HYPERTENSION AND HEART FAILURE

Hypertension

Blood pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body. Hypertension is another term used to describe high blood pressure.

Blood pressure readings are given as two numbers. The top number is called the systolic blood pressure. The bottom number is called the diastolic blood pressure. For example, 120 over 80 (written as 120/80 mmHg).

One or both of these numbers can be too high.

-Normal blood pressure is when your blood pressure is lower than 120/80 mmHg most of the time.

-High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg or above most of the time.

-If your blood pressure numbers are 120/80 or higher, but below 140/90, it is called pre-hypertension.

If you have heart or kidney problems, or you had a stroke, your doctor may want your blood pressure to be even lower than that of people who do not have these conditions.

Causes

Many factors can affect blood pressure, including:

-The amount of water and salt you have in your body

T-he condition of your kidneys, nervous system, or blood vessels

-Your hormone levels

You are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure increases your chance of having a stroke, heart attack, heart failure, kidney disease, or early death.

You have a higher risk of high blood pressure if:

-You are African American

-You are obese

-You are often stressed or anxious

-You drink too much alcohol (more than 1 drink per day for women and more than 2 drinks per day for men)

-You eat too much salt

-You have a family history of high blood pressure

-You have diabetes

-You smoke.

Most of the time, no cause of high blood pressure is found. This is called essential hypertension.

High blood pressure that is caused by another medical condition or medicine you are taking is called secondary hypertension. Secondary hypertension may be due to:

-Chronic kidney disease

-Disorders of the adrenal gland

-Hyperparathyroidism

-Pregnancy or preeclamsia 

-Medications such as birth control pills, diet pills, some cold medicines, and migraine medicines

-Narrowed artery that supplies blood to the kidney (renal artery stenosis).

Symptoms

Most of the time, there are no symptoms. For most patients, high blood pressure is found when they visit their doctors or have it checked elsewhere.

Because there are no symptoms, people can develop heart disease and kidney problems without knowing they have high blood pressure.

Malignant hypertension is a dangerous form of very high blood pressure. Symptoms include:

-Severe headache

-Nausea or vomiting

-Confusion

-Vision changes

-Nosebleed.

Heart failure

Heart failure is a complex syndrome characterised by reduced heart efficiency and resultant haemodynamic and neurohormal responses (Poole-Wilson 1985).

Heart failure is caused by a number of pathological conditions. Some causes are reversible, but others are not.

Causes of heart failure:

-Ischaemic heart disease.

-Hypertension.

-Arrythmias.

-Valve disorders.

-Myocarditis.

-Alcohol-induced cardiomyopathy (heart muscle abnormalities).

-Chemotherapy-induced cardiomyopathy.

-Genetic cardiomyopathies.

-Amyloidosis.

-Sarcoidosis.

-Metabolic disorders.

(*This is a shortened list).

Patients can have acute heart failure without underlying chronic heart failure but more commonly acute presentations are due to destabilisation of chronic disease.

Patients who are well managed can have a good quality of life and extend their prognosis, but heart failure is unpredictable and difficult to prognosticate for individual patients.

Diagnosis

Heart failure should be diagnosed using the pathway in the European Society of Cardiology (ESC) guidelines (McMurray et al 2012).

Once diagnosis is confirmed the severity of the symptoms can be expressed using the New York Heart Association (NYHA) classification.

DRUGS USED IN HYPERTENSION AND HEART FAILURE

Angiotensin-converting enzyme inhibitors:

1. Vasodilator antihypertensive drugs:

-Ambrisentan (Volibris).

-Bosentan (Tracleer).

-Diazoxide (Eudemine).

-Hydralazine Hydrochloride (Apresoline).

-Iloprost (Ventavis).

-Minoxidil (Loniten).

-Sildenafil (Revatio, Viagra).

-Sitaxentan sodium (Thelin).

-Sodium Nitroprusside.

2. Centrally acting antihypertensive drugs:

-Clonindine Hydrochloride (Catapres, Dixarit).

-Methyldopa (Aldomet).

-Moxonidine (Physiotens).

3. Adrenergic neurone blocking drugs:

-Guanethidine Monosulphate (Ismelin).

4. Alpha-adrenoceptor blocking drugs:

-Doxazosin (Cardura).

-Indoramin (Baratol, Doralese).

-Prazosin (Hypovase).

-Terazosin (Hytrin).

-Phenoxybenzamine Hydrochloride (Dibenyline).

-Phentolamine Mesilate (Rogitine).

5. Drugs affecting the renin-angiotensin system:
The main indications of ACE inhibitors are heart failure and hypertension among others.
-Captopril (Capoten).
-Cilazapril (Vascace).
-Enalapril Maleate (Innovace).
-Fosinopril Sodium (Staril).
-Imidapril Hydrochloride (Tanatril).
-Lisinopril (Carace, Zestril).
-Moexipril Hydrochloride (Perdix).
-Perindopril Erbumine.
-Quinapril.
-Ramipril.
-Trandolapril.

Angiotensin-II receptor antagonists
-Candesartan Cilexetil (Amias).
-Eprosartan (Teveten).
-Irbesartan (Aprovel).
-Losartan Potassium (Cozaar).
-Olmesartan Medoxomil (Olmetec).
-Telmisartan (Micardis).
-Valsartan (Diovan).

Renin inhibitors
-Aliskiren (Rasilez).


Sources:
-http://www.nlm.nih.gov/medlineplus/
-BNF 57 March 2009
-nop.rcnpublishing.com/ September 2014/ Volume 26/ Number 7.