1. Presented By:
Nikhil Singh Chauhan
M.Pharm. M. Pharm.
Pharmacy Practice Pharmacy Practice
1st Semester
NIPER, HAJIPUR
MANAGEMENT OF HYPERTENSION

2. • Introduction
• Types of hypertension
• Epidemiology
• Etiology
• Diagnosis
• Management
CONTENTS

3. ● Hypertension (HTN) or high blood pressure,
sometimes called arterial hypertension, is a chronic
medical condition in which the blood pressure in the
arteries is elevated.
• 17th may is world hypertension day.
INTRODUCTION

4. Hypertension is classified as:
● Primary (essential) hypertension
● Secondary hypertension
● “Primary Hypertension" which means high blood pressure with no
obvious underlying medical cause.
● “Secondary Hypertension” are caused by other conditions that
affect the kidneys, arteries, heart or endocrine system.
TYPES OF HYPERTENSION

5. ● Hypertension is reported to be 4th contributor to death in
developed countries and the 7th in developing countries.
● Recent report indicates nearly 1 billion adults(more then
quarter of the world population) had hypertension in year
2000 and this is predicted to increase to 1.56 billion by
year 2025.
● Today mean BP remains very high in many african and
some European countries.
Cont..........
EPIDEMIOLOGY
INTERNATIONAL DATA

6. ● Mean SBP declined in high and middle income countries
but increase in low income countries and even more then
high income countries.
● Hypertension is 25% in urban adults and 10-15% among
rural adults.
● In the INTER HEART and INTER STROKE studies
hypertension accounted for 17.9% & 34.6% of population
at attributable risk Of various CVD risk factor for
coronary arteries disease.
NATIONAL DATA

7. ETIOLOGY OF HYPERTENSION
SOME IDENTIFIABLE CAUSES

8. SPHYGMOMANOMETER IS USED FROM EARLIER TIMES
DIAGNOSIS OF HYPERTENSION

9. 9
Heart failure
Stroke
Coronary heart disease
Myocardial infarction
Left ventricular
hypertrophy
Aortic aneurysm
Retinopathy
Peripheral vascular disease
Hypertensive
encephalopathy
Chronic kidney failure
Cerebral hemorrhage
Adapted from: Arch Intern Med 1996; 156:1926-1935.
All
Vascular
COMMON DISEASES: ATTRIBUTABLE TO
HYPERTENSION
HYPERTENSION

10. IT INCLUDES:
 NON PHARMACOLOGICAL METHOD
 PHARMACOLOGICAL METHOD
MANAGEMENT OF HYPERTENSION

11. ● Reduce sodium intake
● Moderate alcohol consumption
● Dietary changes
● Smoking cessation
● Dietary supplement
● Exercise(yoga, aerobics or games)
NON-PHARMACOLOGICAL METHOD

12. PRIMARY ANTIHYPERTENSIVE AGENTS:
● ACE INHIBITORS
● Calcium CHANNEL BLOCKER
● DIURETICS
● ANGIOTENSIN RECEPTOR BLOCKER
● BETA-BLOCKER
ALTERNATIVE ANTIHYPERTENSIVE AGENTS:
● ALPHA-BLOCKER
● CENTRAL SYMPATHOLYTICS
● DIRECT VASODILATORS
● DIRECT RENIN INHIBITORS
PHARMACOLOGICAL METHODS:
MEDICINAL APPROACH

13. COMMONLY USED MEDICATIONS:
COMMERCIALLY AVAILABLE

14. 14
The
A, B, C, D
Approach
ANTI-HYPERTENSIVE DRUGS:
CLASSIFICATION

15. ANTI-HYPERTENSIVE DRUGS: CLASSIFICATION
• ACEi- Angiotensin converting enzyme inhibitors
-Remipril,Enalpril. Let us call them A
• ARB- Angiotensin Receptor Blockers- losartan-let
us call them A
• BB- Beta-Blockers- Atenolol , Metoprolol,
Carvedilol -let us cal them B
• CCB-Calcium Channel Blockers- Nifedipin-let us
call them C
• DIURETICS -hydrochlorthiazides, spirinolactone,
frusemide-let us call them D

16. AB/CD RULE: HYPERTENSION TREATMENT

17. DUTY OF CLINICAL PHARMACIST
IN MANAGEMENT OF HYPERTENSION

18.  If, goal BP is not achieved by a single drug in full dose
 Then adding another agent will help achieve the goal BP
 Two agents sometimes nullify each others side effects
 Fixed dose combinations will reduce the no. of tablets
 Once daily formulations are good for compliance
 Long Acting formulations for 24 h BP control
 If, three drugs can’t achieve goal BP – Resistant HT
HYPERTENSION – WHY COMBINATIONS ?

19. • BETTER BETA BLOCKER
(CARDIOSELECTIVE & LOBETALOL)
• MOTHER METHYLDOPA (DOC)
• CARE CLONIDINE
• DURING DIHYDROPYRIDINE
• HYPERTENSION HYDRALAZINE
• PREGNANCY PRAZOSIN(alpha blockers)
ANTI-HYPERTENSIVE AGENTS:
SAFE DURING PREGNANCY

20. 20Dr.Sarma@works
COMBINATION THERAPY

21. 21
Beta blockers + Beta1 stimulants : Rebound HT, Paradoxical BP ↑
Beta blockers + Verapamil: Extreme bradycardia, HB, CHF
Thiazide + Furesemide: Potential volume ↓
Alfa-Blocker + Beta blocker : They nullify the effects of each other
Verapamil + Nefidepine : No rationale (cardiac actions contridic)
Beta blocker + ACEI: Not for HT alone, Good for CHF, MI, IHD
SOME IRRATIONAL COMBINATIONS

22. NIKHIL SINGH CHAUHAN