Hypertension, or high blood pressure, is dangerous because it
can lead to strokes, heart attacks, heart failure, or kidney
disease. The goal of hypertension treatment is to lower harmful
high pressures and protect important organs, such as the brain,
heart, and kidneys. In studies, treatment for hypertension has been
associated with reductions in stroke (reduced an average of 35
percent to 40 percent), heart attack (20 percent to 25 percent),
and heart failure (more than 50 percent).
The Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure has classified
"normal blood pressure" as less than 120/80 mmHg,
"pre-hypertension" as 120-139/80-89 mmHg, and "hypertension" as
greater than 140/90 mmHg. All patients with blood pressure readings
greater than 120/80 should be encouraged to make lifestyle
modifications. Treatment with medicine is recommended to lower
blood pressure to less than 140/90 mmHg. For patients who have
diabetes, or chronic kidney disease, the recommended blood pressure
is less than 130/80 mmHg.
Treatment of hypertension involves lifestyle changes and drug
therapy.
Lifestyle changes
A critical step in preventing and
treating hypertension is a healthy lifestyle. You can lower your
blood pressure with these lifestyle changes:
- Losing weight if you are overweight or obese
- Quitting smoking
- Eating a healthy diet, including the Dietary Approaches to Stop
Hypertension (DASH) eating plan (more fruits, vegetables, and
low-fat dairy products, less saturated and total fat)
- Reducing the amount of salt in your diet to 2,400 milligrams
(about 6 grams or 1 teaspoon) a day or less
- Getting regular aerobic exercise (such as brisk walking at
least 30 minutes a day, several days a week)
- Limiting alcohol to two drinks a day for men, one drink a day
for women
In addition to lowering blood pressure on their own, these
measures enhance the effectiveness of antihypertensive
medicines.
Drug therapy
There are several classes of drugs
used to treat hypertension, including:
- Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin receptor blockers (ARBs)
- Diuretics
- Beta blockers
- Calcium channel blockers
The Joint National Committee recommends thiazide-type diuretics
as the first line of therapy for most people who have hypertension.
If the patient has problems with one drug or if it isn't
effective, he or she can be switched to another drug.
A doctor might start a medicine other than a diuretic as the
first line of therapy if a patient has certain medical problems.
For example, ACE inhibitors are often a good choice for a patient
with diabetes.
If a patient's blood pressure is more than 20/10 mmHg
higher than it should be, the doctor might consider starting the
patient on two drugs.
Follow-up
- After starting antihypertensive drug therapy, the patient
should see his or her doctor at least once a month until the blood
pressure goal is reached.
- The doctor should check the patient's serum potassium
(diuretics can lower this) and creatinine (to check the health of
the kidneys) once or twice a year.
- After the blood pressure goal is reached, the patient should
see the doctor every three to six months, depending on whether he
or she has any diseases such as heart failure.