M.A.M College of Pharmacy, Kesanupalli, Narasaraopeta (522601), Palnadu District, Andhra Pradesh.
The most common modifiable risk factor for death and disability is hypertension, which include stroke accelerated coronary disease and systemic atherosclerosis, heart failure chronic kidney disease, lowering blood pressure with antihypertensive drugs and reducing target organ damage and the prevalence of the occurrence of cardiovascular disease. Reducing dietary sodium intake, losing weight if the patient is overweight, getting regular exercise, drinking moderately, and eating more potassium rich foods were all recommended lifestyle changes. The first hypertensive medication should be chosen from one of the four types known to minimize cardiovascular events; thiazide diuretics, ACE inhibitors, ARB’s and calcium channel blockers. In clinical practice two interventional approaches renal denervation and baro-reflex activation therapy are employed to treat variety of treatment resistant hypertension.
Hypertension is defined as persistently elevated arterial blood pressure. It is also known as high blood pressure .According to the World Health Organization (WHO), hypertension is responsible for approximately 10.4 million deaths globally each year. It is often asymptomatic, earning each the name “silent killer” and frequently goes undiagnosed until complication arise. Early identification and effective management are crucial for reducing morbidity and mortality.
Blood Pressure Ranges:
|
Blood Pressure Category |
Systolic (mm Hg) |
Diastolic (mm Hg) |
|
Healthy |
Less than 120 |
Less than 80 |
|
Elevated |
120-129 |
less than 80 |
|
Stage 1 hypertension |
130-139 |
80-89 |
|
Stage 2 hypertension |
140 or higher |
90 higher |
|
Hypertension crisis |
Over 180 |
Over 120 |
Epidemiology:
Pathophysiology:
These include genetic predisposition, environmental factors, and alterations in the body's systems that control blood pressure, such as the nervous, endocrine, and renal systems. Essential hypertension, which has no identifiable cause, is thought to involve disruptions in these regulatory systems, leading to elevated blood pressure.
Here's a breakdown of the key pathophysiological aspects:
Genetic Predisposition:
Family history of hypertension increases the risk of developing the condition.
Environmental Factors:
Diet (excess salt intake), obesity, lack of physical activity, alcohol consumption, and stress all contribute to the development of hypertension.
2. Disrupted Blood Pressure Regulation:
Sympathetic Nervous System:
The sympathetic nervous system plays a crucial role in regulating blood pressure. Over activity of this system can lead to vasoconstriction (narrowing of blood vessels), increased heart rate, and ultimately, elevated blood pressure.
Renal Dysfunction:
The kidneys play a vital role in regulating blood pressure by controlling sodium and water balance. Impaired renal function can lead to fluid retention and increased blood pressure.
Endocrine System:
Hormones like aldosterone and cortisol, produced by the adrenal glands, influence blood pressure. Imbalances in these hormones can contribute to hypertension.
Renin-Angiotensin-Aldosterone System (RAAS):
This system regulates blood pressure through a cascade of hormones. Dysregulation of the RAAS, particularly excessive production of angiotensin II (a potent vasoconstrictor), can elevate blood pressure.
Vascular Changes:
Changes in the structure and function of blood vessels, such asstiffening of the arteries (arteriosclerosis) or damage to the endothelium (lining of blood vessels), can contribute to increased peripheral resistance and hypertension.
Inflammation:
Immune cells and inflammatory processes can contribute to vascular damage and worsen hypertension.
Types of Hypertension
Essential (Primary) Hypertension:
It's believed to result from a combination of genetic and environmental factors that disrupt the body's blood pressure regulation mechanisms.
Secondary Hypertension:
This type of hypertension is caused by an identifiable underlying medical condition, such as kidney disease, endocrine disorders, or sleep apnea.
Clinical Evaluation and Diagnosis:
History and Physical Examination:
BP Measurement
Classification of Anti-hypertensive Agents:
|
ACE inhibitors (Angiotensin converting enzyme inhibitor) |
Enalapril, Lisinopril, Ramipril,Captopril |
|
ARBs(Angiotensin receptor blockers) |
Telmisartan, Olmesartan, Losartan, Candesaratan,Valsartan |
|
Calcium channel blockers |
Amlodipine,Felodipine,Nimodipine,Nifedipine,Isradipine,Verpamil,Diltiazem |
|
Beta blockers |
Atenolol, Metoprolol, Bisoprolol, Labetolol, Propranolol |
|
Diuretics |
Hydrochlorthiazide, Chlorthiazide, Chlorthalidone, Spironolactone, Furosemide. |
|
Direct Vasodilators |
Hydralazine, Minoxidil, Sodium Nitropruside, Diazoxide |
|
Alpha blockers |
Terazozin, Doxazosin, Prazosin |
|
Centre Alpha 2 Agonists |
Clonidine, Methyldopa |
There are more groups of antihypertensive agents which are not in much use. They include:
Management:
Pharmacologic Treatment:
First-line agents:
Combination therapy often needed:
Special populations
Recent advances and future directions
Life style modifications
Complications
Risk Factors
CONCLUSION
Hypertension remains a global health challenge despite being preventable and treatable .Amultifaceted approach including lifestyle changes, pharmacotherapy, and regular monitoring is key to controlling blood pressure and preventing complications. Future innovations in diagnostics and personalized medicine promise to enhance outcomes.
REFERENCES
Dr. Manchineni Prasada Rao*, Dr. V Rajini, Dr. Y Narasimha Rao, Shaik Nusrath, A Review Article on Hypertension, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 7, 493-497. https://doi.org/10.5281/zenodo.15795893
10.5281/zenodo.15795893
