Who treats hypertension, the cardiologist or the general practitioner?
Hypertension is treated by the general practitioner. Only the complicated forms of hypertension are the responsibility of the cardiologist or the hypertension specialist. For example: a hypertensive person who has had a myocardial infarction or heart failure will have to see his cardiologist but will also have to continue to see his GP. Indeed, between two cardiology visits, the general practitioner must continue to monitor this hypertension because he can develop other diseases which will not concern the cardiologist. Losing contact with your doctor is always penalizing. It is a treatment path in which everyone has their place and ideally, specialists should only see resistant hypertensive, that is to say hypertensive uncontrolled after six months of treatment and complicated hypertension,
Why treat a disease that has no symptoms?
Treating a disease that has no symptoms is the prerogative of prevention. We must not forget that hypertension was very symptomatic until the 1960s since there was no treatment. The current risk is that the decline in attention, motivation and prioritization leads to a relaxation of its management and a reappearance of accidents. Treating this pathology makes it possible above all to avoid more serious illnesses, which were very frequent and which have very clearly diminished over the past 40 years. It is thanks to the decrease in the number of cardiovascular accidents that life expectancy has been extended: it has been increased by one quarter per year in France, while at the same time the population has become more sedentary, is not eating much better and has not lost much weight.
Is there any proof of the effectiveness of antihypertensive treatments?
The effectiveness of the treatments is certain. As many studies on thousands of people have shown, the drugs are active on blood pressure levels, but also on the consequences of hypertension such as the reduction of strokes, coronary heart attacks and kidney failure. There is even some evidence for decreasing dementias.
What is the current treatment strategy?
Therapeutic strategies have evolved a lot. In the 1970s, it was believed that a single drug was sufficient to treat hypertension, but now it is accepted that most often a combination of drugs should be used. There are several systems in the body that explain the rise in blood pressure and it is seldom known in advance which one is more responsible. Since a drug acts on only one system, there is a trial and error period during the first six months during which several therapeutic classes will be tested. We therefore know today that it is rare that a single class of drug is sufficient to control hypertension. This happens in 25% of cases, but it is the combination of two therapeutic classes, each acting on different systems that will make it possible to treat the vast majority of patients well. Sometimes in 30-40% of cases it will take three drugs combined and in even rarer cases four or even five.
In the 1980s, the combination of three drugs resulted in the intake of nine tablets per day since their duration of action was short and the combinations in the same pill did not exist. The great evolution of treatment has been the development of fixed combinations of drugs which last 24 hours and which are combinations of two or three tablets. It is now possible to do antihypertensive triple therapies, that is to say a combination of three drugs, with a single tablet to be taken in the morning. This is real progress because the simplification of the intake promotes compliance, essential for the effectiveness of the treatment.
What drugs do we have to treat hypertension?
Seven major therapeutic classes have been developed over the past 50 years to treat high blood pressure. Historically, centrally acting antihypertensive drugs were the first available, followed by beta blockers, diuretics, ACE inhibitors, calcium channel blockers, angiotensin II receptor antagonists and alpha blockers, antagonists of the renin being a little apart. In theory, all molecules from these classes can be used, however the latest recommendations strongly suggest restricting the initial treatment of common hypertension to the five major classes, i.e. beta blockers, diuretics, converting enzyme inhibitors (ACE inhibitors),
Why combine several drugs?
Since arterial hypertension is due to several factors, each class of drug will act on a distinct mechanism of action: some will dilate the vessels, others will slow down the heart rate, others will block a particular system, the systemenine -angiotensin, still others will eliminate water and salt in the urine. Combining several drugs will allow them to "boost" them, the effect being more than additive.
What are the drugs that raise blood pressure?
There is a fairly long list of drugs that raise blood pressure. Among the best known or most common, we can cite the contraceptive pill, in particular estrogens, non-steroidal anti-inflammatory drugs which act by opposing the dilation of the vessels caused by antihypertensive drugs, finally certain anticancer drugs, antiangiogenics, which destroy the small vessels of tumors and thus cause an increase in blood pressure.
Is hypertension treatment for life or can it be stopped?
It is usually a very long course of treatment. If the diagnosis has been made correctly, the permanent nature of the high blood pressure is affirmed and the treatment will fortunately normalize the numbers. If there is no big change in the person taking it, this treatment will be lifelong. Saying that a treatment is lifelong or long-lasting can also be considered good news, it means that we will live a long time thanks to it. However, if it lasts for many years, it is not intended to remain the same over time. It can be strengthened, the therapeutic classes are often changed and it is sometimes lightened. This is why antihypertensive treatment must be monitored regularly by a doctor who checks that it remains in line with the patient's clinical situation.
Is there a risk of hypotension with the treatments?
There is a risk of hypotension. But not all drugs carry this risk because most are antihypertensive drugs rather than hypotensive drugs. According to the initial arterial pressure figures, they adapt their effect and therefore the amplitude of the drop. They sometimes cause a significant decrease when the initial blood pressure is very high, on the other hand they cause a much more moderate drop if the blood pressure is only slightly above normal. The initial arterial pressure, before the initiation of a treatment, must therefore be assessed with precision so as not to be treated too vigorously and thus risk hypotension.
In fragile situations when the cerebral blood pressure regulating system is faulty, for example in the elderly, in patients with neurological disease or who suffer from certain kidney diseases, antihypertensives can cause hypotension. Another risk exists when an acute illness such as pneumonia or gastroenteritis occurs in a patient being treated for hypertension. Blood pressure destabilization and hypotension can then occur.
0 Comments