Anti hypertensives

Most cases of hypertension have no known cause. When there is no known cause of hypertension, the term essential hypertension is used. Essential hypertension has been linked to certain risk factors, such as 

In the United States, African-Americans are twice as likely as Caucasians to experience hypertension. After age 65 years, African-American women have the highest incidence of hypertension. Essential hypertension cannot be cured but can be controlled. Many individuals experience hypertension as they grow older, but hypertension is not a part of healthy aging. For many older individuals, the systolic pressure gives the most accurate diagnosis of hypertension. Display 42-2 discusses the importance of the systolic pressure  

Once essential hypertension develops, management of this disorder becomes a lifetime task. When a direct cause of the hypertension can be identified, the condition is described as secondary hypertension. Among the known causes of secondary hypertension, kidney disease ranks first, with tumors or other abnormalities of the adrenal glands following. In malignant hypertension the diastolic pressure usually exceeds 130 mm Hg. In secondary hypertension, 

From the Sxth Report of the Joint National Committee on FYevention, Detection, B/aluation and Treatment of High Blood Pressure, National High Blood Pressure Education Program, November 1997. (Online.) Available www.nhlbi.nih.gov/gu.delines/hypertension 

Malignant hypertension is a dangerous condition that develops rapidly and requires immediate medical attention. Fbtients with malignant hypertension experience organ damage as die result of hypertension. Target organs of hypertension include the heart, kidney, and eyes (retinopadiy). 

Wlien dnigtlierapy is b in, tlie primary care provider may first prescribe a diuretic (Qiap. 46) or beta ((i) blocker (Cliap. 23) because tliese drugs liave been shown to be hi ily effectiva However, as in many otlier diseases 

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A substituted thiazole ring attached to a reduced imidazole moiety is present in a compound that displays anti hypertensive activity. Reaction of thiourea 61 with methyl iodide to... 

Alteration of the structural pattern produces a pair of adrenergic a-blocking agents which serve as anti hypertensives. These structures are reminiscent of prazoci n. Reaction of piperazine with 2-furoy1 chloride followed by catalytic reduction of the furan ring leads to synthon 69. This, when heated... 

Hydrazinopyridazines such as hydralazine have a venerable history as anti hypertensive agents. It is of note that this biological activity is maintained in the face of major modifications in the heterocyclic nucleus. The key intermediate keto ester in principle can be obtained by alkylation of the anion of pi peri done 44 with ethyl bromo-acetate. The cyclic acylhydrazone formed on reaction with hydrazine (46) is then oxidized to give the aromatized compound 47. The hydroxyl group is then transformed to chloro by treatment with phosphorus oxychloride (48). Displacement of halogen with hydrazine leads to the formation of endralazine (49). ... 

Anti hypertensive Drugs. Table 1 Common side effects of antihypertensive drugs... 

Explain why blood pressure determinations are important during therapy with an anti hypertensive drug. 

Discuss ways to promote an optimal response to therapy, how to manage adverse reactions, and important points to keep in mind when educating patients about the use of an anti hypertensive drug. 

Many antihypertensive drug lower the blood pressure by dilating or increasing the size of the arterial blood vessels (vasodilatation). Vasodilatation creates an increase in the lumen (the space or opening within an arteiy) of the arterial blood vessels, which in turn increases the amount of space available for the blood to circulate Because blood volume (the amount of blood) remains relatively constant, an increase in the space in which the blood circulates (ie, the blood vessels) lowers the pressure of the fluid (measured as blood pressure) in the blood vessels. Although the method by which anti-hypertensive drug dilate blood vessels varies, the result... 

SUMMARY DRUG TABLE ANTI HYPERTENSIVE DRUGS... 

SUMMARY DRUG TABLE ANTI HYPERTENSIVE DRUGS(Cb/7 /m/ecO ... 

FIGURE 42-3. The nurse takes the patient s blood pressure prior to administering an anti hypertensive drug. 

Failure to receive or take anti hypertensive medications... 

If patient is not at goal BP, assess efficacy, safety, and compliance of the antihypertensive regimen to determine if a dose increase or additional anti hypertensive agent (step 8) is needed to achieve goal blood pressure. 

Determine if drug therapy may be contributing to ARF. Consider not only drugs that can directly cause ARF (e.g., aminoglycosides, amphotericin B, NSAIDs, cyclosporine, tacrolimus, ACE inhibitors, and ARBs), but also drugs that can predispose a patient to nephrotoxicity or prerenal ARF (i.e., diuretics and anti hypertensive agents). 

This patient has the subjective symptoms of weight loss, decreased appetite, shortness of breath, and cough. Abnormal laboratory values include elevated temperature, decreased hemoglobin and hematocrit, and decreased CD4 count. Chest x-ray shows diffuse interstitial infiltrates bilaterally. Physical exam reveals thrush. The assessment is possible AIDS with CD4 count of 150 cells/mm3, thrush, a respiratory illness (possibly Pneumocystis jiroveci pneumonia), and anemia of chronic disease. He also has a history of hepatitis B, hypertension, and GERD (on famotidine), poor adherence to his anti hypertensive medications, and likely has an irregular daily regimen due to his occupation as a truck driver. 

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