REGULATION OF BLOOD PRESSURE Arterial blood pressure is a function of cardiac output and p

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REGULATION OF BLOOD PRESSURE Arterial blood pressure is a function of cardiac output and peripheral vascular resistance. Cardiac output is determined by the blood volume, venous tone, stroke volume, and heart rate. Vascular resistance is determined by a variety of neural influences, especially sympathetic tone, and a variety of hormonal factors, especially angio- tensin II. It follows that reduction of blood pressure can be achieved by reducing cardiac output or peripheral vascular resistance. Drug groups useful in hypertension include diuretics, sympathoplegics, vasodilators, and angiotensin converting enzyme inhibitors. Management may involve use of several drugs and requires monitoring of both therapeutic efficacy and toxicity. References: 1. Alderman, MH, Davis TK, Carroll L: Initial antihypertensive therapy. Comparison of prazosin and hydrochlorothiazide. Am J Med 1986; 80 (Suppl 2A): 120. 2. Benowitz NL, Bourne HR: Antihypertensive agents. Chapter 10 in: Basic & Clinical Pharmacology, ed 3, 1987. 3. Brogden RC, et al: Prazosin: A review of its pharmacological properties and therapeutic efficacy in hypertension. Drugs 1977; 14: 163. 4. Chrysant SG, et al: Antihypertensive and metabolic effects of a new converting enzyme inhibitor, enalapril. Clin Pharm Therap 1983; 33: 741. 5. Croog SH, et al: The effects of antihypertensive therapy on the qual- ity of life. N Engl J Med 1986; 314: 1657. 6. Drugs for hypertension. The Medical Letter 1987; 29: 1. 7. Fagan TC, et al: Time course of development of the antihypertensive effect of propranolol. Hypertension 1983; 5: 852. 8. Frohlich ED: Antihypertensive therapy: Newer concepts and agents. Cardiology 1985; 72: 349. 9. Frohlich ED, Cooper RA, Lewis EJ: Review of the overall experience of captopril in hypertension. Arch Intern Med 1984; 144: 1441. 10. Joint National Commission: The 1984 report of the joint national committee on detection, evaluation, and treatment of high blood pres- sure. Arch Intern Med 1984; 144: 1045. 11. Niarchos AP, Weinstein DL, Laragh JH: Comparison of the effects of diuretic therapy and low sodium intake in isolated systolic hyperten- sion. Am J Med 1984; 77: 1061. 12. Pettinger WA: Minoxidil and the treatment of severe hypertension. N Engl J Med 1980; 303: 922. 13. Veterans Administration Cooperative Study Group: Comparison of propranolol and hydrochlorothiazide for the initial treatment of hyper- tension. J Am Med Assoc 1982; 248: 2004. 14. Weinberger MH: Antihypertensive therapy and lipids. Paradoxical in- fluences on cardiovascular disease risk. Am J Med 1986; 80 (Suppl 2A): 64.


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