Hypertension is a pathological condition characterized by constantly high blood pressure, higher than 140/90mmHg. Chronic high blood pressure increases the risk of damage to the kidneys, heart, and brain as well as the risk of development of various cardiovascular diseases (atherosclerosis, for example). Hypertension is more of a sign rather than a separate disease. However, it is not always possible to find the underlying cause of hypertension.
The level of the body’s blood pressure is jointly controlled by the nervous and endocrine systems that influence:
• Blood volume;
• Cardiaс output;
• Peripheral vascular resistance.
The system of blood pressure control can be affected by pharmacological agents. The main goal of therapeutic intervention during hypertension treatment is to reduce high blood pressure. This goal can be achieved with the help of medications that directly or indirectly influence the three factors mentioned above. Controlled hypertension can restrain the further development of organ pathologies.
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As of today, a significant number of antihypertensive medications with different mechanisms of action are used for the treatment of this condition. Moreover, every class of antihypertensive preparations is administered at a certain stage of the disease, and sometimes a complex of drugs can be used.
Here are five of the most common types of medications used for the treatment of hypertension:
Calcium channel blockers (calcium antagonists).
The contraction of the muscle fibers occurs with the involvement of calcium, and vascular walls are not an exception. The hypotensive action of calcium channel blockers is based on their ability to block the calcium channels of the cell membranes and thus prevent the entry of calcium ions into the myocardial cells and smooth muscle cells of the vessel walls. All that causes reduced cardiac output, vasodilation and lowered blood pressure. These medications also reduce the sensitivity of blood vessels to vasopressor substances that cause vascular spasms (such as adrenaline). Calcium channel blockers reduce platelet aggregation and have antianginal and antiarrhythmic effects as well.
Angiotensin-converting enzyme (ACE) inhibitors.
The level of blood pressure is regulated by the kidneys through the renin-angiotensin-aldosterone system; the tone of the vessel walls and the final level of blood pressure depend on the proper functioning of this system. When there is an excess of the hormone angiotensin II (it’s synthesized from angiotensin I with the help of angiotensin- converting enzyme), it causes arterial vasospasm in the systemic circulation, which leads to increased peripheral vascular resistance. So, to provide adequate blood flow to all internal organs, the heart starts working with increased load and pumps blood through the vessels under greater pressure. Angiotensin-converting enzyme inhibitors reduce the production of angiotensin II, which causes vasodilation and thus reduces blood pressure. The use of ACE inhibitors decreases the possibility of cardiovascular complications (myocardial infarction, stroke, severe heart failure, etc.) and the damage to target organs, especially the heart and kidneys.
They provide an antihypertensive effect by reducing cardiac output and the production of renin (that causes vascular spasm) in the kidneys. Due to their ability to regulate the heart rhythm and their antianginal effect, beta-blockers are advantageous for the control of blood pressure in patients with ischemic heart disease, angina as well as chronic heart failure.
Like ACE inhibitors, they are widely used for the treatment of hypertension. This class of antihypertensive medications works by increasing urinary output and excretion of salt from the body, which reduces the circulating blood volume and the volume of extracellular fluid as well as cardiac output and causes widening of the blood vessels – all these mechanisms lead to lowering of blood pressure. Diuretics are most commonly used as a part of a combination therapy of hypertension – they help to remove the excesses of water retained while taking other antihypertensive preparations.
Angiotensin II receptor blockers.
These are the most up-to-date and efficient medications. Like ACE inhibitors, they reduce the effect of angiotensin II, but, unlike the latter, they do not limit their influence to only one single enzyme. They act more broadly, providing a strong antihypertensive effect by blocking the binding of angiotensin with its receptors located on the cells of various body organs. Relaxation of the vessel walls, as well as enhanced renal excretion of excess fluid and salt, is achieved thanks to such targeted action.
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