Hypotension and antihypertensive medications

Hypotension & Antihypertensives

Antihypertensives should not be withheld just for hypotensive purpose. Patients with other high risk conditions, such heart failure, IHD, chronic kidney disease, recurrent stroke, etc., should be given antihypertensives inspite of hypotension. Patients with hypertension target organ damage, or at risk of, should continue antihypertensives, even with hypotensive events. Pregnant women with chronic hypertension who are at risk of preeclampsia should also continue with antihypertensives, even with hypotension situations.

"Therapeutic decisions in individuals with hypertension and other high risk conditions, such as heart failure, IHD, chronic kidney disease, recurrent stroke, etc., should be directed at both the compelling condition and lowering blood pressure" (National High Blood Pressure Education Program, 2004, Aug). According to the authors, 40-50% of patients with heart failure symptoms have preserved systolic function and are more likely to have hypertension, LVH, and isolated diastolic dysfunction. Progression to more severe stages of left ventricular dysfunction can be significantly reduced by effective therapy with the use of antihypertensives.

The authors further explain that hypertension precedes the development of heart failure in approximately 90% of patients and increase risk of heart failure by two to three fold. CAD causes heart failure in approximately two thirds of heart failure patients in the U.S. Type 2 diabetes is also associated with 70-80% chance of premature death from CVD and stroke. Research showed that with each 10 mmHg decrease in systolic blood pressure was associated with average reduction rates of diabetes-related mortality by 15%, MI 11%, and microvascular complications of retinopathy or nephropathy by 13%.

Hypertension target organ damage can be reduced or prevented with the use of antihypertensives (Sartori, 2005). The author also explains that the use of antihypertensives is reasonable in the prevention of cardiovascular events in patients with PAF when a small reduction in life expectancy is expected. And, recommends antihypertensives for patients with noctrinal hypertension.

According to (Carson, 2014), "Hypertensive disorders in pregnancy may cause maternal and fetal mortality and they remain a leading source of maternal mortality." The author explains that women with chronic hypertension in pregnancy have approximately 25% risk of preeclampsia. And recommends antihypertensive use when clear benefit to the mother exists.

Many events can be prevented, instead of caused, when blood pressure is aggressively treated. The use of combination therapy has proven to confound interpretation of the effects of single drugs (National High Blood Pressure Education Program, 2004, Aug). Some studies show patients with CAD are at risk if the diastolic blood pressure is low (