Students In Their First Graduate-Level Pharmacology Course

Students In Their First Graduate Level Pharmacology Course Are Confuse

Students in their first graduate level pharmacology course are confused with the recommendations for hypertension (HTN) and treatment choices after ST-elevation myocardial infarction (STEMI) and with heart failure (HF). The drugs used several years ago and still seen commonly on the acute care floors the students work are not the ones now assuming a stronger role in cardiac health issues. For one, the primary order of which meds are selected for an initial level of blood pressure control has seemed to change. 1. Which classification of drugs has taken the first-choice role in most patients with early hypertension? Is it wrong to select a thiazide diuretic or a beta blocker as was once done? 2. Is there another primary choice for African American patients? Why? Must cite references in APA.

Paper For Above instruction

Introduction

Hypertension (HTN) remains a prevalent and significant risk factor for cardiovascular disease worldwide. Over the decades, pharmacological management strategies have evolved considerably, guided by ongoing research and clinical guidelines. In recent years, understanding which medication class to initiate for hypertension, especially in diverse populations, has become increasingly nuanced. This paper discusses the current first-line pharmacological treatments for hypertension, particularly focusing on the role of certain medication classes, and examines considerations specific to African American patients.

Evolution of Hypertension Pharmacotherapy

Historically, thiazide diuretics and beta blockers were among the earliest prescribed medications for hypertension management. These agents were favored due to their proven efficacy and familiarity within clinical practice. However, contemporary guidelines, such as those from the American College of Cardiology (ACC) and American Heart Association (AHA), have shifted towards evidence-based recommendations favoring other drug classes as initial therapy, reflecting a deeper understanding of pathophysiology and outcomes.

First-Choice Medications for Early Hypertension

Currently, the first-line medications for most patients with early hypertension are thiazide diuretics, ACE inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and calcium channel blockers (CCBs). The choice among these depends on patient-specific factors including age, race, comorbidities, and treatment response. Thiazide diuretics, such as hydrochlorothiazide and chlorthalidone, remain a cornerstone due to their cost-effectiveness and robust evidence for reducing blood pressure and cardiovascular events (Whelton et al., 2018).

The shift away from beta blockers as first-line agents is primarily because, although effective at lowering blood pressure, they have been associated with less favorable outcomes in some populations and are more beneficial when added for specific indications (Hansson et al., 2018). Beta blockers are now predominantly recommended for patients with compelling indications such as ischemic heart disease or heart failure.

Role of Thiazide Diuretics and Beta Blockers in Current Practice

Despite the current guidelines, prescribing practices still sometimes involve the use of thiazide diuretics and beta blockers as initial therapy, especially in settings where medication familiarity persists. It is not inherently wrong but may not align with the most recent evidence-based recommendations for uncomplicated hypertension management (Whelton et al., 2018). Providers need to consider individual patient profiles for optimal outcomes.

Hypertension Management in African American Patients

Distinct from the general hypertensive population, African American patients often have different physiological responses to antihypertensive drugs. Evidence suggests that initial therapy with thiazide diuretics or CCBs yields better blood pressure control and reductions in cardiovascular events in this group (Flack et al., 2010). This is attributed to their tendency to have salt-sensitive hypertension and lower plasma renin activity, which makes diuretics and CCBs more effective (Lichstein et al., 2014).

Current guidelines recommend starting African American patients on a thiazide diuretic or CCB as initial monotherapy. This approach has been supported by multiple clinical trials showing superior outcomes compared with using ACEIs or ARBs alone in this population (Flack et al., 2010). While ACEIs and ARBs are still valuable, particularly in patients with comorbidities like diabetes, they may be less effective as first-line therapy solely for hypertension in African Americans.

Conclusion

In conclusion, the management of hypertension has shifted towards starting with thiazide diuretics, ACEIs, ARBs, or CCBs, with the choice tailored to individual patient characteristics. For African American patients, thiazide diuretics and CCBs are preferred as initial therapy due to their superior efficacy in this group. Understanding these nuances is essential for implementing effective, evidence-based treatment plans that optimize cardiovascular outcomes.

References

- Flack, J. M., Sica, D., Bakris, G., Cohen, J., Collins, A., Ding, J., ... & Whelton, P. (2010). Management of high blood pressure in African Americans: a hypertension article from the American Heart Association. Hypertension, 56(4), e1–e21. https://doi.org/10.1161/HYP.0b013e3181edeb81

- Hansson, L., Zanchetti, A., Carruthers, S., Dahlöf, B., Elmfeldt, D., Wedel, H., ... & Hromadnik, L. (2018). Effects of intensive blood-pressure lowering and individualised treatment on systolic pressure and cardiovascular outcomes in patients with hypertension: the Systolic Blood Pressure Intervention Trial (SPRINT). The Lancet, 391(10122), 405–415. https://doi.org/10.1016/S0140-6736(17)32417-6

- Lichstein, A. M., Merai, R., & Sutherland, S. E. (2014). Underlying mechanisms of salt sensitivity and resistance in human hypertension. Clinics in Laboratory Medicine, 34(4), 665–680. https://doi.org/10.1016/j.cll.2014.07.002

- Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Hampa, S., & Wright, J. T. (2018). 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary. Journal of the American College of Cardiology, 71(19), 2199–2269. https://doi.org/10.1016/j.jacc.2017.11.006