Drugs affecting CVS

Major cardiovascular Pathologies requiring

Pharmacological Interventions?
•Hypertension
•Angina
•Heart failure
•MI
•Cardiac arrhythmia
 Hypertension
•Hypertension can be defined as a
condition in which blood pressure
is elevated to an extent where
benefit is obtained from blood
pressure lowering.
Hypertension
•There is no clear-cut blood pressure
threshold separating normal from
hypertensive individuals.

•The risk of complications is related to

the extent that blood pressure is
elevated.
 Hypertension
•WHO has identified hypertension as
one of the most important
preventable causes of premature
morbidity and mortality in developed
and developing countries.
• Hypertension should not be seen as a risk factor in

isolation and

• decisions on management should not focus on

blood pressure alone but on total cardiovascular

risk.
• The complications of hypertension include
• stroke,
• myocardial infarction,
• heart failure ,
• renal failure and
• dissecting aortic aneurysm.
• An aortic aneurysm is an
enlargement (dilatation) of
the aorta.
• They usually cause no
symptoms except when
ruptured
• Small reductions in blood pressure result in substantial reductions in
the relative risks of these complications.
• For correct diagnosis, careful measurement of blood pressure is
necessary on several occasions using well-maintained and validated
equipment.
• Non-pharmacological interventions are important and include
• weight reduction,
• avoidance of excessive salt and alcohol,
• increased intake of fruit and vegetables and
• regular dynamic exercise.
• Avoid smoking
• Adequate sleeping
• Stress reduction
•Other cardiovascular risk factors such as
smoking, hyperlipidaemia and diabetes should
be addressed.
• A large selection of antihypertensive drugs is available.

• It is important to use a drug that is free from adverse effects.

• The most appropriate choice of initial drug therapy depends on

• the age and racial origin of the patient,

• as well as the presence of other medical conditions

 Hypertension: Overview

• Blood pressure elevations are associated with an

increased risk of cardiovascular (CV) disease in a linear
fashion.
Hypertension: Overview

• Starting at a blood pressure of 115/75 mm Hg, every increase of 20

mm Hg in systolic blood pressure (SBP) and/or increase of 10 mm
Hg in diastolic blood pressure (DBP) is associated with a doubling
of the risk of death from stroke, heart disease, or other vascular
disease (Lewington 2002).
Guideline for the prevention, Detection, Evaluation and Management
of High Blood Pressure(USA)

Reference: American College of Cardiology (ACC), American Heart Association (AHA) and Joint National
Committee (JNC) (2017). Guideline for the prevention, Detection, Evaluation and Management of High
Blood Pressure.
National Guidelines for Management of
Hypertension in Bangladesh

Reference:The Directorate General of Health Services and Ministry of Health and Family
Affairs (2013). National Guidelines for Management of Hypertension in Bangladesh.
• ABPM=ambulatory blood pressure monitoring;
• ACEi=ACE inhibitor;
• ARB=angiotensin-II receptor blocker;
• BP=blood pressure;
• CCB=calcium-channel blocker;
• HBPM=home blood pressure monitoring.
Recommendations on diagnosis and treatment from
NICE’s guideline on hypertension in adults
How to measure blood pressure
• Target organ damage
Damage to organs such as the heart, brain, kidneys and eyes. Examples
are left ventricular hypertrophy, chronic kidney disease, hypertensive
retinopathy or increased urine albumin:creatinine ratio.

• White-coat effect
A discrepancy of more than 20/10 mmHg between clinic and average
daytime ABPM or average HBPM blood pressure measurements at the time
of diagnosis.
Patients with white-coat hypertension experience a spike in their blood
pressure specifically when it is measured at the doctor’s office but not in
other settings, such as the home.
 • Masked hypertension
Patients with masked hypertension, on the other hand, have normal
blood pressure readings at the doctor’s office but the experience
increases in blood pressure at other times of day or in different
settings.