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Hypertension: Symptoms

by Joseph Alpert, MD
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    00:01 if these lifestyle factors continue despite medication.

    00:01 The symptoms, I’ve mentioned before, we call hypertension the silent killer because for years there are no symptoms and when symptoms develop, they are due to damage to various organs.

    00:13 We talked about hypertrophy – or – thickening of the left ventricle and eventual heart failure with shortness of breath, peripheral swelling, fatigue. We talked about stroke and dementia, or cognitive impairment in which patients become forgetful, confused. Their personalities change, they’re not the person they were before this process began. Again, kidney damage.

    00:39 Nephrosclerosis means scarring of the glomerulus so that the glomerulus doesn’t work so the kidney’s function is impaired and this can lead to kidney failure and is a common cause of patients needing dialysis. There can be damage to the retina, which is the photographic plate in the back of the eye, even with small hemorrhages, and can lead to blindness. And finally you can have blood-vessel damage anywhere in the body with atherosclerosis and all the complications that we’ve already been talking about with atherosclerosis.

    01:14 Therapy usually starts with medicines. When we’re dealing with a hypertensive type where surgery isn’t absolutely required – for example coarctation – we would move early on to surgery. But most patients with hypertension are treated with medications. And we have very effective medications these days for controlling hypertension compared to when Franklin Delano Roosevelt died of uncontrolled hypertension because there were no drugs to control his hypertension.

    01:41 The first-line drugs that are most-commonly used are thiazide diuretics and ACE inhibitors and angiotensin blockers. We’re going to go through all the classes in a moment. Calcium-channel blockers are also first-line, particularly for patients with kidney disease. Beta blockers used to be first-line but have been moved down now into second rank. And aldosterone antagonists – remember, aldosterone is released from the adrenal gland secondary to stimulation from angiotensin. And there’s also drugs that block the effect of aldosterone that help lower blood pressure.

    02:20 Let’s look at the drugs in a little more detail.

    02:22 First, let’s look at the thiazide diuretics. Excellent first-line therapy alone or often combined with angiotensin-converting enzyme inhibitors, often called ACE inhibitors, or angiotensin-receptor blockers, often called ARBs. These are generic. They’re inexpensive and they have been shown to reduce cardiovascular events, such as stroke, in patients with hypertension.

    02:49 The aldosterone antagonists are also very effective. They bind at receptors in the kidney, heart, blood vessels and the brain. They block the effect of aldosterone on the kidney and they increase sodium and chloride water excretion and potassium excretion.

    03:09 Beta blockers, as I’ve said, slow the heart rate and they decrease cardiac output. They also decrease renin release to a small degree from the kidney. And these are second-line agents for hypertension.

    03:21 Calcium-channel blockers work by dilating vascular smooth muscle and therefore they decrease peripheral vascular resistance and that decreases blood pressure.

    03:33 The angiotensin-receptor blockers and the angiotensin-converting enzyme inhibitors also help block the release of the angiotensin hormone system that causes vasoconstriction and increased peripheral vascular resistance.

    03:52 Finally just a word to tell you something about how many anti-hypertensive agents are needed for patients who have high blood pressure.

    04:00 Here you see from a number of large, randomized, double-blind controlled trials of hypertension control versus placebo. And you can see most of the trials require at least two – and many of the trials require three drugs and even some four drugs – to control blood pressure. So usually one drug is not enough. And often, of course, the drugs have to be combined with lifestyle changes: weight loss, control of diabetes and so forth. It’s not just the drugs that do the job. There also has to be exercise and weight loss and watching the salt in the diet and so forth.


    About the Lecture

    The lecture Hypertension: Symptoms by Joseph Alpert, MD is from the course Arterial Diseases.


    Included Quiz Questions

    1. Retina.
    2. Cornea.
    3. Iris.
    4. Lens.
    5. Sclera.
    1. Beta-blockers.
    2. Aldosterone antagonists.
    3. Calcium channel blockers.
    4. Thiazide diuretics.
    5. ACE-inhibitors.
    1. Retina.
    2. Cornea.
    3. Iris.
    4. Lens.
    5. Sclera.
    1. Beta-blockers.
    2. Aldosterone antagonists.
    3. Calcium channel blockers.
    4. Thiazide diuretics.
    5. ACE-inhibitors.

    Author of lecture Hypertension: Symptoms

     Joseph Alpert, MD

    Joseph Alpert, MD


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