Treatment of Essential Hypertension (HTN)

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Workshop Outline

High blood pressure (hypertension) occurs in 25% to 35% of adults and children in the United States. Over half of the population over age 65 have hypertension. The prevalence and severity of hypertension increase with age. Hypertension occurs at younger ages in blacks than in whites. If untreated, patients with hypertension eventually become ill and may die of the effects of the disease. There are now ample data to show that lowering of blood pressure, even in patients with mild to moderate hypertension, reduces morbidity and mortality. In about 10% of cases, hypertension is secondary to another disease.
In these cases treatment of the cause should be addressed. In most patients hypertension is of unknown etiology (essential or primary hypertension), and, therefore, specific therapy to correct causative factors is not possible. This has led to the development of drugs that lower blood pressure by various mechanisms:
(1) diuretics,
(2) drugs that affect the renin-angiotensin system,
(3) calcium-channel blockers,
(4) vasodilators, and
(5) drugs that act through the sympathetic nervous system.
Also, nonpharmacologic therapies, including weight loss, exercise, changes in diet, limiting alcohol consumption and smoking cessation, are effective in the treatment of mild hypertension and enhance the efficacy of pharmacologic therapy.

Learning Goals for the HTN Workshop
  1. list the major complications and diseases that result from untreated hypertension;
  2. describe the physiologic factors involved in the regulation of blood pressure;
  3. define hypertension and understand how to evaluate the hypertensive patient appropriately;
  4. establish a therapeutic goal for blood pressure for individual hypertensive patients and be able to periodically reassess whether or not the goal is being met without undue discomfort for the patient;
  5. For each of the major classes of antihypertensive drugs:
    - identify the principal site of action and describe the mechanism(s) by which the drugs lower blood pressure,
    - describe their main hemodynamic effects, and
    - identify the primary advantages, disadvantages, and complications associated with these drugs and relate these to contraindications for their use;
  6. apply the current therapeutic guidelines to treatment of a patient with progressive essential hypertension;
  7. identify factors that promote patient adherence;
  8. list major nonpharmacologic adjuncts to drug therapy that help decrease blood pressure in patients with mild to moderate hypertension; and
  9. identify the first-choice drug for emergency use in a specific patient in hypertensive crisis.