Treatment of hypertension

Treatment of hypertension


treatment the cause in secondary HT if possible.1




2-non pharmacological therapy:



*dietary sodium restirection



*cessation of smoking



*physical exercise



*weight reduction In abuse



Alcohol restirection



*relaxation therapy



3-drugs therapy:


Mild or moderate HT DBP 90-114

1-START BY MONO-THERAPY:



Just use on drug either:



Thiazde………diuretic ex. eldery,H.failure

Betablocker………….young,anixity,

Angina Tachycardia

ACEinhibitor…………high rennin ,H.FAILURE , Diabetic nephropathy

2-DOUBLE THERAPY:



Thiazde+beta blocker


Thiazde+ACEinhibitor


3-TRIPPLE THERAPY:


Thiazde+beta.B+ACE OR hydralazine OR prazosin


Severe hypertension DBP MORE 115

Start with tripple therapy



Or in pt. with renal impairment change thiazde diuretics to loop diuretics



Or if beta blocker contraindication use alpha-2 agonist ex.clonidine &alpha methyldopa

HT resistance to triple therapy:

Loop.D + beta.B +minoxidil


Or


Loop.D +ACE.I +ca –channel blocker


HT emergencies:

Diastolic>130 +complication encephalopathy,papilledema,pulmonary edema,decreased renal function

…………..parenteral therapy:


Na nitroprussid ………..iv infusion


Nitraglycerine ………..iv infusion

Loop.D …………..frusemide iv

Labetalol ………..iv bolus inj.

Trimethaphan…………. iv infusion

Diazoxide…………iv

Hydralazine……….im or iv


Diastolic>130 &no complicated …viorous oral therapy:captopril,clonidine,prazosine


Special cases:

HT+ PREGNANCY ….METHYLDOPA

HT+ COPD……CA ANTAGONIST

HT+DIABETIC……..ACE INHIBITORS

HT+RENAL FAILURE…….ACE INHIBITOR