Hypertension

A. Definition and Overview

• Hypertension is defined by sustained blood pressure of 130/80 mmHg or higher.
• Often asymptomatic, it damages blood vessels over time, increasing the risk of severe health issues.

B. Pathophysiology

• Key Processes:
  • Endothelial Dysfunction: Damaged vessel linings impair regulation.
  • Inflammation and Oxidative Stress: Reactive oxygen species aggravate vessel damage.
  • Vascular Remodelling: Thickened vessel walls reduce blood flow.
  • Increased Peripheral Resistance: Heart workload rises as vessels narrow.

C. Risk Factors

• Modifiable: Unhealthy diet, inactivity, tobacco, excess alcohol, obesity.
• Non-Modifiable: Family history, age over 65, and comorbid conditions (e.g., diabetes, kidney disease).

D. Complications

• Cardiovascular Disease: Heart attack, stroke, heart failure.
• Kidney Disease: Impaired kidney filtration can lead to kidney failure.
• Eye Damage: Retinal blood vessel damage may cause vision loss.
• Cognitive Decline: Reduced brain blood flow contributes to dementia.

Acute Myocardial Infarction (Heart Attack)

A. Definition and Overview

• Myocardial Infarction (MI) occurs when blood flow to the heart is blocked, causing heart muscle death.

B. Pathophysiology

• Primarily due to atherosclerosis (plaque build-up); plaque rupture causes blood clots that obstruct coronary arteries.

C. Clinical Presentation

• Chest Pain: Characterised by tightness or crushing sensation.
• Additional Symptoms: Shortness of breath, nausea, sweating, and pain in upper body regions.

Angina

A. Definition and Overview

• Angina signifies chest pain due to insufficient blood supply to the heart, often linked to coronary artery disease.

B. Types of Angina

• Stable Angina: Occurs predictably with exertion; relieved by rest.
• Unstable Angina: New or worsening chest pain, often signalling a heart attack risk.

C. Pathophysiology

• Reduced blood flow through narrowed coronary arteries leads to angina during increased heart activity.

Pharmacotherapy Options

A. ACE Inhibitors

• Mechanism: Block angiotensin II production to relax blood vessels.
• Examples: Enalapril, lisinopril.
• Considerations: Can cause dry cough and angioedema; avoid during pregnancy.

B. Angiotensin II Receptor Blockers (ARBs)

• Mechanism: Prevent angiotensin II from binding to receptors.
• Examples: Losartan, telmisartan.
• Considerations: Similar benefits as ACE inhibitors with fewer side effects.

C. Calcium Channel Blockers (CCBs)

• Mechanism: Block calcium entry into blood vessel muscles to reduce blood pressure.
• Examples: Amlodipine, diltiazem.
• Considerations: May cause dizziness, headache, and leg swelling.

D. Diuretics

• Mechanism: Increase urine output to reduce blood volume.
• Types: Thiazide (e.g., hydrochlorothiazide), loop (e.g., furosemide), potassium-sparing (e.g., spironolactone).
• Considerations: May lead to electrolyte imbalances and dehydration.

E. Beta-Blockers

• Mechanism: Reduce heart rate and contraction force.
• Examples: Atenolol, metoprolol.
• Considerations: Not typically first-line for hypertension; can cause fatigue and dizziness.

F. Statins

• Mechanism: Lower cholesterol by inhibiting HMG-CoA reductase.
• Benefits: Decrease cardiovascular risk.
• Considerations: Primarily used alongside hypertension management, not directly for it.

Lifestyle Modifications

A. Diet

• Reduce Sodium: Aim for less than 1,500 mg daily.
• DASH Diet: Emphasize fruits, vegetables, and whole grains.
• Potassium-Rich Foods: Bananas, avocados, potatoes.

B. Physical Activity

• Exercise Regularly: 150 minutes of moderate or 75 minutes of vigorous exercise weekly.
• Strength Training: Twice weekly.

C. Weight Management

• Even modest weight loss can significantly lower blood pressure.

D. Other Lifestyle Changes

• Quit Smoking: Essential for cardiovascular health.
• Limit Alcohol: Practice moderation.
• Manage Stress: Techniques include mindfulness, deep breathing.
• Prioritise Sleep: Aim for 7-9 hours nightly.

Conclusion

Managing hypertension effectively requires combining pharmacotherapy with lifestyle modifications. Healthcare providers, particularly pharmacists, play an essential role in educating patients, monitoring for side effects, and encouraging adherence to treatment. Working in collaboration, healthcare providers can help patients achieve optimal blood pressure control and reduce hypertension-related risks.

References

1. Mayo Clinic. (n.d.). High Blood Pressure (Hypertension): Diagnosis and Treatment. Retrieved from https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosis-treatment/drc-20373417
2. World Health Organization. (n.d.). Hypertension Fact Sheet. Retrieved from https://www.who.int/news-room/fact-sheets/detail/hypertension#:~=Overview
3. Cleveland Clinic. (n.d.). Hypertension (High Blood Pressure). Retrieved from https://my.clevelandclinic.org/health/diseases/4314-hypertension-high-blood-pressure
4. American Heart Association. (n.d.). The Facts About High Blood Pressure. Retrieved from https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure
5. National Institute for Health and Care Excellence. (2019). Hypertension in Adults: Diagnosis and Management (NICE Guideline NG136). Retrieved from https://www.nice.org.uk/guidance/ng136
6. National Heart, Lung, and Blood Institute. (n.d.). Treatment for High Blood Pressure. Retrieved from https://www.nhlbi.nih.gov/health/high-blood-pressure/treatment
7. Patient.info. (n.d.). Hypertension Treatment. Retrieved from https://patient.info/doctor/hypertension-treatment