When to Start Medication for High Blood Pressure: A Comparison of ACE Inhibitors and ARBs - Pharmacology

Dr. Xie Weigong reply Pharmacology

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Hello, Miss Shuping: The normal blood pressure for adults is a systolic pressure of less than 130 mmHg and a diastolic pressure of less than 85 mmHg.
Generally, if the systolic pressure is greater than 140 mmHg and the diastolic pressure is greater than 90 mmHg, it may indicate hypertension.
However, a single measurement is not sufficient for diagnosis; the patient should return for at least two measurements spaced one to several weeks apart, and the average of these readings should be used for diagnosis.
If the diastolic pressure is between 85-95 mmHg and the systolic pressure is less than 140 mmHg, blood pressure should be monitored at least once a year to closely supervise blood pressure and implement lifestyle changes to delay or prevent the onset of hypertension.
Such patients rarely require medication.

Conditions for treatment include:
1.
Assessing diastolic pressure:
a.
Above 130 mmHg requires hospitalization.
b.
115-129 mmHg requires immediate treatment.
c.
110-114 mmHg requires treatment.
d.
90-88 mmHg requires treatment under the following conditions:
- Age under 40 with systolic pressure exceeding 160 mmHg.
- Evidence of target organ damage.
- Risk factors for vascular sclerosis.
- Family history of hypertension and vascular sclerosis.
- Blood pressure exceeding 140/85 mmHg during pregnancy.
2.
Determining if secondary hypertension requires surgical treatment.
ENALAPRIL primarily functions as an antihypertensive agent and can prevent congestive heart failure.
It can be used alone as initial therapy or in combination with other antihypertensives, especially diuretics.
The usual dosage range is 10-40 mg daily, taken once or divided into two doses, with a maximum daily dose of 80 mg.
For patients with renal impairment, congestive heart failure, or those currently on diuretics, the initial dose should be reduced.

For essential hypertension, the starting dose depends on the severity of hypertension, typically 10-20 mg once daily.
For renovascular hypertension, the initial dose must be reduced (5 mg or less), with most patients tolerating a single daily dose of 20 mg.
In cases of congestive heart failure, the usual dosage is 10-20 mg daily, taken once or in divided doses.
Side effects are generally mild and temporary, not requiring discontinuation of the medication.
Dizziness and headaches are the most common side effects, with fatigue occurring in 2-3% of patients; other side effects occur in less than 2% of cases, including hypotension, orthostatic hypotension, syncope, nausea, diarrhea, muscle cramps, rash, and cough.
There are occasional reports of renal impairment, renal dysfunction, and oliguria.
Precautions for patients with renal impairment include reducing the dose or frequency of administration.
Some hypertensive patients without significant kidney disease may experience a temporary slight increase in blood urea and serum creatinine levels when ENALAPRIL is given concurrently with diuretics, necessitating a reduction in the dose of ENALAPRIL and/or discontinuation of the diuretic.
COZAAR primarily works by blocking the absorption of angiotensin II in tissues, preventing vasoconstriction and thus treating hypertension.
The initial dosage is 50 mg daily, which should be halved if used with diuretics or in cases of liver dysfunction.
This medication is rapidly absorbed through the gastrointestinal tract, reaching peak plasma concentration within one hour.
Side effects are generally mild, with dizziness being the most common, and there are no significant adverse effects.
Precautions include the potential for increased serum potassium levels.

ENALAPRIL and COZAAR have different mechanisms of action, but their antihypertensive effects are comparable, with COZAAR generally having fewer side effects.

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Reply Date: 2006/11/15