Essential Hypertension

األساسي الدم ضغط ارتفاعHypertension is the term used to describe high blood pressure.Blood pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body.

Blood pressure readings are usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high.

The top number is called the systolic blood pressure, االنقباضي الدم and ضغطthe bottom number is called the diastolic blood pressure. االنبساطي الدم .ضغط

Normal blood pressure is when your blood pressure is lower than 120/80 mmHg most of the time.

High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg or above most of the time.

If your blood pressure numbers are 120/80 or higher, but below 140/90, it is called pre-hypertension

Causes:االسبابMany factors can affect blood pressure, including:

● How much water and salt you have in your body فى والملح الماء كمية الجسم

● The condition of your kidneys, nervous system, or blood vessels الكلى حالةالدم واوعية العصبى والجهاز

● The levels of different body hormones الدم فى الهرمونات مستوىYou are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure increases your chance of having a stroke, heart attack, heart failure, kidney disease, and early death.You have a higher risk of high blood pressure if you:

● Are African American● Are obese سمنة عندك● Are often stressed or anxious مستمر عصبى ضغط عندك● Drink too much alcohol (more than one drink per day for women and more

than two drinks per day for men)● Eat too much salt in your diet الملح وخصوصا كتير بتاكل ● Have a family history of high blood pressure بالضغط متأثر العائلة تاريخ

العصبى● Have diabetes سكر عندك● Smokeبتدخن

Most of the time, no cause of high blood pressure is found. This is called essential hypertension.High blood pressure that is caused by another medical condition or medication is called secondary hypertension. Secondary hypertension may be due to:

● Chronic kidney disease المزمن الكلى مرض ● Disorders of the adrenal gland (pheochromocytoma or Cushing syndrome )● Pregnancy (see: preeclampsia)● Medications such as birth control pills الحمل منع حبوب diet pills ,حبوب

some cold medications ,تخسيس برد ادوية and migraine medications ,ادويةالنصفى الصداع

● Narrowed artery that supplies blood to the kidney (renal artery stenosis )● Hyperparathyroidism الدرقية الغدة فى تضخم

Symptomsاالعراض Most of the time, there are no symptoms. For most patients, high blood pressure is found when they visit their health care provider or have it checked elsewhere.Because there are no symptoms, people can develop heart disease and kidney problems without knowing they have high blood pressure.

If you have

a severe headache حاد صداع

nausea or vomiting وقئ ترجيع

bad headache سئ صداع

confusionارتباك

changes in your vision or nosebleeds الرؤية فى مشاكل

you may have a severe and dangerous form of high blood pressure called malignant hypertension . خبيث عالى ضغط

Exams and Testsاالختبارات Your health care provider will check your blood pressure several times before diagnosing you with high blood pressure. It is normal for your blood pressure to be different depending on the time of day.

Blood pressure readings taken at home may be a better measure of your current blood pressure than those taken at your doctor's office. Make sure you get a good quality, well-fitting home device. It should have the proper sized cuff and a digital readout.

Practice with your health care provider or nurse to make sure you are taking your blood pressure correctly. See also: Blood pressure monitors for home

Your doctor will perform a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your body.

Tests may be done to look for:

● High cholesterol levels الكوليسترول مستوى ● Heart disease, such as an echocardiogram or electrocardiogram

● Kidney disease, such as a basic metabolic panel and urinalysis or ultrasound of the kidneys

TreatmentThe goal of treatment is to reduce blood pressure so that you have a lower risk of complications. You and your health care provider should set a blood pressure goal for you.If you have pre-hypertension, your health care provider will recommend lifestyle changes to bring your blood pressure down to a normal range. Medicines are rarely used for pre-hypertension.

Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It is very important that you take the medications prescribed to you. If you have side effects, your health care provider can substitute a different medication.

cardioselective beta blockersmechanism of action:

Beta blockers work by changing how certain sensors in the body, called beta receptors, respond to signals from the central nervous system. These medications are used to treat heart and blood pressure problems because both the heart and blood vessels have very high numbers of beta receptors. There are also high numbers of beta receptors in the lungs, but these receptors are slightly different in structure. Cardioselective beta blockers are able to tell the two apart. The cardioselective beta blockers

atenolol

atenolol 50-100mg ateno50-100mg atenolol50-100mg

blockium50-100mg tenormin25-50-100mg tensolol50-100mg

metoprolol

betaloc100mg low press100mg

bisoprolol

bisocard5-10mg concor2.5-5-10mg bistol10mg

non cardioselective beta blockermechanism of action :

Beta-blockers are drugs that bind to beta-adrenoceptors and thereby block the binding of norepinephrine and epinephrine to these receptors. This inhibits normal sympathetic effects that act through these receptors. Therefore, beta-blockers are sympatholytic drugs. Some beta-blockers, when they bind to the beta-adrenoceptor, partially activate the receptor while preventing norepinephrine from binding to the receptor. These partial agonists therefore provide some "background" of sympathetic activity while preventing normal and enhanced sympathetic activity. These particular beta-blockers (partial agonists) are said to possess intrinsic sympathomimetic activity (ISA). Some beta-blockers also possess what is referred to as membrane stabilizing activity (MSA). This effect is similar to the membrane stabilizing activity of sodium - channels blockers that represent Class I antiarrhythmics .

The first generation of beta-blockers were non-selective, meaning that they blocked both beta-1 (β1) and beta-1 (β2) adrenoceptors. Second generation beta-blockers are more cardioselective in that they are relatively selective for β1 adrenoceptors. Note that this relative selectivity can be lost at higher drug doses. Finally, the third generation beta-blockers are drugs that also possess vasodilator

actions through blockade of vascular alpha - adrenoceptors .

nebivolol

niblet5mg symbian 5mg

sotolol

betacor

alpha& beta blocker carvedolol

cardilol 25 dilatrol carvid 6.25-25mg

carvipress carvena carvedolol

calcium channel blockermechanism of action:

Currently approved CCBs bind to L-type calcium channels located on the vascular smooth muscle, cardiac myocytes, and cardiac nodal tissue (sinoatrial and atrioventricular nodes). These channels are responsible for regulating the influx of calcium into muscle cells, which in turn stimulates smooth muscle contraction and cardiac myocyte contraction. In cardiac nodal tissue, L-type calcium channels play an important role in pacemaker currents and in phase 0 of the action potentials. Therefore, by blocking calcium entry into the cell, CCBs cause vascular smooth muscle relaxation (vasodilation), decreased myocardial force generation (negative inotropy), decreased heart rate (negative chronotropy), and decreased conduction velocity within the heart (negative dromotropy), particularly at the atrioventricular node .

nicardipine hcl

20-50mg

micard pelcard

lacidipine

2-4mg

lacipil lodipine lacidac

amlodipine

5_10mg

alkapress amilo amlodipine

myodura norvasc vasonorm

regcor cardiovasc

deltiazem

60-90-120-180mg

telzim sr nimotop tildiem

slow-zem peltiam mono tidiem

dilatcor-xl delay-tiazem sr altiazem

nefidipine

10-20mg

epilat adalat nifepin

felodipine

2.5-5-10mg

logimax plentopine

plendil felocor

nitratemechanism of action :

General Pharmacology

Nitric oxide (NO), a molecule produced by many cells in the body, and has several important actions (click here for details ). In the cardiovascular system, NO is primarily produced by vascular endothelial cells. This endothelial-derived NO has several important functions including relaxing vascular smooth muscle (vasodilation), inhibiting platelet aggregation (anti-thrombotic), and inhibiting leukocyte-endothelial interactions (anti-inflammatory). These actions involve NO-stimulated formation of cGMP. Nitrodilators are drugs that mimic the actions of endogenous NO by releasing NO or forming NO within tissues. These drugs act directly on the vascular smooth muscle to cause relaxation and therefore serve as endothelial-independent vasodilators.

There are two basic types of nitrodilators: those that release NO spontaneously (e.g., sodium nitroprusside) and organic nitrates that require an enzymatic process to form NO. Organic nitrates do not directly release NO, however, their nitrate groups interact with enzymes and intracellular sulfhydryl groups that reduce the nitrate groups to NO or to S-nitrosothiol, which then is reduced to NO. Nitric oxide activates smooth muscle soluble guanylyl cyclase (GC) to form cGMP. Increased intracellular cGMP inhibits calcium entry into the cell, thereby decreasing intracellular calcium concentrations and causing smooth muscle relaxation (click here for details ). NO also activates K+ channels, which leads to hyperpolarization and relaxation. Finally, NO acting through cGMP can stimulate a cGMP-dependent protein kinase that activates myosin light chain phosphatase , the enzyme that dephosphorylates myosin light chains, which leads to relaxation.

Tolerance to nitrodilators occurs with frequent dosing, which decreases their efficacy. The problem is partially circumvented by using the smallest effective dose of the compound coupled with infrequent or irregular dosing. The mechanism for tolerance is not fully understood, but it may involve depletion of tissue sulfhydryl groups, or scavenging of NO by superoxide anion and the subsequent production of peroxynitrite that may inhibit guanylyl cyclase.

Primary Cardiovascular Actions

of Nitrodilators

Systemic vasculature

● vasodilation● (venous dilation > arterial dilation)● decreased venous pressure● decreased arterial pressure (small effect)

Cardiac

● reduced preload and afterload● (decreased wall stress)● decreased oxygen demand

Coronary

● prevents/reverses vasospasm● vasodilation (primarily epicardial vessels)● improves subendocardial perfusion● increased oxygen delivery

Although nitrodilators can dilate both arteries and veins, venous dilation predominates when these drugs are given at normal therapeutic doses. Venous dilation reduces venous pressure and decreases ventricular preload. This reduces ventricular wall stress and oxygen demand by the heart, thereby enhancing the oxygen supply / demand ratio . A reduction in preload (reduced diastolic wall stress) also helps to improve subendocardial blood flow, which is often compromised in coronary artery disease. Mild coronary dilation or reversal of coronary vasospasm will further enhance the oxygen supply/demand ratio and diminish the anginal pain. Coronary dilation occurs primarily in the large epicardial vessels, which diminishes the likelihood of coronary vascular steal . Systemic arterial dilation reduces afterload, which can enhance cardiac output while at the same time reducing ventricular wall stress and oxygen demand. At high concentrations, excessive systemic vasodilation may lead to hypotension and a baroreceptor reflex that produces tachycardia. When this occurs, the beneficial effects on the oxygen supply/demand ratio are partially offset. Furthermore, tachycardia, by reducing the duration of diastole , decreases the time available for coronary perfusion, most of which occurs during diastole (click here for more details ).

isosorbide mononitrate

20-25-40-50-100mg

monomack monocard cardioguard m

effox ismo imdur

nicorandil

20mg

randil

isosorbide dinitrate

1.25-2-5-10-20-40mg

cardiket coronit dinitra

isomack isordil

nitroglycerin

angised nitromack retard nitroderm tts

nitroguard nitronal nitrostat

nitrotard deponitnt5 nitrocare SR

tridil

Angiotensin II Receptor antagonistvalsartan

disartan tareg valsar

idisartan

losartan potasium

losartan remtozar lozapress

lozar kanzar cozaar

amozar losarmepha

irbesartan

aprovel

eprosartan

teveten

telmisartan

micardis

candisartan

atacand atacand plus candesar

Angiotensin II Receptor inhibitorsmechanism of action:These drugs have very similar effects to angiotensin converting enzyme ( ACE ) inhibitors and are used for the same indications (hypertension, heart failure , post- myocardial infarction ). Their mechanism of action, however, is very different from ACE inhibitors, which inhibit the formation of angiotensin II. ARBs are receptor antagonists that block type 1 angiotensin II (AT1) receptors on bloods vessels and other tissues such as the heart. These receptors are coupled to the Gq - protein and IP 3 signal transduction pathway that stimulates vascular smooth muscle contraction. Because ARBs do not inhibit ACE, they do not cause an increase in bradykinin, which contributes to the vasodilation produced by ACE inhibitors and also some of the side effects of ACE inhibitors (cough and angioedema).ARBs have the following actions, which are very similar to ACE inhibitors:

● Dilate arteries and veins and thereby reduce arterial pressure and preload and afterload on the heart.

● Down regulate sympathetic adrenergic activity by blocking the effects of angiotensin II on sympathetic nerve release and reuptake of

norepinephrine.● Promote renal excretion of sodium and water (natriuretic and diuretic

effects) by blocking the effects of angiotensin II in the kidney and by blocking angiotensin II stimulation of aldosterone secretion.

● Inhibit cardiac and vascular remodeling associated with chronic hypertension, heart failure , and myocardial infarction .

lisinopril

lisopril lisinopril sinopril

zestril maxitrel

perindopril

coversyl adwipril

enalpril

acapril enalapril lotrial

ezalapril renitic press light

benzapril

cibacen

ramipril

ramitac tritace tritace protect

ramipril corpril

moexipril

primox

captopril

capoten captopril

lotensine hypopress

fosinopril

monopril

centrally acting anti hypertensiveclonidine

catapress

phentolamine

rogitine

prazocin

minipress

methyl dopa

methyldopa aldomet adamat

kadomet farcodopa epidopa

vasodilator antihypertensivesodium nitroprusside

niprid nipruss sodium nitroprusside

adenergic and dopamenergic agentdobutamine

dobutrix dobutamine

adrenaline

adrenaline

dopamine

dopamine intropin

isoprenaline

isupril

natural product

hybisc master-hibiscus royatens

multiingredientatenolol+chlorthalidone

50-100+12.5-25mg

tenoret tenoretic

blockium diu tenedone

capotril+indapamide

33+3mg

normaten

verpamil+trandolapril

180+2mg

tarka

atenolol+amiloride

50-100 +2.5-5mg

teklo hipress D atenoretic

atenolol+nefidipine

tenolat SR

amlodipine +valsartan

exforge 5_10+160mg

resperine+clopramide+dihydroergocristine

1+5+0.1mg

brinerdin hypoten

perindopril+indapamide

2+0.625mg

preterex bipreterex

bisoprolol+hydrochlorthalidone

2.5-5-10+6.25-12.5-25mg

lodoz concor plus 5 concor plus 10

bisocard plus bistol plus cardivo care

telmisartan+hydrochlorthalidone

80-12.5mg

micardis plus

captopril+hydrochlorthalidone

50+25mg

capozide farcopril plus

capojed H hypopress D

ramipril+hydrochlorthalidone

2.5-5+12.5-25mg

tritace comp tritace comp l s

fosinopril+hydrochlorthalidone

10-20+12.5mg

monozide

valsartan+hydrochlorthalidone

80-160+12.5mg

disartan co co tareg co diovan

benzapril+hydrochlorthalidone

cibradex 10-12.5mg

enalapril maleate+hydrochlorthalidone

co renitic 20+12.5mg enalazide 10+1.5mg

thiazopril 20+12.5mg ezapril co 20+12.5mg

lisinopril+hydrochlorthalidone

zestoretec 20+12.5mg sinopril co 20+12.5mg lisitens20+12.5mg

losartan k+hydrochlorthalidone

losartan comp50+12.5mg losazide50+12.5mg remtozar d 100+12.5mg

kanazar h 100+12.5mg modazar 100+25mg losarmephaplus50+12.5mg

fortzaar 100+25mg hyzaar 50+12.5mg

hysartan 50+12.5mg lora-z 50+12.5mg

irbesartan +hydrochlorthalidone

coaprovel 300mg+12.5mg coaprovel fort 300mg+25mg

xtension 150+12.5mg xtension plus 300+12.5mg

felodipine+metoprolol

logimax 5+50mg

minoxidil

2.5+5+10mg

loniten minoxidil

imidazoline receptor antagonistmechanism of action:

There are three classes of imidazoline receptors:[1]

● I1 receptor – mediates the sympatho-inhibitory actions of imidazolines to lower blood pressure, (NISCH or IRAS, imidazoline receptor antisera selected)

● I2 receptor – an allosteric binding site of monoamine oxidase and is involved in pain modulation and neuroprotection.

● I3 receptor – regulates insulin secretion from pancreatic beta cells Activated I1-imidazoline receptors trigger the hydrolysis of phosphatidylcholine into DAG. Elevated DAG levels in turn trigger the synthesis of second messengers arachidonic acid and downstream eicosanoids.[2] In addition, the sodium - hydrogen antiporter is inhibited, and enzymes of catecholamine synthesis is induced. The I1-imidazoline receptor may belong to the neurocytokine receptor family, since its signaling pathways are similar to those of interleukins.[2]

moxonidine

cynt 0.2-0.3mg

relminidine

hyperium0.4-1mg

Advices to The Patients: للمريض نصايحYou can do many things to help control your blood pressure, including:

● Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water. See: High blood pressure and diet الماء من المزيد اشرب

● Exercise regularly -- at least 30 minutes of aerobic exercise a day. تدرباالقل على دقيقة 30يوميا

● If you smoke, quit -- find a program that will help you stop. لبرنامج انضمالتدخين عن لالقالع

● Limit how much alcohol you drink -- one drink a day for women, two a day for men الكحوليات . قلل

● Limit the amount of sodium (salt) you eat -- aim for less than 1,500 mg per day. المستطاع قدر على الملح قلل

● Reduce stress -- try to avoid things that cause you stress. You can also try meditation or yoga. اليوجا مارس و العصبى الضغط قلل

● Stay at a healthy body weight -- find a weight-loss program to help you, if you need it وزنك على حافظ

Possible Complications قد التى المشاكلالمرض اهمال من تحدث

When blood pressure is not well controlled, you are at risk for:● Bleeding from the aorta , the large blood vessel that supplies blood to the

abdomen , pelvis , and legs االورطى شريان من نزيف ● Chronic kidney disease المزمن الكلى مرض ● Heart attack and heart failure القلب وقصور القلبية النوبات ● Poor blood supply to the legs لالرجل الدم وصول فى نقص ● Stroke الدماغية السكتة ● Problems with your vision الرؤية فى مشاكل

References:http :// www . nlm . nih . gov / medlineplus / ency / article /000468. htm

http :// www . medicinenet . com / high _ blood _ pressure / article . htm

http :// www . cvpharmacology . com / cardioinhibitory / beta - blockers . htm