Hypertension – Medical Treatment
Possible Drug Combinations
The treatment is an initial immunotherapy with a drug in response is inadequate, as multiple combinations. Drug of first choice for drug therapy are ACE inhibitors, AT1 antagonists, beta blockers, diuretics and calcium antagonists. The choice depends on the age and comorbidities of the individual. ACE-inhibitors reduce the synthesis of pressor angiotensin II and thus the activity of the renin-angiotensin-aldosterone system. Angiotensin-1 receptor antagonists share the same system at another point on; they prevent the effects of angiotensin II at the angiotensin-1 receptor (AT1 receptor).
They are sometimes better tolerated than ACE inhibitors. In the case of beta-blockers agents from the group of β-1 are selective agents used. The β 1-receptors are localized at the heart of their resistance is lowered over the decrease in cardiac output of the heart, blood pressure. Diuretics, preferred by the thiazide-type, create an on increasing fluid secretion in the kidney, a reduction in volume in the vascular system and subsequently decrease in blood pressure. Calcium antagonists reduce the nifedipine-type vascular tone in the arteries.
These drug groups are considered with regard to mortality reduction as therapeutically regards the impact on the total number of organ complications (stroke, heart attack, heart failure), but there is a heterogeneous study situation. Means the second choice are alpha blockers, potassium, α2-agonists and NO donors.
Refractory Hypertension
Refractory hypertension is defined as hypertension, consists of three or more despite treatment with high-pressure medications, including at least one diuretic, is not in the target area. Approximately 20-30% of hypertensive therapy resistance is particularly in advanced age or obesity. Often, the resistance to therapy, a secondary high-pressure form is based. The most common cause is a hyperaldosteronism, other causes include obstructive sleep apnea syndrome, chronic renal disease, renal artery stenosis or pheochromocytoma. All patients with refractory hypertension should, therefore, the aldosterone /renin ratio are determined to avoid including hyperaldosteronism, even if the serum is-potassium normal. Addition of spironolactone in low doses (25 mg / day) or amiloride to standard therapy in most cases reach the therapy-resistant hypertension, hypotension, irrespective of the amount of the aldosterone / renin ratio. Common side effect of spironolactone is breast tenderness, which occurs in 10% of treated men. The risk of hyperkalemia is low because of the serious consequences but is potassium controls needed, especially in patients with chronic kidney disease, diabetes, elderly, or coadministration of an ACE inhibitor or AT1 antagonists.
Other therapeutic options
A Swiss firm has developed a vaccine (CYT006-AngQb) against arterial hypertension, but is still in testing. This aims to make patients the production of antibodies that are specifically directed against angiotensin II, and should reduce the activation of the renin-angiotensin-aldosterone system. In particular, early morning blood pressure peaks to be avoided by the treatment. The practical significance is unclear, extensive clinical data are not yet available.
