Treatment of hypertension –
Treatment of hypertension consists of taking care of self, avoiding stress.
To take healthy diet with less salt, regular exercise and taking antihypertensive medications.
Physical exercise, Stress management, Quitting smoking, Home blood pressure monitors and Low sodium diet
ACE inhibitor, Diuretic, Beta blocker, Antihypertensive drug, Calcium channel blocker and Vasodilator
Blood pressure measurement
Blood pressure measurement by physician (MD General Medicine)
To diagnose high blood pressure, your physician will examine you take thorough medical, surgical history .
Blood pressure assessment will be done manually or with the help of automatic BP measuring instrument. When blood pressure is being checked using a cuff, placed around your arm ,It’s important that the cuff fits appropriately as too much tight cuff or too loose cuff will give wrong results.
If blood pressure is to be checked for first time it should be measured in both arms to see if there’s a difference. After that, the arm with the higher reading should be accepted.All these minor things need to be observed very carefully in treatment of hypertension.
Blood pressure is measured in millimeters of mercury (mm Hg). A blood pressure reading has two numbers.
Top number, called systolic pressure. The first, or upper, number measures the pressure in the arteries when the heart beats.
Bottom number, called diastolic pressure. The second, or lower, number measures the pressure in the arteries between heartbeats.
High blood pressure (hypertension) is diagnosed if the blood pressure reading is equal to or greater than 130/80 mm Hg. A diagnosis of high blood pressure is usually based on the average of two or more readings taken on separate occasions.Just if for the first time we get reading of high blood pressure then immediate starting anti-hypertensive medications if the wrong thing as if due to physiological reasons the blood pressure is elevated ,it reverts to normal in some time.
Blood pressure is grouped according to how high it is. This is called staging. Staging helps a lot to guide treatment of hypertension.
Stage 1 hypertension. The top number is between 130 and 139 mm Hg or the bottom number is between 80 and 89 mm Hg.
Stage 2 hypertension. The top number is 140 mm Hg or higher or the bottom number is 90 mm Hg or higher.
Sometimes the bottom blood pressure reading is normal (less than 80 mm Hg) but the top number is high. This is called isolated systolic hypertension. It’s a common type of high blood pressure in people older than 65.
If you are diagnosed with high blood pressure, your provider may recommend tests to check for a cause.
Ambulatory BP monitoring can detect abnormal changes in BP that might go unnoticed when it’s only measured in the doctor’s clinic. It can detect white coat hypertension, masked hypertension, and sustained hypertension.It is required for those patients who show lot of fluctuations in BP measurement and so it is important in the treatment of hypertension in such patients.
A longer blood pressure monitoring test may be done to check blood pressure at regular times over six or 24 hours. This is called ambulatory blood pressure monitoring.
Investigations in hypertension –
Testing & Diagnosis
As soon as you visit your doctor, he/she will review your medical history, along with conducting a physical exam of your body and running some usual lab tests.
First, the doctor will assess your blood pressure.
Nowadays, the blood pressure measurement can be done by an automatic BP measuring instrument. And this device makes it even easy to measure one’s BP at home and also facilitates the treatment of hypertension.
The normal systolic blood pressure range is between 110-155 mm Hg, and the diastolic blood pressure range lies between 60-90 mm Hg.
After coming to the physician’s clinic, the patient should sit relaxed for at least 10 minutes and then get his/ her blood pressure checked. Otherwise, there are chances of getting a false high reading. Blood pressure should be measured once daily and for 5 consecutive days.
If persistent high readings for the first 5 days are noticed, the patient will require an antihypertensive medication from a qualified doctor (MD Medicine).
If too high blood pressure is witnessed, the patient might need to get hospitalized as decided by the treating physician (MD-General Medicine).
Ambulatory care (24 hours blood pressure monitoring) might also be necessary but only in selected cases, as decided by the physician (MD-Medicine), who is in charge of facilitating the proper treatment of hypertension to the concerned patient.
Doctors usually advise the following blood tests to be conducted on the patient.
Fasting and post-prandial blood sugar
Lipid Profile – Serum cholesterol, HDL Cholesterol, LDL cholesterol, VLDL Cholesterol, HDL/LDL ratio, and total triglyceride level
Thyroid function tests – T3, T4, and TSH
Serum creatinine and blood urea nitrogen
Serum electrolytes like – Sr Sodium and Serum Potassium.
Here are a few other tests that will help to determine the real cause of your heart-related symptoms.
An electrocardiogram helps to record and monitor the heart’s electrical activity to know if any diseases or disorders are present so that prompt treatment can be started along with treatment of hypertension.
An echocardiogram helps to take a detailed picture of the heart using ultrasound to know if any diseases or disorders are present so that prompt treatment can be started.
Coronary angiography is primarily done to examine the blood flow through coronary arteries.
An exercise stress test is typically done to look at how your heart responds to exercises.
A nuclear stress test helps to examine the flow of blood into the heart.
Your Physican may ask you to regularly check your blood pressure at home. Home monitoring is a good way to keep track of your blood pressure and facilitates treatment of hypertension in a better way. It let’s you know if your medicine is working or if your condition is getting worse.
Devices are available that measure your blood pressure at your wrist or finger ,but they are not recommended as they can provide less reliable results.
Treatment of hypertension-
Changing your lifestyle can help control and manage high blood pressure .Your physician may recommend that you make lifestyle changes including:
Stress relaxation exercises
Eating a heart-healthy diet with less salt
Getting regular physical activity
Maintaining a healthy weight or losing weight
Getting 7 to 9 hours of sleep daily
Sometimes lifestyle changes aren’t enough to treat high blood pressure. If they don’t help, your provider may recommend medicine to lower your blood pressure.
Medications for treatment of hypertension-
Decision regarding this is taken by your physician depending on the health of patient and severity of hypertension. Two or more blood pressure drugs often work better than one. It can take some time for the physician to find the medicine or combination of medicines that works best for you.
Your goal blood pressure level should be decided first You should aim for treatment of hypertension goal of less than 130/80 mm Hg if:
You’re a healthy adult age 65 or older
You’re a healthy adult younger than age 65 with a 10% or higher risk of developing cardiovascular disease in the next 10 years
You have chronic kidney disease, diabetes or coronary artery disease
The ideal blood pressure goal can vary with age and health conditions, particularly if you’re older than age 65.
Medicines used for treatment of hypertension include:
Water pills (diuretics). These drugs help remove sodium and water from the body.
There are different classes of diuretics, including thiazide, loop and potassium sparing. Which one your physician recommends depends on your blood pressure measurements and other health conditions, such as kidney disease or heart failure. Diuretics commonly used to treat blood pressure include chlorthalidone, hydrochlorothiazide (Microzide) and others.
A common side effect of diuretics is increased urination. Urinating a lot reduces blood potassium levels. A good balance of potassium is necessary to help the heart beat correctly. If you have low potassium (hypokalemia), your physician may recommend a potassium-sparing diuretic that contains triamterene.
Angiotensin-converting enzyme (ACE) inhibitors. These drugs help relax blood vessels and help in the treatment of hypertension. They block the formation of a natural chemical that narrows blood vessels. Examples include lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril and others.
Angiotensin II receptor blockers (ARBs). These drugs also relax blood vessels. They block the action, not the formation, of a natural chemical that narrows blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) and others.
Calcium channel blockers. These drugs help relax the muscles of the blood vessels. Some of these slow your heart rate. They include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others. Calcium channel blockers may work better for older people for treatment of hypertension and Black people than do ACE inhibitors alone.
Avoid grapefruit products when taking calcium channel blockers. Grapefruit increases blood levels of certain calcium channel blockers, which can be dangerous. Talk to your provider or pharmacist if you’re concerned about interactions.
Other medicines sometimes used for treatment of hypertension.
If normal blood pressure ranges is not achieved then following medications are required –
Alpha blockers. These medicines reduce nerve signals to blood vessels. They help lower the effects of natural chemicals that narrow blood vessels. Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others.
Alpha-beta blockers. Alpha-beta blockers block nerve signals to blood vessels and slow the heartbeat. They reduce the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
Beta blockers. These medicines reduce the workload on the heart and widen the blood vessels and thus help in the treatment of hypertension .This helps the heart beat slower and with less force. Beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL, Kapspargo sprinkle) and others.
Beta blockers are combined with other blood pressure drugs to work better.
Aldosterone antagonists. These may be used for treatment of hypertension which is resistant (resistant hypertension). They block the effect of a natural chemical that can lead to salt and fluid buildup in the body. Examples are spironolactone (Aldactone) and eplerenone (Inspra).
Renin inhibitors. Aliskiren (Tekturna) slows the production of renin, an enzyme produced by the kidneys that starts a chain of chemical steps that increases blood pressure.
Due to a risk of serious complications, including stroke, aliskiren should not be taken with ACE inhibitors or ARBs.
Vasodilators. These medicines stop the muscles in the artery walls from tightening and thus help in treatment of hypertension .This prevents the arteries from narrowing. Examples include hydralazine and minoxidil.
Central-acting agents. These medicines prevent the brain from informing the nervous system to increase the heart rate and narrow the blood vessels. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv) and methyldopa.
Always take blood pressure medicines as prescribed. Never skip a dose or abruptly stop taking blood pressure medicines without the permission of your physican. Suddenly stopping certain ones, such as beta blockers, can cause a sharp increase in blood pressure which is called rebound hypertension.
If you skip doses because of cost, side effects or forgetfulness, you need to consult your physician.
Treatment of hypertension in resistant cases(Treating resistant hypertension)-
You may have resistant hypertension if:
You take at least three different blood pressure drugs, including a diuretic and still your blood pressure remains stubbornly high.
Your physician should check for a possible second cause of the high blood pressure.
Having resistant hypertension doesn’t mean your blood pressure will never get lower. If your physician/nephrologist,
cardiologist can determine the cause, a more effective line of management can be created.
Treatment of hypertension in resistant cases(Treating resistant hypertension)may involve many steps, including:
Changing blood pressure medicines to find the best combination and dosage.
Reviewing all your medicines, including those bought without a prescription.
Checking blood pressure at home to see if medical appointments cause high blood pressure. This is called white coat hypertension.
Eating healthy, managing weight and making other recommended lifestyle changes.
High blood pressure during pregnancy
If you have high blood pressure and are pregnant, discuss with your care providers how to control blood pressure during your pregnancy.
Eat healthy foods. Eat a healthy diet. Choose fruits, vegetables, whole grains, poultry, fish and low-fat dairy foods. Get plenty of potassium from natural sources, which can help lower blood pressure. Eat less saturated fat and trans fat.
Use less salt. Processed meats, canned foods, commercial soups, frozen dinners and certain breads can be hidden sources of salt.All these things help in the treatment of hypertension in a better way. Check food labels for the sodium content. Limit foods and beverages that are high in sodium. A sodium intake of 1,500 mg a day or less is considered ideal for most adults. But ask your provider what’s best for you.
Limit alcohol. Even if you’re healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women, and up to two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.If these things are followed treatment of hypertension is greatly helped.
Don’t smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your care provider for strategies to help you quit.
Maintain a healthy weight If you’re overweight or have obesity, losing weight can help control blood pressure and lower the risk of complications. Ask your health care provider what weight is best for you. In general, blood pressure drops by about 1 mm Hg with every 2.2 pounds (1 kilogram) of weight lost. In people with high blood pressure, the drop in blood pressure may be even more significant per kilogram of weight lost.Along with medicatons regular physical exercise and maintainence of normal body weight is a regular part of treatment of hypertension.
Get more exercise. Regular exercise keeps the body healthy. It can lower blood pressure, ease stress, manage weight and reduce the risk of chronic health conditions. Aim to get at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity, or a combination of the two.
If you have high blood pressure, consistent moderate- to high-intensity workouts can lower your top blood pressure reading by about 11 mm Hg and the bottom number by about 5 mm Hg
Practice good sleep habits. Poor sleep may increase the risk of heart disease and other chronic conditions. Adults should aim to get 7 to 9 hours of sleep daily. Kids often need more. Go to bed and wake at the same time every day, including on weekends. If you have trouble sleeping, talk to your provider about strategies that might help.Taking regular sleep is also important aspect of treatment of hypertension.
Manage stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to reduce stress.
Try slow, deep breathing. Practice taking deep, slow breaths to help relax. Some research shows that slow, paced breathing (5 to 7 deep breaths per minute) combined with mindfulness techniques can reduce blood pressure. There are devices available to promote slow, deep breathing. It may be an good option if you have anxiety with high blood pressure or can’t tolerate standard treatments.Managing stress is also a part of treatment of hypertension.
Fiber, such as blond psyllium and wheat bran
Minerals, such as magnesium, calcium and potassium
Supplements or products that increase nitric oxide or widen blood vessels — called vasodilators — such as cocoa, coenzyme Q10, L-arginine and garlic
Omega-3 fatty acids, found in fatty fish, high-dose fish oil supplements and flaxseed
Deep breathing or mindfulness are alterative medicine techniques that can help you relax. These practices may temporarily reduce blood pressure.
For high blood pressure, some basic questions to ask your physician include:
What kinds of investigations will I need?
What should be my blood pressure goal?
Do I need any medicines?
Is there a generic alternative to the medicine you’re prescribing for me?
What foods should I eat or avoid?
What’s an appropriate level of physical activity?
How often do I need to schedule appointments to check my blood pressure?
Should I monitor my blood pressure at home?
I have other health conditions. How can I best manage them together?
What websites do you recommend?
All these questions arise in the mind of patient before starting treatment of hypertension.
What to expect from your doctor
Your physician may ask you the following questions –
Is there any family history of high cholesterol, high blood pressure or heart disease?
Describe your diet and exercise habits
Are you Alcoholic ? How many drinks do you have in a week?
Do you smoke? Is there any tobacco addiction ?
When did you last have your blood pressure checked? What was the result?
What you can do in the meantime
All these healthy lifestyle changes, such as quitting smoking, eating healthy foods and getting more exercise should be made which are all important in the treatment of hypertension.
. These are the important ways to protect yourself against high blood pressure and its complications, including heart attack and stroke.