Goals of Drug Therapy for Hypertension and Antihypertensive Treatment

Question
Describe the goals of drug therapy for hypertension and the different antihypertensive treatment. 
Describe types of arrhythmias and their treatment
Discuss Atrial Fibrillation
Discuss types of anemia, causes, symptoms, and treatment options

Answer
Goals of Drug Therapy for Hypertension and Antihypertensive Treatment Types of Arrhythmias and Their Treatment Atrial Fibrillation Types of Anemia, Causes, Symptoms, and Treatment Options
1. Goals of Drug Therapy for Hypertension
Lowering blood pressure with drug therapy in a patient with hypertension is unequivocally beneficial. For every 10 mmHg reduction in mean systolic blood pressure, there is a 40% reduction in the rate of fatal stroke and a 15% reduction in the rate of coronary heart disease and other vascular diseases. These are the findings from a meta-analysis of over 60 hypertension trials. The benefits of reducing diastolic pressure are very similar to those of reducing systolic pressure, and in relative terms, the effects of antihypertensive drug treatment are similar in the elderly and the middle-aged. Available data do not show a clear threshold below which lower blood pressure no longer has benefit, so it is best to achieve the greatest reduction possible, especially considering the variety of antihypertensive agents currently available.
Drug therapy for hypertension has as its primary goal the achievement of a blood pressure level that reduces the risk of adverse cardiovascular events and target organ damage. The delay in progression of hypertension to a level that requires polypharmacy to control or the prevention of established hypertension from getting worse are additional important goals. So the ultimate objective in hypertensive patients is control. Control of blood pressure from an elevated level to a lower level is the major determinant of reduced morbidity and mortality. The specific goals of drug therapy occur within the broader framework of lowering blood pressure, reducing cardiovascular risk, and preventing target organ damage.
1.1. Lowering Blood Pressure
Objective is to perusing this issue is to lower the blood pressure to solve the problem of hypertension. Hypertension is cured by reducing elevated blood pressure, preventing its associated cardiovascular complications, and decreasing resultant morbidity and mortality. To achieve it is to resolve the problem of hypertension. Situation where patients easily get back to their primary condition before treatment due to they stop consume medicine. This condition will not with immediate result, but requires persistent changes of lifestyle and pharmacological treatment for years. Lifestyle modification include weight reduction, high regular aerobic exercise, alcohol reduction, sodium intake reduction, and maintain diet based on DASH (Diet Approach to Stop Hypertension). But this modification has limitations, because it will show the result if done in massive level and takes a long time, so it will not compatible if combined with drug therapy. Pharmacological treatment will base on administration of antihypertensive drugs with various classes, started from the cheapest one, effective, and safe with minimal side effects for long term use. So it tailored to what patients need and can be monitored. Given the J-shaped association between diastolic blood pressure and cardiovascular and renal disease, and fixed small risks of antihypertensive drug treatment, drug therapy is recommended for all patients with stage 1 hypertension and higher. For patients with prehypertension and diabetes, the decision to use drug therapy depends on an assessment of total cardiovascular risk, with drug therapy recommended for high risk patients. This recommendation applies not only to the elderly, but also to older adults with isolated systolic hypertension. Role of antihypertensive drug is to lower the blood pressure, but current evidence also supported the different classes of antihypertensive drug to prevent cardiovascular complication which independent from its blood pressure lowering effect. This unique effect is very favorable for hypertensive patients.
1.2. Reducing Cardiovascular Risk
That’s why risk reduction can be seen as simplifying hypertension-related goals. High blood pressure is oftentimes associated with diabetes and dyslipidemia, and addressing these conditions can have a two-fold benefit. Nevertheless, it is important to remember that if these are not severe and there are no obvious associated target organ damages, it may be more appropriate to change lifestyle and monitor the patient while treating the blood pressure. Nevertheless, if judged to be severe or at high risk of progressing, then drug treatment would be associated with improved prognosis.
Cardiovascular risk is greatly increased when a person has high blood pressure. However, in most cases, it is more efficient to treat the blood pressure itself rather than trying to separately treat the cardiovascular risk. In some cases, the risk may need treating independently, and the best way of identifying these patients is understanding which other risk factors are present and whether these are reversible and can be influenced by drug treatment.
1.3. Preventing Target Organ Damage
Preventing target organ damage: Hypertension, if not controlled, can lead to a number of complications as a result of target organ damage. Organ damage can occur because of ischemia. This is the inadequate supply of blood and oxygen to a particular organ. Ischemia as a result of hypertension is caused by arteriolosclerosis and it can lead to left ventricular hypertrophy, myocardial infarction, heart failure, aneurysm or peripheral arterial disease. Hypertension can cause damage to the heart in a number of ways. It is a major risk factor for diseases of the arteries and the most common cause of aneurysm. High blood pressure can also lead to left ventricular hypertrophy, in which the muscle of the left ventricle is thickened, which can cause heart failure, and also a heart attack. Hypertension is a major contributor to chronic kidney disease. It can cause damage to the small blood vessels in the kidneys and lead to glomerular sclerosis. This is the hardening of the glomerulus, which is the site in the kidney where the blood is filtered. It can ultimately lead to end-stage renal failure. High blood pressure is the most important risk factor for stroke. It can lead to impaired brain function and a major risk factor for dementia. High blood pressure has shown to be an important risk factor in the pathogenesis of retinopathy and macular degeneration. Preventing target organ damage means treating or even reversing the harmful changes that have occurred in the major organs of the body. It is the most important goal in treating patients with hypertension. In a number of the clinical trials, it has been the prevention of target organ damage in which have been the primary end-point. This is because the prognosis and quality of life for patients with diseases due to target organ damage can be very poor and anything that can prevent this would be a great achievement. An example of this is in the Systolic Hypertension in the Elderly Program (SHEP) trial, in which older patients were treated with chlorthalidone to try and prevent stroke. This was found to be successful and the risk of stroke was reduced by 36% in non-diabetic patients and 51% in diabetic patients.
2. Antihypertensive Treatment
2.1. Lifestyle Modifications
2.1.1. Dietary Changes
2.1.2. Regular Exercise
2.1.3. Weight Loss
2.2. Medications
2.2.1. Diuretics
2.2.2. Beta Blockers
2.2.3. Calcium Channel Blockers
2.2.4. Angiotensin-Converting Enzyme (ACE) Inhibitors
2.2.5. Angiotensin II Receptor Blockers (ARBs)
2.2.6. Renin Inhibitors
2.2.7. Alpha Blockers
2.2.8. Central Agonists
2.2.9. Vasodilators
2.2.10. Combination Therapy
1. Types of Arrhythmias
1.1. Atrial Fibrillation
1.2. Ventricular Tachycardia
1.3. Atrial Flutter
1.4. Supraventricular Tachycardia
1.5. Bradycardia
2. Treatment of Arrhythmias
2.1. Medications
2.1.1. Antiarrhythmic Drugs
2.1.2. Beta Blockers
2.1.3. Calcium Channel Blockers
2.1.4. Digoxin
2.2. Electrical Cardioversion
2.3. Catheter Ablation
2.4. Implantable Devices
2.4.1. Pacemakers
2.4.2. Implantable Cardioverter-Defibrillators (ICDs)
2.4.3. Cardiac Resynchronization Therapy (CRT)
2.5. Surgical Interventions
1. Introduction to Atrial Fibrillation
2. Causes and Risk Factors
3. Signs and Symptoms
4. Diagnosis of Atrial Fibrillation
5. Treatment Options
5.1. Rate Control
5.2. Rhythm Control
5.3. Anticoagulation Therapy
5.3.1. Warfarin
5.3.2. Direct Oral Anticoagulants (DOACs)
5.4. Catheter Ablation
5.5. Surgical Procedures
5.5.1. Maze Procedure
5.5.2. Pulmonary Vein Isolation
5.6. Lifestyle Modifications
5.7. Follow-up and Monitoring
1. Introduction to Anemia
2. Types of Anemia
2.1. Iron-Deficiency Anemia
2.2. Vitamin B12 Deficiency Anemia
2.3. Folate Deficiency Anemia
2.4. Hemolytic Anemia
2.5. Aplastic Anemia
3. Causes of Anemia
3.1. Nutritional Deficiencies
3.2. Chronic Diseases
3.3. Genetic Disorders
3.4. Bone Marrow Disorders
4. Symptoms of Anemia
4.1. Fatigue
4.2. Weakness
4.3. Shortness of Breath
4.4. Pale Skin
5. Treatment Options for Anemia
5.1. Iron Supplements
5.2. Vitamin B12 Injections
5.3. Folic Acid Supplements
5.4. Blood Transfusion
5.5. Bone Marrow Transplantation