Disorders of the cardiovascular system include diseases of blood vessels and the heart. These conditions are commonly treated with four categories of medications: diuretics, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and vasodilators. This paper will discuss the difference between the four mentioned types of medications. After that, an example patient scenario that uses diuretics for treating high blood pressure and peripheral edema will be described.
The first type of medication to be discussed is diuretics. Diuretics increase the excretion of sodium and water by kidneys, thus widening blood vessels and lowering blood pressure (Mann, 2019). This category is the first-line medication for treating patients with chronic heart failure (CHF) regardless of their age, sex, or individual characteristics (Faris, Flather, Purcell, Poole-Wilson, & Coats, 2016). In the short term, diuretics are proved to reduce pulmonary congestion and edema, thus quickly relieving the symptoms of CHF and improving the patient’s state (Faris et al., 2016).
In this respect, diuretics are better at the beginning of the treatment of cardiovascular diseases than ACE inhibitors that take weeks to show their clinical effect (Faris et al., 2016). However, they should not be used as monotherapy because it leads to the patient’s instability; rather, they should be combined with beta-blockers and ACE inhibitors (Faris et al., 2016). Thus, diuretics are the right choice for first-line treatment but cannot be the only medication for curing cardiovascular diseases.
The second category of medicine used for treating cardiovascular disorders is ACE inhibitors. This group reduces the production of angiotensin II, the hormone that causes blood vessels to narrow, thus increasing blood pressure (Mann, 2019). Evidence shows that ACE inhibitors reduce mortality in patients with heart failure, high blood pressure, acute myocardial infarction, and diabetes (Goyal, Cusick, & Thielemier, 2019).
ACE inhibitors have a rare but serious side effect, angioedema, meaning the swelling of the throat, tongue, and lips (Mann, 2019). This type of medication is contraindicated during pregnancy because it may lead to renal disorders or the death of the fetus (Goyal et al., 2019). However, if a patient has no intolerance to ACE inhibitors, they are the major medications for treating cardiovascular diseases.
Calcium channel blockers are the third type of pharmacological treatment of heart disorders. These drugs reduce the amount of calcium that enters the heart, pancreas, and vascular smooth muscles (McKeever & Hamilton, 2019). The lesser amount of calcium cause muscles to relax and, therefore, widens blood vessels and lowers blood pressure (Mann, 2019). Calcium channel blockers are effective peripheral vasodilators, which is why they are used for treating hypertension, vasospasm, and migraines (McKeever & Hamilton, 2019).
Non-dihydropyridines, which are a type of calcium channel blockers, may lower the heart rate too much and, therefore, are contraindicated in patients with HFrEF, AV block, and sick sinus syndrome (McKeever & Hamilton, 2019). Thus, this type of medication should be used in specific cases.
The final type of medication to be considered is vasodilators. These drugs, also known as nitrates, relax smooth muscles and dilate blood vessels, and they are prescribed to patients with intolerance to ACE inhibitors (Shah, Gandhi, Srivastava, Shah, & Mansukhani, 2017). Their common side effect is headache, which causes 10% of patients to refuse this medication (Tarkin & Kaski, 2016). Thus, vasodilators help treat patients with hypertension and heart failure when other drugs cannot be used.
An example patient scenario to be discussed is as follows: a female 64-year-old patient has hypertension. Her baseline BP is 136/87, and she is currently on 10 mg of amlodipine and complains of having swollen ankles. The physician would most likely prescribe diuretics and, more specifically, furosemide. This drug is commonly prescribed for patients with hypertension and edema (Shah et al., 2017). Furthermore, the physician would recommend discontinuation of amlodipine, which is a calcium channel blocker, meaning that it may cause peripheral edema (McKeever & Hamilton, 2019). The change in medication is likely to cure the swelling and treat hypertension.
References
Faris, R. F., Flather, M., Purcell, H., Poole-Wilson, P. A., & Coats, A. J. (2016). Diuretics for heart failure. The Cochrane Database of Systematic Reviews, 4(4). Web.
Goyal, A., Cusick, A.S., & Thielemier, B. (2019). ACE inhibitors. Web.
Mann, J. F. E. (2019). Patient education: High blood pressure treatment in adults (Beyond the Basics). Web.
McKeever, R.G., & Hamilton, R. J. (2019). Calcium channel blockers. Web.
Shah, A., Gandhi, D., Srivastava, S., Shah, K. J., & Mansukhani, R. (2017). Heart failure: A Class review of pharmacotherapy. Pharmacy & Therapeutics, 42(7), 464-472.
Tarkin, J.M., & Kaski, J.C. (2016). Vasodilator therapy: Nitrates and Nicorandil. Cardiovascular Drugs and Therapy, 30(4), 367-378.