Basis of the Physiological and Pharmacological Treatments - Assignment Example

Heading: Depression Case Study Your name: Course name: Professors’ name: Date Introduction The paper aims at providing some basis of the physiological or biochemical and pharmacological treatments that are available for hypertensive condition of Mr. DC. Moreover, it seeks to examine certain evidence for the treatment interventions for the condition. Lastly, the paper will comment on best practice prescribing for hypertension with reference the aforementioned evidence. Physiological or biochemical treatment of hypertension Many studies indicate that the systolic and diastolic blood pressure can be raised or lowered by normotensives by use of feedback methods. Following earlier investigations, it is explicit that voluntary control can be obtained by hypertensive patients (Mohler 2006, pp. 523-530). This is a method that conditions individuals to enhance their health through the control of various body processes that often happen involuntarily, for instance, breathing and heart rate. This is achieved through the attachment of electrodes on the patients’ skins so as to measure their levels of blood pressure, as a biofeedback physician guides the patients into mental exercises (Llewelyn & Kennedy 2003, pp. 85-90). By trial and error, patients learn to recognize those mental actions that lead to lower blood pressure levels. Notably, this method needs 20 weekly sessions before results are seen. Additionally, the patients can be treated by the autogenic training. This involves teaching the patient on how to coordinate his body and mind in order to have the body relax in reaction to a certain mental action. It comprises of six standard principles that cause the body to relax. The patient can learn the exercises through observation of teacher’s demonstrations, or studying them on their own, then trying them alone many or a few times in a day. According to Molinari, Compare and Parati (2006, pp. 165-170), meditation is another physiological technique that helps in the treatment of hypertension. Besides, transcendental meditation (TM) entails repetition of a phrase or word; mantra while the patient is seated and eyes closed. The practice stresses on deep breathing, muscle relaxation, and an effort to eliminate any distractive thoughts. This can be done alone or in a guided environment, and should be done 20 minutes, twice a day. The aforementioned physiological methods are influential in the regulation of the blood pressure in an individuals’ system. Non-pharmacology interventions Non-pharmacological techniques used in the treatment of hypertension include dietary salt restriction, reduction of alcohol intake, ingestion of low-fat diet or a high-fiber, and more physical activity (Kunnamo & läkaresällskapet 2005, pp. 727-730). These methods are instrumental in the effective regulation of the patients’ blood pressure levels. Pharmacology interventions There are many drugs that can be used in treating high blood pressure among patients. Some of them include calcium channel blockers, rennin-agonists, rennin inhibitors, beta-blockers alpha-blockers and combination medications (Lindsay & Gaw 2004, pp. 121-125). To start with, diuretics are suggested as the initial line of treatment for majority of patients who are hypertensive (Higgins & Green 2005, pp. 5-10). This drug is appropriate of the patients who have developed a resistant hypertension. The use of the drug greatly improves the patients’ blood pressure levels. Moreover, studies indicate that the application of increased diuresis and furosemide imperatively improves the control of blood pressure among the elderly patients whose blood pressure could not be controlled by multidrug. Higgins and Green (2005, pp. 5-10) note that combination therapy is another effective method of treating hypertension among patients. Investigations demonstrated that additive antihypertensive advantage through the combination of two agents of varied categories. For instance, when thiazide diuretics are combined with other agents from other categories, they become more effective in the treatment of high blood pressure (Lip &Felmeden 2004, pp.1-10). However, there is hardly information on the efficacy of combining more than three medicine categories can improve the control of blood pressure of a patient. Additionally, Higgins and Green (2005, pp. 5-10) maintain that the combination of the many drugs should be on designed on an individual by considering prior advantage, adverse events history, contributing factors, which include concomitant sickness process, for instance, diabetes and patient monetary limitations. Moreover, widespread challenge of regulating blood pressure has caused a rise in the treatment algorithms for antihypertensive agents’ prescription; combination and as monotherapy. What is more, Lindsay and Gaw (2004, pp. 121-125) assert that hypertension treatment can be done through the withdrawal of medications that interfere with blood pressure regulation. Some of the drugs that interfere with the normal blood pressure ought to be removed among patients of resistant hypertension. Here, in a situation in which analgesics are essential, acetaminophen can be used instead of NSAIDS in subjects with resistant blood pressure. Nevertheless, it is vital to know that acetamininophen will offer little if any anti-inflammatory advantage. Describe the evidence for the efficacy of typical therapeutic interventions for their condition There are numerous evidence-based reviews on the possible treatment of hypertensive conditions among people. To begin with, there is a review that re-evaluates beta-blockade’s role as a first-line treatment for high blood pressure comparative to every other category of antihypertensive drugs (Wiysonge, Bradley, Mayosi, Maroney, Mbewu, Opie & Volmink 2007, pp. 3-8). In the review, a study’s main objectives included quantification of the impact of beta-adrenergic blocking agents that are used as a first-line therapy or monotherapy on mortality and morbidity in hypertensive adults. Besides, Wiysonge, Bradley, Mayosi, Maroney, Mbewu, Opie and Volmink (2007, pp. 3-8) note that the study is aimed at establishing whether the impact on mortality and morbidity are similar to the other categories of anti-hypertensive medicine. Another objective is to establish whether the use of first-line beta-blocker treatment is related to increased events of detrimental effects in comparison to placebo or other antihypertensive categories. Further, the study aims at determining whether the beta-blockade effects vary by dose and type of beta-blocker, and by age or ethnicity. After the research, the results indicated that beta-blockers are inferior to different calcium channel blockers for all stroke, mortality and absolute cardiovascular events, and rennin-angiotensin system prevention for stroke. Through the comparison of the beta-blockers with other treatments (Galm and Wright 2009, pp. 4-9) managed to demonstrates that beta-blockade is inferior in the reduction of stroke. Besides, Khan and McAlister (2006, pp. 12-15) discovered that beta-blockers are inferior to other treatments on both complex results of main cardiovascular conditioned and stroke for old hypertensive individuals, but did not find any distinction between the in effects with younger patients. Imperatively, the evidence did not clearly indicate whether beta-blockers can be used as first-line medicine in the hypertension therapy. However, presently, beta blockers are usually used as first-line hypertension treatment. The only limitation with this class of drugs is that it is inferior to other classes, such as, calcium blockers, thiazides, and rennin angiotensin system inhibitors. Secondly, there is a review about the use of a new category of antihypertensive drugs, which is Calcium Channel Blockers (CCBs) (Chen, Zhou, Yang, Guo, Zhu, Yang, Wang, Yang & He 2010, pp. 2-10). There is little information on the impact of using the CCBs in high blood pressure therapy. The study’s objective was to establish whether CCBs employed as a first-line drug in the treatment of hypertension vary from other classes of drugs. The strategy used in the study is the Randomized Controlled Trial (RCT) that involved about 100 hypertensive individuals, and a follow up of more than two years. Eligible researches were used in accordance with whether a first-line CCB was comparable to other antihypertensive categories of drugs (Chen, Zhou, Yang, Guo, Zhu, Yang, Wang, Yang & He 2010, pp. 2-10). Results indicated that CCBs can be effectively used as first-line hypertension treatment drugs, as displayed by many studies conducted. According to the author’s conclusion, the studies demonstrated that CCBs do not influence mortality relative to other first-line antihypertensive drug categories. Besides, it was realized that CCBs minimized stroke, cardiovascular mortality and total cardiovascular occurrence in comparison beta-blockers. Additionally, Chen, Zhou, Yang, Guo, Zhu, Yang, Wang, Yang & He (2010, pp. 2-10) argue that first-line CCBs increased congestive heart complication events and total cardiovascular events relative to diuretics. Moreover, first-line CCBs were noted to minimize stroke cases in relation to ARBs and ACE inhibitors. Following these findings, diuretics are preferably used in the decrease of cardiovascular cases. Nevertheless, the review fails to indicate whether the ACE inhibitors, CCBs and ARBs ought to be used as second-line drugs in the treatment of hypertension. Therefore, CCBs are generally used as first-line drugs in the hypertension therapy, but there is insufficient information on whether it can reduce acute cardiovascular cases. Thirdly, there is another review that evaluates the occasional use of alpha-blockers as a hypertension drug. In this study, the main objective is to quantify the dose-related diastolic or systolic blood pressure lowering efficacy of the alpha-blockers as compared to the placebo therapy of basic hypertension (Heran, Galm & Wright 2009, pp. 4-9). In the selection criteria, the randomized, double-blind, controlled attempts assessing the BP lowering efficacy monotherapy and alpha blocker in relation to placebo for 3 to 12 weeks among primary hypertensive patients. According to Wright (2009, pp. 5-7), there is evidence that BP lowering impacts f various categories of antihypertensive drugs cannot always facilitate the decrease in cardiovascular or mortality morbidity. Heran, Galm and Wright (2009, pp. 4-9) also say that alpha blockers are applied as pharmacological agents for hypertension therapy. According to Courtney C H, McCance D R, Atkinson, Bassett, Ennis and Sheridan (2003, pp. 2-7), alpha blockers are broadly used as a second or third prescription, and may be as first-line drugs in the hypertensive individuals with related benign prostatic hyperplasia. Evidently, basing on the reduced number of published RCTs, the BP lowering impact of alpha blockers is self-effacing. There is no medically sensible BP reduction distinction between various alpha blockers. This study never offered a good approximation of the events of harms related to alpha blockers due to short time of trials, and lack of reports on serious impacts on majority of the trials. Therefore, alpha blockers are occasionally applied in the decrease of the elevated BP (Galm and Wright 2009, pp. 4-9). This category includes drugs like doxazosin, prazosin and terazosin. The fourth treatment reviewed is the antiplatelet therapy of hypertension. In this study, the objective is to carry out organized review of the antipletet and anticoagulant’s role in the treatment of the hypertensive cases, and those patients with diastolic and systolic blood pressure, separated diastolic or systolic blood pressure (Lip &Felmeden 2004, pp.1-10). According to the Lip and Felmeden (2004, pp.1-10), for primary treatment in patients with raised BP, antipletet therapy with ASA may not be recommended because the magnitude of advantage, a decrease in myocardial infarction, is canceled by an impairment of the same degree, a rise in main hemorrhage. In the case of secondary therapy of hypertensive patients, the antiplatelet treatment is recommended because the extent of sufficiently assessed in patients with raised BP. The antipletelet drug, aspirin, administered on a daily basis by the patients who are undergoing hypertension therapy, minimizes cases of heart attacks to a low degree, but it raises the events of main bleeding cases to the same extent (Lip &Felmeden 2004, pp.1-10). Aspirin is, thus, not suggested for patients that have not experienced heart attack or stroke. Nevertheless, for those that have suffered heart attack or stroke before should be given a low-dose of aspirin since the advantages outweigh the harms. The use of warfarin alone or when combined with aspirin is impropriate with hypertensive patients. Therefore, attempts with modern medicine glycoprotein IIIa/IIb inhibitors, clopidogrel and ticlopidine are required for hypertensive patients. Best practice prescribing Following the patients’ medical history, medication and the literature reviews, it is vital to determine whether Mr. DC is receiving the appropriate treatment. Explitly, some of the medication that he has received since 2009 includes Lodam SR 200mg bi-daily, Tofranil 50 mg bi-daily, and Imigran 50 mg 100 mg at the start of migraine. This indicates that the patient is taking antidepressant and pain relievers. According to the patient’s present condition, it is evident that he is not receiving an appropriate treatment. Despite the use of Imigran 50 100mg, he occasionally suffers from migraines. Moreover, despite the pain relievers that he is taking, Mr. DC still suffers from back pains and migraines. Additionally, he takes antidepressants, but it seems that the situation is worsening. Furthermore, the patient is being under treated because none of the medications he is undergoing is suitable for the hypertensive, obese and hypercholestrol conditions of the patient. Therefore, the clinicians should administer antipletelet on the patient since he has not suffered heart attack or stroke. Another drug that should be used on Mr. DC is the beta-blockers and CCBs so as to lower his elevated blood pressure (Lip &Felmeden 2004, pp.1-10). Conclusion Mr. DC is a patient suffering from depression, hypertension, high cholesterol level, high blood sugar level, and obesity. Therefore, since the early medication he has undergone does not seem to be working, it is imperative that his health providers consider changing the medication. Moreover, it is vital that they put him under hypertensive therapy so as to reduce cases of cardiovascular complications. Besides, some physiological interventions for hypertension treatment should include biofeedback, autogenic training and meditation. In addition, non-pharmacological interventions that include dietary salt restriction, reduction of alcohol intake, ingestion of low-fat diet or a high-fiber, and increase in physical activity can also be used. References Chen N, Zhou M, Yang M, Guo J, Zhu C, Yang J, Wang Y, Yang X & He L 2010, ‘Calcium channel blockers versus other classes of drugs for hypertension’, Cochrane Database of Systematic Reviews, vol. 4, no.8, pp. 2-10. CD003654. DOI: 10.1002/14651858.CD003654. Courtney C H, McCance D R, Atkinson A B, Bassett J, Ennis C N & Sheridan B 2003, ‘Effect of the alpha-adrenergic blocker, doxazosin, on endothelial function and insulin action’, Metabolism: clinical and experimental, vol. 2, no. 9, pp. 2-7. Heran BS, Galm BP & Wright JM 2009, ‘Blood pressure lowering efficacy of alpha blockers for primary hypertension’, Cochrane Database of Systematic Reviews, vol. 2.no. 4, pp. 4-9. CD004643. DOI: 10.1002/14651858.CD004643. Higgins JPT& Green S 2005, ‘Cochrane Handbook for Systematic Reviews of Interventions 4.2.5 [updated May 2005]’, The Cochrane Library, vol.2, no.3, pp. 5-10. Khan N & McAlister FA 2006, ‘Re-examining the efficacy of [beta]-blockers for the treatment of hypertension: a meta-analysis’, CMAJ, vol.174, no. 4, pp. 12-15. Kunnamo, I & läkaresällskapet, F 2005, Evidence-based medicine guidelines, Duodecim Medical Publications John Wiley & Sons, Helsinki, Finland Chichester, West Sussex, England Hoboken, NJ, USA. pp. 727-730. Lindsay, GM & Gaw A 2004, Coronary heart disease prevention: a handbook for the health-care team, Churchill Livingstone, Edinburgh New York. pp. 121-125 Lip GYH &Felmeden, DC 2004, ‘Antiplatelet agents and anticoagulants for hypertension’, Cochrane Database of Systematic Reviews, vol.2 no.2, pp. 1-10. CD003186. DOI: 10.1002/14651858.CD003186. Llewelyn, S & Kennedy, P 2003, Handbook of clinical health psychology, J. Wiley, Chichester, West Sussex, England Hoboken, NJ. pp. 85-90. Mohler, ER 2006, Advanced therapy in hypertension and vascular disease, B.C. Decker, Hamilton, Ont. pp. 523-530. Molinari, E, Compare, A & Parati, G 2006, Clinical psychology and heart disease, Springer, New York. pp. 165-170. Wiysonge CSU, Bradley HA, Mayosi BM, Maroney RT, Mbewu A, Opie L & Volmink J 2007, ‘Beta-blockers for hypertension’, Cochrane Database of Systematic Reviews, vol.2, no. 1, pp. 3-8. CD002003. DOI: 10.1002/14651858.CD002003. Wright J M & Musini V M 2009, ‘First-line drugs for hypertension’, Cochrane Database of Systematic Reviews, vol.8, no.3, pp. 5-7. Read More