Treatment of High Blood Pressure
The goal of treatment for most hypertensive patients is to lower the SBP (Systolic blood pressure) below 140 mmHg and the DBP (Diastolic blood pressure) below 90 mmHg. In some patients, as those with diabetes, it is recommended that SBP maintained below 130 mmHg and a DBP less than 85 mmHg.
Management of high blood pressure is focused on lifestyle modification and pharmacological therapy. Management of secondary hypertension may require surgical correction of the underlying problem such as removal of a pheochromocytoma.
Follow-up visits should focus on identification of new risk factors, evidence of end-organ damage and adequacy of blood pressure control. However, regardless of the therapy, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Resistance to antihypertensive treatment is more often due to patients’ noncompliance to medications or use of NSAIDs or alcohol abuse than to underlying secondary causes.
Lifestyle Modifications
Sufficient evidence supports the beneficial effects of healthy lifestyle modifications in the prevention and management of hypertension.
The following modifications are recommended as the first steps in treating mild-to-moderate hypertension:2
- Include enough calcium, potassium and magnesium in the diet
Individuals in the prehypertensive category also require health-promoting lifestyle modifications in order to prevent further progress to full-fledged hypertension.
Pharmacological Management
The choice of antihypertensive drugs depends on numerous factors including the presence of coexisting medical conditions, adverse effects and drug interactions.
Commonly used groups of antihypertensives (and the examples of each) are:
- Diuretics: chlortalidone and hydrochlorothiazide.
- Angiotensin-converting enzyme (ACE) inhibitors: captopril, enalapril and lisinopril.
In general, clinicians follow the following recommended guidelines while starting pharmacotherapy:1
- Patients should be started on a low-dose of the initial medication and the dose should be gradually titrated upward every 1–2 months, depending upon the response to therapy.
- Most patients will require two or more antihypertensives at lower doses to achieve the target BP and to lower the adverse effects of the individual drugs in high doses.
- Thiazide-type diuretics should be used for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes.
- A diuretic or a long-acting calcium channel blockers may be more effective in elderly patients with isolated systolic hypertension.
- An angiotensin converting enzyme (ACE) inhibitor should be the initial treatment for hypertension associated with CHF, diabetes mellitus and post-myocardial infarction.
- An ARB may be substituted in patients who develop persistent cough subsequent to ACE inhibitor therapy.
Alternative Therapies
Alternate therapies in the management of high blood pressure include acupuncture, biofeedback, herbal medicine, meditation and yoga. These approaches are focused only on the reduction in BP but not in the overall morbidity and mortality. Therefore, alternative therapies should be considered as adjuncts to lifestyle modification and drug therapy in the management of high blood pressure.
Next page: Questions to ask your doctor about high blood pressure
Written by: Healthplus24 team
Date last updated: April 14, 2012