Clinical%20Pharmacy.pdf

University of Santo Tomas: Course Audit Clinical Pharmacy & Pharmacotherapeutics

Hypertension

  • Definition: Persistently elevated arterial blood pressure (BP).

  • Types:

    • Secondary Hypertension: Specific cause identified.

    • Primary (Essential) Hypertension: Unknown etiology.

  • Mechanism: Increased Peripheral Vascular Resistance (PVR) or Cardiac Output (CO).

Hypertension-Mediated Organ Damage (HMOD)

  • Definition: Structural or functional alteration of arterial vasculature/organs due to elevated BP.

  • End Organs Affected: Brain, heart, kidneys, arteries, eyes. (hyper-KABEH)

Hypertension Pathophysiology

  • Equation: BP = PVR x CO, where CO = Heart Rate (HR) x Stroke Volume (SV).

  • Contributing Factors:

    • Overactivation of Renin-Angiotensin-Aldosterone System (RAAS).

    • Increased sodium intake, volume overload, and sympathetic nervous system overactivity.

    • Genetic alterations affecting cell membranes and renal sodium retention.

Diagnosis of Hypertension

  • Primary Findings: Patients are usually asymptomatic; elevated BP on physical examination.

  • Diagnosis Procedure: Average of two or more readings, taken over two separate encounters.

Blood Pressure Classification (ACC/AHA & ESC/ESH)

  • Categories:

    • Optimal: <120/<80 mmHg

    • Normal: <120/80 mmHg

    • Elevated: 120-129/<80 mmHg

    • High BP Stage 1: 130-139 or 80-89 mmHg

    • Stage 2 Hypertension: >140/>90 mmHg

    • Hypertensive Crisis: >180/>120 mmHg

Hypertensive Emergencies

  • Definition: Severe elevation of BP accompanied by acute HMOD.

  • Types:

    • Malignant Hypertension

    • Hypertensive Encephalopathy

    • Hypertensive Thrombotic Microangiopathy

Medication Management

  • 1st Line Drugs: Thiazides, ACE inhibitors, ARBs, or Calcium-channel blockers. do

  • 2nd Line Drugs: Loop diuretics, potassium-sparing diuretics, beta-blockers.

  • Combination Therapy: Use of RAS blocker with a CCB or thiazide preferred.

  • Avoiding Combinations: ACE inhibitors should not be combined with ARBs.

Classic Symptoms of Hypertension

  • Often asymptomatic but can lead to organ damage if untreated.

Management Strategies

  • Lifestyle modifications: Weight loss, sodium reduction, and regular exercise recommended.

  • Continuous monitor for severe hypertension using antihypertensive therapy as needed.

Conclusion

  • Hypertension if left uncontrolled can lead to serious health complications. Early detection and treatment through both pharmacologic and lifestyle interventions are crucial.