VI -
What to do in case of a high blood pressure
6.1
- First of all, to eliminate a false high blood pressure
6.2
- To eliminate an obvious cause responsible for a high blood pressure
6.3
- To start a treatment without drug: life style modifications
6.4 - According to
the circumstances, to treat by using drugs
6.5 - Anti-hypertensive
therapy
6.6 - Why does the doctor prescribe a given anti-hypertensive
drug and not another? The choice of the first treatment.
6.6
Why do physicians prescribe a given antihypertensive drug and not
another? The choice of the first drug
Usually, the treatment of
a high blood pressure always begins with the prescription of only one
drug or an association with a slightly proportioned diuretic drug (in
only one tablet).
The factors entering into
account for the choice of the first antihypertensive therapy are related
to the patient and the tolerance of the drug.
6.6.1- The elements to
be taken into account concerning the patient are:
- His age, because of the possible appearance of a renal insufficiency and
of the deterioration of the blood pressure regulation which can be responsible
for an arterial hypotension;
- The existence
of a renal insufficiency encourages the physician to prescribe an
angiotensin-converting enzyme inhibitor or an angiotensine receptor
antagonist, by introducing them gradually and by supervising the
renal function with very regular blood tests. The diuretics, apart
from the soludactone, can be used first.
Nevertheless other antihypertensive
drugs can be prescribed by checking the adaptation of the quantity
of drug according to the renal biological test (dosage of creatinine).
- The existence
of a diabetes is very important to consider because the antihypertensive
drugs of the family of the angiotensin-converting enzyme inhibitor
are prescribed first, if there is no renal insufficiency.
- If the subject has already
presented a myocardial infarction or presents an angina pectoris, a
treatment by beta-adrenoreceptor blocking drugs or an angiotensin-converting
enzyme inhibitor will be prescribed first.
- In the event of cardiac
insufficiency, the physician prescribes an angiotensin-converting enzyme
inhibitor.
6.6.2- Elements related
to the drug
The patient with a high blood
pressure must tolerate his drug well, because the treatment of the
high blood pressure is very long.
Thus, the physician prescribes
the best drug for his patient, having an effectiveness 24 hours a day,
and compatible with the other treatments taken by his patient.
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last modified on : 28 sep 2003 |
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