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Kidneyscience.info

Dr Narender Goel MD (Internal Medicine and Nephrology)

Financial Disclosure: None, Conflict of Interest: None What is Blood pressure?
While heart contracts blood is pumped in to major arteries. Thereby a pressure in exerted on vessel wall which is also known as systolic blood pressure; represented by upper number in a blood pressure reading. While heart relaxes, volume of blood present in the circulation exerts pressure on vessel wall which is also known as diastolic blood pressure; represented by lower number in a blood pressure reading. What is Hypertension?
High blood pressure also known as hypertension (HTN) is very common in western countries. It is estimated that one in every 3 adult person in the United States has HTN. Blood pressure is checked manually using sphygmomanometer or using electronic machines. Most instruments use arm or wrist cuff. HTN is defined as blood pressure ≥140/90 mmHg (measured at rest) measured over 3 consecutive visits. What are stages of HTN?
7th Joint national committee has proposed and revised stages of HTN in 2003 Why it is important to be aware about HTN?
It is a very common condition in western adult population, patients with chronic kidney disease, end-stage renal disease on dialysis or kidney transplantation. It is 2nd most common cause of end-stage renal disease. HTN is also significantly associated with stroke, peripheral vascular disease, congestive heart failure, heart attack and death. Patients often don’t feel any symptoms from HTN unless BP is very high which can cause headache, chest pain, shortness of breath; which could be signs of life Untreated and undiagnosed HTN is detrimental to health and early intervention can reduce the risk of associated complications (KNOW YOUR BLOOD PRESSURE). What are the causes of HTN?
It is not very clear that what causes hypertension. It appears that multiple factors contribute to development of HTN such as genetic predisposition; impaired handling of sodium and chloride by kidney and environmental factors, sedentary lifestyle and aging further contributes. Chronic kidney disease, excess hormones, over the counter and herbal medications containing mahuang, ephedra, amphetamines, pseudoephedrine and licorice (mulethi) can cause HTN. Substance abuse with cocaine, amphetamines What are the tests usually done for patients with HTN?
Your doctor will first attempt to identify any reversible or curable causes of HTN such as hormonal excess which can be evaluated using several different blood tests. Besides urinalysis, complete blood count, kidney function test and electrolytes should be routinely checked. Eye examination (fundoscopy) can suggest extent of HTN damage. Electrocardiogram and echocardiogram may show changes of HTN on heart. How can HTN be managed?
First step is lifestyle modifications which include weight loss, exercise (for 30 minutes for 5 times per week), smoking cessation, moderation of alcohol consumption and low DASH (dietary approach to stop hypertension) is known to be the best dietary regimen to reduce blood pressure. Components of DASH diet are 2) Diet rich in fiber, vegetables, whole grains and low fat dairy products Learn more about DASH diet at U.S Department of Health and Human Services. What are different classes of medications which can be used?
There are several classes of medications which can be used to control blood pressure. It is very common for patients to need 2-3 medications to control blood pressure. Compliance to medication and low salt diet is of utmost importance. Taking medications at bedtime instead of in morning has been shown to achieve better blood pressure control. Choice of medication will depend upon clinical status, level of kidney function, electrolytes and other medical conditions. 1) ACE Inhibitors: There are several medications belonging to this class such as
ramipril, lisinopril, fosinopril, captopril etc. (note: all name ends in pril). These are very
good and effective antihypertensive medications and often a leading choice medication. Major adverse effects are as follows: rise in serum potassium, dry cough, temporary & slight decrease in kidney function, serious allergic reaction causing tongue and lip You must stop ACE Inhibitors and immediately report to healthcare provider if you 2) Angiotensin receptor blockers (ARB): There are several medications belonging
to this class such as valsartan, telmisartan, losartan, olmesartan etc. (note: all name ends in sartan). These are very good and effective antihypertensive medications and
often a leading choice medication along with ACE Inhibitors. Major adverse effects are as follows: rise in serum potassium, temporary & slight decrease in kidney function, serious allergic reaction causing tongue and lip swelling You must stop ARB and immediately report to healthcare provider if you develop Combination of ACE Inhibitors and ARB is harmful and should be avoided. 3) Diuretics or water pill: These medications help your kidney to excrete excess
water and salt in to the urine. Hydrochlorothiazide (HCTZ), furosemide (Lasix), metolazone, triamterene, spironolactone and amiloride are commonly used Discuss individual medication adverse effects with your doctor. 4) Calcium Channel Blockers (CCB): Commonly used medications among this class
are amlodipine (Norvasc), nifedipine XL, diltiazem and verapamil. These are also among preferred class of prescribed antihypertensive. Amlodipine can cause ankle swelling while diltiazem and verapamil can slow down your Discuss individual medication adverse effects with your doctor. 5) Beta blockers: Commonly used medications among this class are atenolol,
metoprolol (Lopressor, Toprol XL), carvedilol, nevibolol, bisoprolol (note: all name ends in olol). This class is commonly prescribed for patients with heart failure or coronary
It is suggested that this class of medication be used with caution in patients with asthma, peripheral vascular disease or diabetics. 6) Clonidine, Hydralazine and minoxidil are less commonly used medications It would be helpful to have some information about these medications as it will enable you to have an informed discussion with your healthcare providers. Disclosure and Disclaimer: This is a Not for profit website and not endorsed by any other society,
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