From the Guidelines
Hypertension (HTN) treatment should prioritize lifestyle modifications and pharmacotherapy with first-line medications including thiazide diuretics, ACE inhibitors/ARBs, calcium channel blockers, and beta-blockers, with a target blood pressure goal below 130/80 mmHg for most patients. The pathophysiology of HTN involves multiple mechanisms, including increased sympathetic nervous system activity, renin-angiotensin-aldosterone system (RAAS) activation, endothelial dysfunction, and sodium/water retention, leading to elevated peripheral vascular resistance and cardiac output 1. The etiology of HTN can be primary (essential) in 90-95% of cases or secondary due to conditions like renal disease, endocrine disorders, or medications.
Pathophysiology and Etiology
The pathophysiology of HTN is complex and multifactorial, involving various mechanisms such as:
- Increased sympathetic nervous system activity
- RAAS activation
- Endothelial dysfunction
- Sodium/water retention The etiology of HTN can be classified into primary (essential) or secondary causes, with primary causes accounting for 90-95% of cases.
Treatment
Treatment of HTN begins with lifestyle modifications, including:
- Reduced sodium intake
- DASH diet
- Exercise
- Weight loss
- Limited alcohol intake Pharmacotherapy is initiated with first-line medications, including:
- Thiazide diuretics (reducing blood volume by increasing sodium excretion)
- ACE inhibitors/ARBs (blocking RAAS, reducing vasoconstriction and aldosterone release)
- Calcium channel blockers (relaxing vascular smooth muscle by preventing calcium influx)
- Beta-blockers (reducing heart rate and contractility by blocking beta-adrenergic receptors) Second-line options include aldosterone antagonists, alpha-blockers, and direct vasodilators.
Medication Choice and Target Blood Pressure
Medication choice depends on patient characteristics, comorbidities, and compelling indications, with combination therapy often needed to achieve target blood pressure goals below 130/80 mmHg for most patients 1. The American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension guidelines recommend individualized treatment, with regular monitoring for efficacy and adverse effects 1.
Recent Guidelines and Recommendations
Recent studies have emphasized the importance of individualized treatment and regular monitoring for efficacy and adverse effects 1. The 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline recommends first-line treatment with thiazide diuretics, ACE inhibitors, ARBs, or calcium channel blockers, with a target blood pressure goal below 130/80 mmHg for most patients 1. The European Society of Cardiology/European Society of Hypertension guideline also recommends similar first-line treatments, with a focus on individualized therapy and regular monitoring 1.
Conclusion is not allowed, so the answer just ends here.
From the FDA Drug Label
Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit
The pathophysiology of Hypertension (HTN) is not directly described in the label, but it is mentioned that elevated systolic or diastolic pressure causes increased cardiovascular risk. The etiology of Hypertension (HTN) is not directly described in the label. The label does mention that antihypertensive drugs from various pharmacologic classes can reduce cardiovascular morbidity and mortality by lowering blood pressure, but it does not describe the specific mechanisms of action of these drugs at a pathophysiological level. 2
From the Research
Pathophysiology of Hypertension
- Hypertension is a complex condition involving the interplay of multiple factors, including a reduced number of functioning nephrons, sodium retention and volume expansion, upregulation of the sympathetic nervous system, hormonal factors such as upregulation of the renin-angiotensin-aldosterone system, and endothelial dysfunction 3.
- The pathophysiology of hypertension is closely intertwined with chronic kidney disease, as hypertension can lead to deteriorating renal function and progressive chronic kidney disease can contribute to worsening hypertension 3.
- Other conditions, such as obstructive sleep apnea, can also share common risk factors and pathophysiology with hypertension and chronic kidney disease, including chronic volume overload, hyperaldosteronism, increased sympathetic activity, endothelial dysfunction, and increased inflammatory markers 4.
Etiology of Hypertension
- Hypertension is a leading risk factor for cardiovascular disease and all-cause mortality globally 3.
- The etiology of hypertension is multifactorial, involving genetic, environmental, and lifestyle factors, as well as underlying medical conditions such as chronic kidney disease and sleep apnea 3, 4.
Anti-Hypertension Medications
- Various anti-hypertension medications work at a pathophysiological level to treat hypertension, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, and diuretics 5, 6.
- ACE inhibitors and ARBs exert cardioprotective effects that are independent of blood pressure reduction, making them reasonable first-line agents for most patients 6.
- Beta-blockers and diuretics can also be effective in managing hypertension, with low doses resulting in minimal changes in lipid profile 7.
- The choice of anti-hypertension medication depends on individual patient factors, including comorbidities and the presence of chronic kidney disease or other underlying conditions 6.