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Rational Use of Beta Blockers in Management of Hypertension Khawaja Tahir Mehmood, Fatima Amin, Hafiza Kiran Ismail, Ayesha Irfan

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Rational Use of Beta Blockers in Management of Hypertension Khawaja Tahir Mehmood, Fatima Amin, Hafiza Kiran Ismail, Ayesha Irfan Khawaja Tahir Mahmood et al /J. Pharm. Sci. & Res. Vol.3(1), 2011,1029-1034 Rational Use of Beta Blockers in Management of Hypertension Khawaja Tahir Mehmood, Fatima Amin, Hafiza Kiran Ismail, Ayesha Irfan. Lahore College for women university Lahore, Pakistan Abstract: Hypertension is an extremely common disorder. It is major risk factor for cardiovascular morbidity and mortality through its effects on target organs like brain heart kidney eyes. In Pakistan magnitude of problem of uncontrolled hypertension is greater. .Treatment of hypertension decreases morbidity and increases life expectancy. Beta blockers are widely used in the treatment of hypertension. Beta blockers are effective only when they are rationally prescribed and used. It is retrospective type of study during which data of 50 hypertensive patients with primary hypertension using beta blockers were collected to analyze whether beta blockers are rationally prescribed and used. After therapy with beta blockers Blood pressure is effectively controlled. After the therapy 20 % patient have B.P in range of 110-130, 56% patients have B.P in range of 120- 130 and 24% have B.P in range of 130-140.It is concluded that blood pressure is effectively controlled when beta blockers rationally used. It should be given with caution in older and diabetic patients because it increases the risk of stroke in older patients. It is most effective when given in combination. Key words; Beta blockers, Hypertension, rational use, INTRODUCTION: systolic hypertension, white coat hypertension Hypertension is defined as either a sustained and resistant hypertension. (5, 6) systolic blood pressure of greater than 140 Although exact causes of primary hypertension mmHg or sustained diastolic blood pressure of is not fully understood it is known that some greater than 90mmHg. High blood pressure factors that contribute include smoking, also known as hypertension is usually defined obesity, alcohol consumption, lack of exercise. as having a sustained blood pressure of 140/90 Secondary hypertension is caused by endocrine mmHg or above. Hypertension is defined as diseases, narrowing of aorta, may also be repeatedly elevated blood pressure exceeding caused by steroids, medicines, pregnancy, 140/90mmHg. (1, 2, 3) contraceptive pills. A family history of Seventh report of Joint National Committee hypertension increases likelihood that an classifies hypertension into four categories for individual will develop hypertension diseases. the purpose of treatment and management. The (7) categories are normal less than 120/80 , pre Hypertension or high blood pressure usually hypertension 120-139/80-89, stage 1 causes no symptoms and high blood pressure is hypertension 140-159/90-99, stage 2 often called as Silent Killer. People who have hypertension 160 and above/ 100 and above . hypertension typically don’t know it until their (4) blood pressure is measured. Sometime people Hypertension is basically of two types’ primary with markedly elevated blood pressure may hypertension and secondary hypertension. The develop headache, dizziness, blurred vision, vast majority of patients with hypertension nausea, vomiting, chest pain, shortness of about 90-95% have primary hypertension in breadth. In chronic high blood pressure which underlying cause is unknown. Secondary commonly found organ damages are heart hypertension in which underlying cause is attack, heart failure, kidney failure, eye known affects a small percentage of patients. damage. (8) Typically hypertension attributed In these cases hypertension causes are known symptoms like dizziness and headache are and medical. The medical reasons behind high more prevalent in hypertensives and are closely blood pressure can be liver, kidney, or heart related to blood pressure levels in untreated and diseases. Apart from these two types other rare treated conditions. (9) types include malignant hypertension, isolated Hypertension is a major risk factor for cardiovascular morbidity and mortality through 1029 Khawaja Tahir Mahmood et al /J. Pharm. Sci. & Res. Vol.3(1), 2011,1029-1034 its effects on target organs like brain, kidney, committee on detection evaluation and heart, and eye. Hypertension causes organ treatment of hypertension recommends thiazide damage by direct physical effects of increase diuretics and beta blockers as first line agents blood pressure as well as active promotion of for hypertension because of risk reductions in atherosclerosis and thrombogenesis. Presence vascular morbidity and mortality. JNC 7 of target organ damage makes a dramatic recommends thiazide diuretics for first line difference to clinical outcomes in hypertension. treatment of hypertension and recommends The target organ effects of hypertension are other drugs like beta blockers ACE inhibitors particularly manifest in heart, brain, kidney, calcium channel blockers if thiazide diuretics peripheral arteries and eyes. Hypertension is are contraindicated. Beta blockers are a progressive cardiovascular syndrome arising recommended in JNC 7 report as first line from complex and interrelated etiologies. Early therapy in patients with compelling indications markers of the syndrome are often present such as ischemia, heart diseases and heart before blood pressure elevation is sustained. failure. (12) Progression is strongly associated with Life style modifications play very important functional and structural cardiac and vascular role in prevention and management of abnormalities that damage the heart, kidneys, hypertension. Studies provide evidence that brain, vasculature, and other organs and lead to reduction in salt intake help in prevention and premature morbidity and death. (10) lowering of blood pressure. Increase physical Different diagnostic methods are used to activity and decrease alcohol intake are also detect high blood pressure. Blood pressure is very effective in reducing blood pressure. Some usually measured by sphygmomanometer. other interventions for reducing high blood Sphygmomanometer or blood pressure guage is pressure includes Stress management, use of an instrument which is used to measurement pill supplementation to increase Potassium, fish blood pressure and detection of hypertension. oils, calcium and magnesium, dietary fibers, Diagnosis of hypertension is usually made after and change in fat ,fatty acids, carbohydrates two or more readings after the first visit. The and protein intake. (13) different methods used for diagnosis of Beta blockers are widely used in the treatment hypertension includes Patient medical history, of hypertension .Beta blockers are still physical examination , electrocardiograph recommended as first line agents by guidelines. (ECG) , chest X-rays, blood and urine tests, Beta blockers are recommended as first line electrocardiography (ultrasonic cardiography), therapy when indicated for example with heart magnetic resonance imaging (MRI), fast failure. For more than 3 decades beta blockers computerized tomography (CT), cholesterol have been widely used in the treatment of and blood sugar levels. (11) hypertension (14). National and international Treatment of hypertension is important because guidelines have promoted beta blockers as it is serious condition that can damage blood being on equal footing with thiazide diuretics, vessels and lead to serious conditions including calcium channel blockers, renin –angiotensin- heart attack, kidney failure, and vision aldosterone system blockers, and angiotensin problems. The management of hypertension receptors blockers. (15) involves pharmacological treatment as well as The sixth report of joint national committee on lifestyle modifications. The goal of detection evaluation and treatment of antihypertensive therapy is to reduce hypertension support diuretics and beta cardiovascular and renal morbidity. The drugs blockers as first line agents for hypertension used for treatment of hypertension includes because of proven reductions in morbidity and thiazide diuretics, beta blockers, angiotensin mortality. Most commonly used beta blockers converting enzyme inhibitors, calcium channel are atenolol, metoprolol, nadolol, propanolol, blockers, angiotensin receptor blockers, timolol. Beta blockers are of two types vasodilators .The sixth report of joint national selective and nonselective beta blockers. 1030 Khawaja Tahir Mahmood et al /J. Pharm. Sci. & Res. Vol.3(1), 2011,1029-1034 Selective beta blockers specifically block beta blockers were associated with high risk of 1 receptors. Nonselective beta blockers block stroke. Beta blockers appear to be less effective both beta 1 and 2 receptors. Evidence suggests in reducing cardiovascular outcomes than that lipophillic beta blockers relatively are best. thiazide diuretics particularly in older Cardio selectivity appears to be advantage for individuals. (21, 22, 23) risk reduction in smokers and also concerning Beta blockers are not effective for blood side effects and quality of life. (16, 17) pressure reduction in treating hypertension in Beta blockers are drugs that bind to beta blacks as they are in whites. The effectiveness adrenergic receptors but do not activate them of beta blockers can be increased by adding thereby block the actions of beta adrenergic thiazide diuretics. (30) agonists. Beta blockers reduce blood pressure Recently questions have been raised regarding very effectively in both systolic and diastolic the safety and effectiveness of beta blockers. hypertension. Beta blockers antagonize the The weaknesses identified include
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