Hypertension Therapy Update 2003

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Pramote Teerapong


Assessment of hypertension includes history taking, physical examination and laboratory investigation to verify the disease, staging the severity and duration of the disease and assess the risks and complications. JNC-7 recently classified the hypertension stages into normal (<120 I and <80 mm.Hg), prehypertension (120-139 /or 80-89 mm.Hg), hypertension stage I ( 140-159 I or 90-99 mm.Hg) and stage II (≥ 160 I or ≥ 100 mm.Hg). Management of hypertension includes life style modification and taking antihypertensive agents. Hypertensive patients with no complication should control the blood pressure below 140/90 mm.Hg. Those who have the kidney disease or diabetes mellitus shoud have the blood pressure below 130/80 mm.Hg. JNC-7 has recommended proper antihypertensive agents for compelling indications such as heart failure, post-myocardial infarction, high risk of coronary artery disease, diabetes, chronic kidney disease and prevention of recurrent stroke.

First choice antihypertensive agents are diuretics, beta blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers. Others are second choice antihypertensive drugs include alpha-1 blockers, central alpha-2 agonists or centrally acting drugs, adrenergic neuron blockers, and direct vasodilators. First choice antihypertensive agents can be used alone or in combination but other antihypertensive drugs are used as adjunct. Indications, adverse effects, mechanism or mode of actions of the antihypertensive agents are mentioned in details in this article.


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