MEDICATIONS FOR CARDIOVASCULAR DISORDERS
Nidal Harb, MD, FACC, FACP
What are the types of heart disease medications?
Since 1919, cardiovascular disease has been the number 1 killer in the United States. It claims the lives of more than 40% of Americans. Worldwide, more than half of the population suffers from complications of atherosclerosis or hardening of the arteries.
Over the past 25 years, there has been tremendous progress in the way we treat heart disease. This includes the development of new procedures and techniques to treat cardiovascular diseases. A major advance in the last century was the development of newer cardiac medications.
This chapter will discuss information about medications that are used to treat many aspects of heart disease. This chapter will provide you with useful information about medications that you may be taking as well as potential alternatives. Certainly, this book is not intended to tell you which, if any, medication is best for you, since only your physician can determine this after appropriate evaluation.
These medications usually have 2 names: a brand name and a generic name. Brand names may differ from company to company depending on the pharmaceutical manufacturer. All medications with the same chemical structure, however, share the same generic names. Due to Food and Drug Administration (FDA) regulations in the United States, brand and generic name medications should be equal in effectiveness and safety. Sometimes, the tablets may differ in size or color due to the inactive substance that is usually added to the medications. Your physician may allow the use of generic medications; however, please keep in mind that not all brand names have or could be obtained generically because of the patent protection law in the United States.
Once medication is taken, it is absorbed in the stomach or gut and then processed in the liver and eventually eliminated from the body either through the kidney or through the liver. In order to obtain a certain level of medication in the body, the drug has to be taken on a certain schedule depending on the medications used. Some of those medications have a special delivery system, which makes it long acting.
On many occasions, each medicine has different indications. Your doctor will individualize treatment based on your specific problems. Each medication may be used for several different medical problems.
This chapter will discuss lipid-lowering medications and medications for the treatment of heart failure, high blood pressure, arrhythmia disorder, coronary artery disease, and heart attacks, in addition to other vascular problems.
Antihypertensive medications
Over the past 50 years, there has been a significant drop in the incidence of heart attacks and strokes. A main reason for this drop is the development of newer medications to treat high blood pressure.Today, there are more than 100 different medications that can be used to treat this ailment.A combination of different drugs also can be utilized.
The most commonly used drugs are:
Diuretic drugs
Beta-blockers
Calcium channel blockers
ACE inhibitors
Alpha-blockers
Angiotensin II receptor blockers (ARBs)
Centrally acting drugs
Other antihypertensive medications.
Beta-blockers, ACE inhibitors, ARBs, calcium channel blockers, and diuretics are the most commonly used medications. Less frequently used are centrally acting drugs, alpha-blockers, and other drugs, including hydralazine and minoxidil.
Most antihypertensive medications reduce high blood pressure by relaxing the vessel wall and thus increasing the diameter of the vessel. Others may reduce the force with which the heart pumps the blood. Diuretics will cause increased urine output, which will result in reduced volume of blood present in the circulation.
BLOOD PRESSURE MEASUREMENT TECHNIQUES
| Method | Notes |
| In-office | Two readings, 5 minutes apart, sitting in chair; confirm elevated reading in contralateral arm |
| Ambulatory blood pressure monitoring | Indicated for evaluation of "white coat hypertension;" absence of 10–20% blood pressure decrease during sleep may indicate increased cardiovascular disease risk |
| Patient self-check | Provides information on response to therapy; may help improve adherence to therapy and is useful for evaluating "white coat hypertension" |
CLASSIFICATION OF BLOOD PRESSURE (BP)
| Category | SBP mmHg |
| DBP mmHg |
| Normal | < 120 | and | < 80 |
| Prehypertension | 120–139 | or | 80–89 |
| Hypertension, stage I | 140–159 | or | 90–99 |
| Hypertension, stage 2 | 160 | or | 100 |
SBP = Systolic blood pressure
DBP = Diastolic blood pressure |
Principles of lifestyle modification
Lifestyle modification plays an important role in the prevention and treatment of heart disease.To promote lifestyle modification, your doctor will:
Encourage healthy lifestyles for all individuals
Prescribe lifestyle modifications for all patients with prehypertension and hypertension
Support the components of lifestyle modifications, which include weight reduction, the DASH eating plan, dietary sodium restriction, aerobic physical activity, and moderation of alcohol consumption.
LIFESTYLE MODIFICATION RECOMMENDATIONS
| Modification | Recommendation | Avg SBP Reduction† |
| Weight reduction | Maintain normal body weight (body mass index 18.5–24.9 kg/m2) | 5–20 mmHg/10 kg |
| DASH eating plan | Adopt a diet rich in fruits, vegetables, and low-fat dairy products with reduced content of saturated and total fat | 8–14 mmHg |
| Dietary sodium reduction | Reduce dietary sodium intake to 2.4 g sodium or 6 g sodium chloride | 2–8 mmHg |
| Aerobic physical activity | Regular aerobic physical activity (such as brisk walking) at least 30 minutes per day, most days of the week | 4–9 mmHg |
| Moderation of alcohol consumption | Men: Limit to 2 drinks* per day. Women and lighter weight persons: Limit to 1 drink* per day | 2–4 mmHg |
*1 drink = ½ oz or 15 mL ethanol (such as 12 oz beer, 5 oz wine, 1.5 oz 80-proof whiskey)
†Effects are dose and time dependent |
