Hypertension and Hyperlipidemia in Obesity
Hypertension and Hyperlipidemia in Obesity
Hypertension and Hyperlipidemia in Obesity
Age is one factor that significantly affects the pharmacokinetics (PK) and pharmacodynamics (PD) of medications that are routinely used to treat and manage cardiovascular conditions. For patient AO who has obesity and has been diagnosed with hypertension and hyperlipidemia, the PK and PD of the drugs he has been put on will be affected to a large extent by his age (Katzung, 2018; Rosenthal & Burchum, 2018). It is known that with growing age, the first pass metabolism by the cytochrome P450 isoenzymes in the liver becomes less effective. This is because of the deterioration of the liver with age. As a result, the oral drugs that are metabolised in the liver to inactive metabolites through this pathway accumulate in the body after administration because of the delay in metabolising them (Hammer & McPhee, 2018; Huether & McCance, 2017). Hydralazine is one such drug that might suffer this fate and which patient AO is taking. The other way that age affects the PK and PD of cardiovascular medications is through the fact that renal function declines with age. As a result, excretion of drugs through the renal route is compromised in older subjects and the drug and its metabolites can accumulate in the body to dangerous levels. Both atenolol and hydralazine are affected by this scenario (Rosenthal & Burchum, 2018). In older patients, absorption of substances from the gastrointestinal tract also becomes less efficacious. This includes oral medications. As a result, drugs taken orally, as is the case with patient AO, may not be optimally absorbed. This leads to lower plasma concentrations that may not reach therapeutic levels (Katzung, 2018; Rosenthal & Burchum, 2018). Hypertension and Hyperlipidemia in Obesity
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Older patients have also been known to possess less lean body mass. This mass decreases as one ages. Unfortunately, the distribution of several drugs is dependent on lean body mass. As such, these drugs will not reach all the areas they are supposed to reach because of the age-related deficiency in lean body mass. Their effectiveness is therefore compromised in such older patients (Rosenthal & Burchum, 2018; Katzung, 2018). Lastly but not least, because of these shortcomings, the pharmacodynamics of many of these medications will be affected in that their actions will be prolonged due to accumulation in the blood and body tissues (Katzung, 2018).
How these Changes Might Affect the Patient’s Recommended Drug Therapy
Apart from the importance of lifestyle changes that patient AO must effect to mitigate the effects of obesity and hyperlipidemia (Rubenfire, 2018), the changes in PK and PD will necessitate alterations in the dosages of the respective drugs (Armstrong, 2014). For instance, sertraline is known to predispose elderly patients to the risk of falls under normal circumstances (Katzung, 2018). In an older patient with much more prominent of these deteriorative changes, the effect of sertraline may be magnified. Because of this, the dose will need to be reduced in older patients (Armstrong, 2014). Again because of the reduction in renal function, the dosages of both atenolol and hydralazine may also need to be reduced in older patients. This is because they and their metabolites accumulate in the bodies of older patients because of reduced renal excretion (Huether & McCance, 2017; Hammer & McPhee, 2018). Luckily, doxazosin is beneficial in both hypertension and lipid control in older patients. Therefore, its dose may be left as it is. As for simvastatin, it also appears to be stable at the usual dosages (Katzung, 2018; Rosenthal & Burchum, 2018). Hypertension and Hyperlipidemia in Obesity
How to Improve the Patient’s Drug Regime
The most important step to achieve this is to reduce the dosages of the drugs whose PK and PD are adversely affected by age as discussed above. This is in line with the bioethical principle of beneficence. That is doing the most good to the patient as opposed to causing them harm by leaving the dosages as they are (Fowler & ANA, 2015). The reason is to enhance the therapeutic value of the cardiovascular drugs and reduce adverse effects.
References
Armstrong, C. (2014). JNC 8 guidelines for the management of hypertension in adults. American Family Physician, 90(7):503-504. https://www.aafp.org/afp/2014/1001/p503.html
Fowler, M.D.M., & American Nurses Association. (2015). Guide to the Code of Ethics for Nurses with interpretive statements: Development, interpretation, and application, 2nd ed. Silver Spring, MD: American Nurses Association.
Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. New York, NY: McGraw-Hill Education.
Huether, S.E. & McCance, K.L. (2017). Understanding pathophysiology, 6th ed. St. Louis, MO: Elsevier, Inc.
Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14th ed. New York, NY: McGraw-Hill Education.
Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
Rubenfire, M. (2018). 2018 AHA/ACC Multi-society guideline on the management of blood cholesterol. American College of Cardiology. Retrieved 9 March 2020 from https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/11/09/14/28/2018-guideline-on-management-of-blood-cholesterol
Hypertension and Hyperlipidemia in Obesity
