A 5'6", 210 pound, 64 year old man had a physical exam prior to his retirement for corporate work. His blood pressure was greater than 180/115 mmHg on three separate days (normal blood pressure is 120/80). Further examination showed normal to low plasma renin activity, elevated systemic vascular resistance (SVR), x-ray showed left ventricular hypertrophy and retinal hemorrhage and cardiac output was 7.2 L/min (normal is 3.5 to 5.5 L/min). Recommended therapy was weight reduction to his ideal weight, low salt diet. If these life style changes did not change his condition the following medication will be started in the following order: oral diuretics progress to beta blockers and then to a vasodilator. Required:
a. What is the diagnosis for this individual?
b. Why is it suggested that the patient go on a low sodium diet?
c. Explain the site and mechanism of action of each of these prescribed medications.

Explanation:

a.

The individual should be diagnosed for hypertension or high blood pressure.

b.

It is recommended that the patient should take low sodium diet because when sodium or salt enters the blood stream it increases the amount of water or fluids in the blood stream that leads to rise in blood pressure. The blood pressure increases if we take high salt diet due to which arterioles constrict.

c.

Diuretics- Diuretics are the first recommended therapy in treating hypertension. Diuretics such as thizides , pottasium sparing agents. Thiazide acts on distal convoluted tubule that inhibits Na+ and Cl - symporter. Diutetic removes water from body as urine and loss of salt.

Beta blockers - These are antagonists. They block the beta receptors found on the target cell membrane. Beta blockers slows down blood pressure. Atenolol is the beta blocker used for hypertension.

Alpha1 blocker - alpha 1 receptors helps in smooth muscle contraction and vasoconstriction. Vasodilator increases blood flow in the body that are devoid of oxygen that helps to reduce blood pressure.

angiotensin converting enzyme inhibitor - blocks angiotensin converting enzyme that prevents converting angiotensin I to angiotensin II and increases bradykinin levels in the body. These inhibitors helps in lowering blood pressure.

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