WHAT IS HYPERTENTIONWHAT IS HYPERTENTION

HYPERTENTIONHYPERTENTION

High blood pressure (HBP)or High blood pressure (HBP)or hypertension means high pressure hypertension means high pressure (tension) in the arteries(tension) in the arteries. .

High blood pressure does not mean High blood pressure does not mean excessive emotional tension, although excessive emotional tension, although emotional tension and stress can emotional tension and stress can temporarily increase blood pressuretemporarily increase blood pressure..

RANGES OF BLOOD RANGES OF BLOOD PRESSUREPRESSURE

Normal blood pressure is below Normal blood pressure is below 120/80.120/80.

Blood pressure between 120/80 and Blood pressure between 120/80 and 139/89 is called pre-hypertension.139/89 is called pre-hypertension.

Blood pressure of 140/90 or above is Blood pressure of 140/90 or above is considered High Blood Pressure.considered High Blood Pressure.

EFFECTS OF EFFECTS OF HYPERTENTIONHYPERTENTION

Coronary artery dieasesCoronary artery dieases

Left ventricular hypertrophy Left ventricular hypertrophy

Acute myocardial infarction Acute myocardial infarction

Cerebral hemorrhage Cerebral hemorrhage

HYPERTENTION TREATMENTHYPERTENTION TREATMENT

Calcium Channel BlockersCalcium Channel Blockers

ACE InhibitorsACE Inhibitors

Angiotensin II Receptors Blockers (ARB) Angiotensin II Receptors Blockers (ARB)

Beta BlockersBeta Blockers

Diuretics Diuretics

Direct Renin InhibitorsDirect Renin Inhibitors

CALCIUM CHANNEL BLOCKER’SCALCIUM CHANNEL BLOCKER’S

BRAND BRAND NAMENAME

GENERIC GENERIC NAMENAME

COMPANYCOMPANY AVAILBILTAVAILBILTYY

PRICPRICEE

ADALATADALAT NifedipineNifedipine BayerBayer 10mg 10mg 20mg 20mg

3.56 3.56 4.904.90

NORVASCNORVASC AmlodipineAmlodipine PfizerPfizer 5mg 5mg 10mg10mg

11.92 11.92 23.3323.33

HERBESSERHERBESSER DiltiazemDiltiazem HighnoonHighnoon 30mg 30mg 60mg 60mg SR 90mg SR 90mg SR 180mg SR 180mg

3.78 3.78 6.88 6.88 13 13 2424

CALAN SRCALAN SR VerapamilVerapamil SEARLESEARLE 240mg SR240mg SR 77

ACE INHIBITOR’SACE INHIBITOR’S

BRAND BRAND NAMENAME

GENERIC GENERIC NAMENAME

COMPANCOMPANYY

AVAILBILTAVAILBILTYY

PRICPRICEE

CAPOTENCAPOTEN CaptoprilCaptopril B-MSB-MS 25mg 25mg 50mg 50mg

6.67 6.67 1313

RENITECRENITEC EnalaprilEnalapril MSDMSD 5mg 5mg 10mg 10mg 20MG20MG

5 5 9.23 9.23 18 18

ZESTRILZESTRIL LisinoprilLisinopril ICIICI 5mg 5mg 10mg 10mg 20mg20mg

5.47 5.47 10.73 10.73 21 21

COVERSYLCOVERSYL PerindoprilPerindopril SERVIERSERVIER 2mg 2mg 4mg 4mg 8mg 8mg

9.90 9.90 14.90 14.90 23.523.5

BETA BLOCKER’SBETA BLOCKER’S

BRAND BRAND NAMENAME

GENERIC GENERIC NAMENAME

COMPANCOMPANYY

AVAILBILTAVAILBILTYY

PRICPRICEE

MEPRESORMEPRESOR MetoprololMetoprolol NovartisNovartis 100mg 100mg 6.25 6.25

TENORMINTENORMIN AtenololAtenolol ICIICI 25 mg 25 mg 50mg 50mg 100mg100mg

55

66

99

CONCORCONCOR BisoprololBisoprolol MerckMerck 2.5mg 2.5mg 5mg 5mg 10mg 10mg

4.29 4.29 9.37 9.37 17.47 17.47

CARLOVCARLOV CarvedilolCarvedilol HiltonHilton 6.25mg 6.25mg 12.5mg 12.5mg 25mg25mg

5.5 5.5 8.5 8.5 14.514.5

ANGIOTENSIN II RECEPTOR ANGIOTENSIN II RECEPTOR BLOCKER’SBLOCKER’S

BRAND BRAND NAMENAME

GENERIC GENERIC NAMENAME

COMPANCOMPANYY

AVAILBILTAVAILBILTYY

PRICPRICEE

COZAARCOZAAR Losartan potassiumLosartan potassium MSDMSD 50mg 50mg 100mg 100mg

51.67 51.67 8080

DIOVANDIOVAN ValsartanValsartan NovartisNovartis 80mg 80mg 160mg160mg

37.64 37.64 5757

ADVANTADVANT CandesartanCandesartan GetzGetz 8mg 8mg 16mg 16mg

11 11 20 20

OMSANAOMSANA OlmesartanOlmesartan HiltonHilton 20mg 20mg 40mg40mg

16 16 2828

DIURETICSDIURETICS

BRAND BRAND NAMENAME

GENERIC GENERIC NAMENAME

COMPANCOMPANYY

AVAILBILTAVAILBILTYY

PRICPRICEE

ALDACTONEALDACTONE SpironolactoneSpironolactone SearleSearle 25mg 25mg 100mg 100mg

1.5 1.5 7.7 7.7

LASIXLASIX FrusemideFrusemide Sanofi Sanofi AventisAventis

20mg 20mg 40mg 40mg InjInj

1 1 1.65 1.65 55

LASORIDELASORIDE Frusemide/ Frusemide/ AmilorideAmiloride

Sanofi Sanofi AventisAventis

40mg/ 5mg 40mg/ 5mg 3.323.32

SPIROMIDESPIROMIDE Spironolactone/ Spironolactone/ FrusemideFrusemide

SEARLESEARLE 20mg 20mg 40mg40mg

3.73.7

5.245.24

DIRECT RENIN INHIBITOR’SDIRECT RENIN INHIBITOR’S

BRAND BRAND NAMENAME

GENERIC GENERIC NAMENAME

COMPANCOMPANYY

AVAILBILTAVAILBILTYY

PRICPRICEE

RAZILESRAZILES AlkesrinAlkesrin NovartisNovartis 150mg 150mg 300mg 300mg

70 70 120120

BRITISH HYPERTENTION BRITISH HYPERTENTION SOCIETYSOCIETY

BHS says that for the treatment of BHS says that for the treatment of hypertension hypertension

CCB,s ARB,s ACEI,s and Diuretics are CCB,s ARB,s ACEI,s and Diuretics are first line treatment where as BB,s are first line treatment where as BB,s are demoted on the last option due to demoted on the last option due to 28% onset of diabetes in young 28% onset of diabetes in young hypertensive patients.hypertensive patients.

ALL CLINICAL DATA ALL CLINICAL DATA SUGGESTSSUGGESTS At least II drugs are require to achieve the At least II drugs are require to achieve the

goal.goal.

Previously the combination's are used for Previously the combination's are used for hypertension hypertension

A+B C+D A+B C+D

Now A+C A+D Now A+C A+D

KYOTO HEART STUDYKYOTO HEART STUDY

Background:Background: Effects of Valsartan on morbidity andEffects of Valsartan on morbidity and

mortalitymortality in uncontrolled hypertensive in uncontrolled hypertensive patients with high cardiovascular risks.patients with high cardiovascular risks.

Objective:Objective: The objective was to assess the add-on The objective was to assess the add-on

effect of Valsartan on top of conventional effect of Valsartan on top of conventional treatment for high-risk hypertension in treatment for high-risk hypertension in terms of the morbidity and mortality.terms of the morbidity and mortality.

Methods:Methods: It was a multicentre, ProspectiveIt was a multicentre, Prospective Randomised Open Blinded Randomised Open Blinded

Endpoint (PROBE) design study.Endpoint (PROBE) design study. 3031 patients (43% female age 66) with uncontrolled 3031 patients (43% female age 66) with uncontrolled

hypertension.hypertension.

Treatment:Treatment: Valsartan or non ARB for 3.27 years. Baseline blood Valsartan or non ARB for 3.27 years. Baseline blood

pressure was 157/88 and at the end was 133/76. pressure was 157/88 and at the end was 133/76.

Conclusion:Conclusion: Valsartan add-on treatment to improve blood pressure Valsartan add-on treatment to improve blood pressure

control prevented more cardiovascular events than control prevented more cardiovascular events than conventional non ARB treatment in high risk hypertensive conventional non ARB treatment in high risk hypertensive patients.patients.

EXTOR (EXTOR (Amlodipine / Valsartan)Amlodipine / Valsartan)

FDA has approved Extor is first line FDA has approved Extor is first line treatment for stage II hypertensive treatment for stage II hypertensive patients.patients.

80% of patients are not on goal with 80% of patients are not on goal with monotherapy.monotherapy.

Extor also improves CV out comes.Extor also improves CV out comes. Extor is a need of every hypertensive Extor is a need of every hypertensive

which further reduce complications.which further reduce complications.