Learn About Your Heart...
Made Simple


By Nicolas Shammas, MD


A new, comprehensive sourcebook for
heart and vascular disease patients

Cardiovascular Health Topics



1.
Statistics about Heart and Blood Vessel Diseases in the United States
2.
Structure and Function of the Heart and Blood Vessels
3.
Diseases of the Blood Vessels of the Heart
4.
Surgical Therapies for the Cardiovascular Patient
5.
Peripheral Vascular Disease
6.
Diseases of the Blood Vessels of the Head and Neck
7.
Strokes: How to Survive Them and How to Prevent Them
8.
Valvular Heart Disease
9.
Heart Rhythms: How to Recognize Them and Treat Them
10.
Congestive Heart Failure
11. Understanding Cardiomyopathy, or Weak Heart Muscle
12. Children and Heart Disease
13. Diseases of the Pericardium
14. Systemic Illnesses, Infections and Drugs that Affect the Heart
15. Erectile Dysfunction: a Vascular Disease
16. Cardiovascular Disease Prevention
17. Heart Healthy Nutritional Tips
18. Cardiac Rehabilitation
19. Medications for Cardiovascular Disorders
20. Heart Tests You Need to Know
21. Learn What to Do in a Medical Emergency
22. How to Choose Your Doctor and Hospital
23. Medical Research and How You Can Get Involved
24. Taking the Next Step — A Few Community Resources to Help You Live More Healthfully
25. How Much Did You Learn from This Book: Take a Simple Test



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:

  1. Diuretic drugs

  2. Beta-blockers

  3. Calcium channel blockers

  4. ACE inhibitors

  5. Alpha-blockers

  6. Angiotensin II receptor blockers (ARBs)

  7. Centrally acting drugs

  8. 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 160or 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


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