Nowadays, the problem of hypertension is highly topical in connection with its wide occurrence and an obvious tendency to the increase in the incidence. The hypertension is caused by the primary disorder in the neurohumoral regulation of vascular tone. Today, everyone is well aware of the fact that hypertension is not a fully curable disease, and the use of antihypertensive drugs by courses is highly undesirable since their withdrawals can lead to an exacerbation of the disease. Disorders of arterial pressure are considered adult diseases; however, quite often it occurs in children. Therefore, it is very important to recognize its symptoms and to implement the necessary treatment. For this, it is important to understand pathophysiological risk factors, possible consequences, and treatment modalities to eliminate or avoid adverse consequences.
Physiopathology of the Condition
The pathogenesis of hypertension is complicated and it has not been fully studied thus far. It is known that in case of dysfunction of the tone of peripheral vessels, a favorable environment is created for the formation of hypertensive disease (Samuel, 2017). It happens because deformed blood vessels cannot ensure the regulation of metabolism. In particular, the spinal bulb and hypothalamus cease to function properly because of the impaired work of these organs. The chain continues in the arterioles, which respond to the minute release of blood from the heart. Thus, the pressure in the internal organs is increased because the arteries do not dilate. Furthermore, with an increase in blood pressure in the kidneys, the body begins to actively produce renin. This hormone enters the bloodstream, where it begins to interact with the most powerful substance angiotensinogen.
The pathologys primary risk factor is the neuropsychic overstrain of higher nervous activity that occurs due to emotional influences. In recent years, the correlation between the level of blood pressure and content of sodium urethic hormone in blood plasma, personal and psychological characteristics of patients, especially in young people, are considered to have a paramount importance (Gordeuk, Castro, & Machado, 2016). The viscosity of blood and its mass are important for the capacity for the bloodstream and expansion. In addition, a major role in the development of the disease belongs to adrenal glands, which are involved in the regulation of the myogenic and vasomotor components of vascular tone in primary hypertension. However, in addition to causative factors, conditions predisposing to the development of this disease also play an important role.
These conditions include numerous factors such as heredity, excessive consumption of salt, professional activity associated with severe and frequent neuropsychic overloads, overweight, age-related changes, excessive use of alcohol, kidney failure, and some others. For example, if a person has a metabolic syndrome, then most likely one has an increased amount of insulin circulating in ones blood (Gordeuk, Castro, & Machado, 2016). Because of this, the diameter of the blood vessels narrows and the body retains too much water and sodium. Thus, the blood pressure is kept chronically elevated. The results of numerous studies indicate that this disease is characterized by high blood pressure, which often exceeds 140/90 (Samuel, 2017). Ultimately, high blood pressure is observed in all people who often experience a vasospasm. In infants and children younger than 6 years, hypertension is often triggered by stenosis, thrombosis of the renal arteries, as well as their anomalies.
In the initial stages of hypertensions development, clinical aspects are not manifested clearly. The patient may be not aware of the increase in blood pressure for a long time. However, during this period, a person may already start experiencing such nonspecific complaints as rapid fatigability and irritability. In addition, at the early stages, patients complain of neurotic disorders. Thus, they are disturbed by general weakness, performance decrement, inability to focus on work, insomnia, transient headaches, heaviness in the head, dizziness, noise in the ears, and some other symptoms (Garimella & Uhlig, 2014). Later, many patients may suffer from shortness of breath when exercising.
Furthermore, hypertension often leads to the heart pain, caused by the increase of blood pressure, which is associated with intensified heart function. Thus, hypertrophy results in a dissociation between the needs and capabilities of the myocardium, which is clinically manifested by angina pectoris (Samuel, 2017). In addition to angina pectoris, other manifestations include cardiac pain, floaters, visual blurs, and flashing lightning may appear. Besides, patients often suffer from central nervous system disorders, which can be manifested by pseudo-neurotic syndrome such as rapid fatigability, performance decrement, memory loss, signs of irritability, weakness, etc. (Acton, 2013). However, many individuals do not experience any unpleasant sensations, and arterial hypertension is detected incidentally.
In order to start receiving an adequate high-pressure treatment, a patient needs to seek advice from a cardiologist. Lisinopril is one of the most well-known and well-studied inhibitors used for hypertension treatment. According to the research, the main mechanism of its action is based on the blocking of the active zinc-containing domain of the angiotensin-converting enzyme, which causes a decrease in the synthesis of angiotensin II and a decrease in the activity of the renin-angiotensin system as a whole (Garimella & Uhlig, 2014). The chemical structure of Lisinopril contains a carboxyl group, which binds the zinc-containing angiotensin converting enzyme (ACE) domain (Edmunds & Mayhew, 2013). Unlike most ACE inhibitors, Lisinopril is not a pro-drug. Absorbed in the digestive tract, it does not undergo further metabolic transformations and is excreted unchanged by the kidneys. Its effect begins an hour after ingestion; the peak of the effect develops in 4-6 hours, and the duration of the effectiveness reaches 24 hours, which provides a convenient mode of administration - once a day (Edmunds & Mayhew, 2013). Ultimately, this medication does not have a lipophilic effect and practically does not bind to plasma proteins.
As a rule, doctors recommend taking the drug in the morning. The initial dose of Lisinopril is 5 mg one time per day (Acton, 2013). If the dose does not provide a sufficient therapeutic effect, it can be increased to 10-20 mg once a day, depending on the clinical response of the patient (Acton, 2013). However, Lisinopril has some side effects; for example, it may lead to dry cough, bronchitis, sometimes - sinusitis, rhinitis, and shortness of breath. Besides, it may induce dizziness, weakness, visual impairment and loss of consciousness in patients with sodium deficiency, dehydration, and heart failure (Edmunds & Mayhew, 2013). Therefore, this information should be considered during the treatment with Lisinopril.
Contraindications to the application of Lisinopril are determined by the presence of some pathological conditions. Patients with severe renal dysfunction, azotemia, hyperkalemia, bilateral renal artery stenosis or arterial stenosis, cannot use this drug; besides, a condition after kidney transplantation, pregnancy, lactation, and some other conditions are contraindications as well (Acton, 2013). In addition, this medication is not used for the treatment of children under 6 years of age. Other possible adverse effects of Lisinoprils administration include loss of fluid and salts. Therefore, it is necessary to compensate fluids intake before starting treatment with Lisinopril. Admittedly, most patients suffering from hypertension must be treated with 2-3 types of medications simultaneously. Lisinopril can be combined with amlodipine, nifedipine GITS, hydrochlorothiazide, and some other medications. The prescription of combined therapy for the treatment of hypertension is a key point of modern approach to the treatment.
The Effects of Lisinopril on Hypertension
Lisinopril causes a significant decrease in blood pressure and is well tolerated by patients. Many studies assert that Lisinopril in a dose of 10-20 mg per day proves to be more effective than other medications such as felodipine or calcium antagonists (Acton, 2013). Lisinopril is more effective in reducing systolic and diastolic pressure, is better tolerated by patients, and has a lower frequency of side effects occurrence. In addition, the patients that received treatment with this drug demonstrated a tendency to normalization of blood lipid levels and lowering of blood glucose levels. Lisinopril is among the medications that can be recommended for the treatment of hypertension in children. In a relatively small study, patients with arterial hypertension were randomized for the treatment with Lisinopril in the same dose of 25 mg per day (Acton, 2013). The medication demonstrated its effectiveness in reducing blood pressure. In another 24-hour blood pressure monitoring, the hypotensive efficacy of Lisinopril and diuretic hypothiazide was compared. The study included 124 patients with arterial hypertension, where Lisinopril was prescribed in doses of 10-40 mg, and hypothiazide in doses of 12.5-50 mg per day; the duration of treatment was 12 weeks (Edmunds & Mayhew, 2013). Both drugs significantly lowered blood pressure; the degree of decrease in systolic AD was the same, and the diastolic blood pressure decreased more in the Lisinopril group. Therefore, this drug appears to be rather effective in hypertension treatment.
Hypertension is one of the dominant matters of healthcare concern. This disease may affect both adults and children and can manifest during the first years of life. Therefore, it is important to be aware of the physiopathology of the condition, its clinical presentation, and treatment. Although the pathogenesis of hypertension has not been fully studied today, it is known that it occurs due to a dysfunction of the tone of peripheral vessels. Clinical presentation of hypertension can be not clearly pronounced in the initial stage. Nevertheless, later patients may experience different health issues. There are different treatment modalities for hypertension, this study focuses on Lisinopril, showing its pros and cons.
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