Drug,Combinations,For,High,Blo health Drug Combinations For High Blood Pressure

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Factors Influencing the Treatment of Hypertension Several factors may be responsible for the hypertension of a patient and we do not always know the cause in each one of them. The drugs described above do not cure hypertension, these only lower the BP and let the patient live a normal or near normal life. A patient's response varies from drug to drug or the combination. After careful trial and selection a drug is selected which may have to be taken for a long time and perhaps for the whole life. The following advice may be useful: Elderly Patients: Multiple drug trials have shown better protection against stroke and other complication in the treatment of elderly than in the middle-aged. In elderly group there is rise in systolic BP while diastolic may remain normal. This is called as Isolated Systolic Hypertension (ISH-SBP of 160 mm Hg or above). Old dictum of calculation of BP as 90+ age is no longer tenable. Non-drug treatment includes exercise, salt restriction, liberal potassium, weight reduction and Control over fats. Walking sharpens cognitive skills in elderly. Low doses of thiazides are considered to be effective. Nifedipine and amlodipine are second alternatives. There are problems in the use of beta-blockers. ACE-Is are also used in elderly. One advantage is that these drugs improve insulin sensitivity in elderly diabetics so that diabetes is properly controlled. As a precaution, low doses should be administered initially, to try to maintain diastolic BP below 80 mm Hg. Overweight Patients: These patients have high cardiac output, low peripheral resistance and increased plasma volume. Apart from vigorous weight reduction, fat restricted low caloric diet should be given. Low dose diuretics are recommended for hypertension. ACE inhibitors do not have adverse effect of lipids and are able to improve left heart function. Therefore, this group is commonly prescribed in obese patients.Diabetic Patients: Association of diabetes with high BP is common in a large number of patients. The harmful effects of high BP are more pronounced in diabetics. Therefore tight control of diabetes and hypertension requires use of multiple drugs. This may result in interactions some of which can be harmful to the patients. In diabetes BP goals are lower than for nondiabetic (as stated earlier). The aim is to be keep to 80 mm Hg or lower. High doses of diuretics and beta-blockers impair insulin action, therefore, best avoided. ACE inhibitors improve glucose tolerance and kidney function in diabetes and hence they are the logical choice. Asthmatic Patients: CCBs have bronchodilator effect. Therefore, nifedipine and amlodipine should be used in ashmatics. Beta-blockers are best avoided. ACE-Is can increase cough.Patients with High Blood Lipid Levels: If given, the dose of diuretics should be as low as possible. Betablockers tend to increase triglyceride levels, decrease HDL (high is good) and impair insulin sensitivity, so is best avoided. In contrast, prazosin clearly improves the lipid profile and is the logical choice. As ACE-Is and CCBs are 'lipid neutral' they may be used.Cost-effectiveness: As the prevalence of high BP is increasing even in low socio-economic class, the cost of the therapy is becoming a major factor in drug selection. In general generic drugs are very effective and relatively inexpensive. Sometimes fixed dose combinations (FDCs) are cheaper than two or three individual drugs. Newer drugs (not necessarily better) are always costlier than time tested older drugs. Diuretics, CCBs and ACE-Is are becoming cheaper and are cost effective too. Use of Other Drugs while on Treatment of Hypertension: This is very important. One may suffer frorp other disease during treatment and may take medicines which may interact adversely with each other. Remember that if extra medication is needed then the prescribing physician should be informed about drugs being taken for hypertension. In Cough and Cold: Do not self medicate with OTC formulas. These may have drugs like phenylpropanolamine and ephedrine which may oppose the BP lowering effects of antihypertensives. Those patients taking propranolol or atenolol may have severe rise in BP with such cough/cold remedies. Some patients with depression are given tricyclic antidepressants which antagonize BP lowering effects of clonidine. A number of pain relievers may also oppose the BP lowering effects of drugs. Thus aspirin, indomethacin, ibuprofen should be used sparingly and the treating physician should be informed about using them. Article Tags: High Blood, Best Avoided, Lowering Effects