Page 187 - Basic _ Clinical Pharmacology ( PDFDrive )

SECTION III CARDIOVASCULAR-RENAL DRUGS

11
C H A P T E R

Antihypertensive Agents

Neal L. Benowitz, MD

C ASE STUD Y

A 35-year-old man presents with a blood pressure of examination is remarkable only for moderate obesity. Total
150/95 mm Hg. He has been generally healthy, is sedentary, cholesterol is 220, and high-density lipoprotein (HDL)
drinks several cocktails per day, and does not smoke cholesterol level is 40 mg/dL. Fasting glucose is 105 mg/dL.
cigarettes. He has a family history of hypertension, and his Chest X-ray is normal. Electrocardiogram shows left ven-
father died of a myocardial infarction at age 55. Physical tricular enlargement. How would you treat this patient?

Hypertension is the most common cardiovascular disease. In a accurate prediction of efficacy and toxicity. The rational use of
National Health and Nutrition Examination Survey (NHANES) these agents, alone or in combination, can lower blood pressure
carried out in 2011 to 2012, hypertension was found in 29% with minimal risk of serious toxicity in most patients.
of American adults and 65% of adults age 65 years or older.
The prevalence varies with age, race, education, and many other HYPERTENSION & REGULATION OF
variables. According to some studies, 60–80% of both men and
women will develop hypertension by age 80. Sustained arterial BLOOD PRESSURE
hypertension damages blood vessels in kidney, heart, and brain Diagnosis
and leads to an increased incidence of renal failure, coronary
disease, heart failure, stroke, and dementia. Effective pharma- The diagnosis of hypertension is based on repeated, reproducible
cologic lowering of blood pressure has been shown to prevent measurements of elevated blood pressure (Table 11–1). The diagno-
damage to blood vessels and to substantially reduce morbidity and sis serves primarily as a prediction of consequences for the patient; it
mortality rates. However, NHANES found that, unfortunately, seldom includes a statement about the cause of hypertension.
only one-half of Americans with hypertension had adequate blood Epidemiologic studies indicate that the risks of damage to
pressure control. Many effective drugs are available. Knowledge kidney, heart, and brain are directly related to the extent of
of their antihypertensive mechanisms and sites of action allows blood pressure elevation. Even mild hypertension (blood pressure

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