihypertensive medicines, Antihypertensive Medicines, High Blood Pressure Medicines, High blood pressure medicines, Blood Pressure Medicines, ANTIHYPERTENSIVES, Hypotensive agents, Antihypertensive drug, Antihypertensive, Hypotensive agent (product), Hypotensive agent (substance), Hypotensive agent, Antihypertensive agent, Antihypertensive agent, NOS, Antihypertensive drug, NOS, Hypotensive agent, NOS, Hypotensive Agents, Hypotensive Drugs, Hypotensives, Antihypertensive Agent |
| French | Agents antihypertenseurs, Médicaments antihypertenseurs, Anti-hypertenseurs, Antihypertenseurs |
| Swedish | Blodtryckssänkande medel |
| Czech | hypotenzíva, antihypertenzíva, hypotonika |
| Finnish | Verenpainelääkkeet |
| Italian | Farmaci antiipertensivi, Antiipertensivi |
| Russian | GIPOTENZIVNYE SREDSTVA, ANTIGIPERTENZIVNYE SREDSTVA, АНТИГИПЕРТЕНЗИВНЫЕ СРЕДСТВА, ГИПОТЕНЗИВНЫЕ СРЕДСТВА |
| Croatian | ANTIHIPERTENZIVI |
| Polish | Leki obniżające ciśnienie, Leki hipotensyjne, Leki przeciwnadciśnieniowe |
| Japanese | 血圧下降剤, 降圧剤, 抗高血圧症薬, 抗高血圧薬, 血圧降下剤, 血圧降下薬, 降圧物質, 降圧薬 |
| Spanish | Antihipertensivos, Fármacos Antihipertensivos, Agentes Antihipertensivos, agente antihipertensivo, agente hipotensor (producto), agente hipotensor (sustancia), agente hipotensor, droga antihipertensiva |
| Norwegian | Blodtrykkssenkende midler |
| Portuguese | Agentes Anti-Hipertensivos, Fármacos Anti-Hipertensivos, Anti-Hipertensivos |
| German | Antihypertonika, Blutdrucksenkende Mittel, Antihypertensiva |
