What Is The Treatment For Hypertension

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Measuring Blood Pressure At Home

Blood pressure is most often measured with a device known as a sphygmomanometer. You must have seen it with your doctor or in a clinic. It consists of a stethoscope, arm cuff, dial, pump, and valve. You can get your blood pressure measured by a health care provider, at a pharmacy, or you can have it tested at your home.

Home monitoring devices are easily available and are inexpensive, just make sure to check if the cuff fits. Home blood pressure readings can be especially helpful in diagnosing and monitoring hypertension but before beginning the treatment of blood pressure, you should bring these results to a doctors and check your blood pressure once again.

And have it checked against the home readings for accuracy. You can also bring the same device to your doctor for confirmation.

What Are The Risks Of Resistant Hypertension

Over time, uncontrolled hypertension damages the arteries, contributing to their stiffening. As the arteries become narrower and less flexible, the heart has to work harder to move blood through the body. Uncontrolled high blood pressure can lead to stroke, heart attack, heart failure and other heart conditions cause damage to your kidneys, memory and vision and contribute to erectile dysfunction.

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When Treatment Is Recommended

Everyone with high blood pressure is advised to make healthy lifestyle changes.

Whether medicine is also recommended depends on your blood pressure reading and your risk of developing problems such as heart attacks or strokes.

Your doctor will carry out some blood and urine tests, and ask questions about your health to determine your risk of other problems:

• if your blood pressure is consistently above 140/90mmHg , but your risk of other problems is low you’ll be advised to make some changes to your lifestyle
• if your blood pressure is consistently above 140/90mmHg and your risk of other problems is high you’ll be offered medicine to lower your blood pressure, in addition to lifestyle changes
• if your blood pressure is consistently above 160/100mmHg you’ll be offered medicine to lower your blood pressure, in addition to lifestyle changes

Treatment Of High Blood Pressure

Treatment for HBP depends on its severity and associated risks of developing other diseases. Treatment options include:

Lifestyle changes

• Make and keep appointments to see your doctor for routine check-ups and follow-up tests.

Medications

• ACE inhibitors will help blood vessels relax and open up, leading to a lower blood pressure.
• Angiotensin II receptor blockers will help blood vessels open up, leading to a lower blood pressure.
• Beta blockers will help reduce your blood pressure.
• Alpha blockers will help reduce the arteries resistance, relaxing the muscle tone of the vascular walls.
• Alpha-2 receptor agonists will help reduce blood pressure by decreasing the activity of the sympathetic portion of the involuntary nervous system.
• Calcium channel blockers will help relax and open up narrowed blood vessels, reduce heart rate and lower blood pressure.
• Combined alpha and beta blockers are used as an IV drip for those patients experiencing a hypertensive crisis.
• Central agonists will help decrease the blood vessels ability to tense up or contract.
• Diuretics water pills will help reduce the amount of fluid retention in your body.
• Peripheral adrenergic inhibitors will help reduce blood pressure by blocking neurotransmitters in the brain.
• Vasodilators will help the muscle in the walls of the blood vessels to relax, allowing the vessel to dilate.

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Data Collection And Analysis

The outcomes assessed were mortality, stroke, coronary heart disease , total cardiovascular events , decrease in systolic and diastolic blood pressure, and withdrawals due to adverse drug effects. We used a fixedeffect model to to combine dichotomous outcomes across trials and calculate risk ratio with 95% confidence interval . We presented blood pressure data as mean difference with 99% CI.

Diagnosis Ambulatory Blood Pressure Monitoring

Quality statement

Rationale

Quality measure

Structure:Process:

What the quality statement means for each audience

Service providersHealthcare professionalsCommissionersPeople with suspected hypertension

Data source

Definitions

Ambulatory blood pressure monitoring

Suspected hypertension

Equality and diversity considerations

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What Are The Complications Of Uncontrolled Hypertension

• Chest pain, also called angina.
• Heart attack, which occurs when the blood supply to the heart is blocked and heart muscle cells die from lack of oxygen. The longer the blood flow is blocked, the greater the damage to the heart.
• Heart failure, which occurs when the heart cannot pump enough blood and oxygen to other vital body organs.
• Irregular heart beat which can lead to a sudden death.

How Hypertension Is Diagnosed

Hypertension is usually diagnosed during a routine body checkup. It is advisable to visit a general physician on the off chance that you develop high blood pressure. People who are between the age group of 18 to 39 and 40 years or older are at a higher risk of developing high blood pressure. An appropriate sized arm cuff is used to diagnose Hypertension. There are some machines available which can analyze your blood pressure levels for free.

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Referral To A Specialist For People With Resistant Hypertension

Quality statement

Rationale

Quality measure

Structure:Process:

Description of what the quality statement means for each audience

Service providersHealthcare professionalsCommissionersPeople with resistant hypertension

Data source

Definitions

Resistant hypertension

Tolerability Profile Of Antihypertensive Drugs

Besides their ability to lower BP and to reduce cardiovascular outcomes, it is important to consider the tolerability profile of antihypertensive drugs as tolerability is the major determinant of the long-term persistence on therapy. Actual antihypertensive agents have a much better tolerability profile than earlier drugs with the development of new generations within classes. For most classes, the incidence of adverse effects is dose dependent. This is true for diuretics, beta blockers, and calcium antagonists. Therefore, increasing the dose may not always be the right strategy to adapt therapy. One exception is blockers of the RAS . With these agents, the incidence of side effects is not dose dependent. The major side effects of antihypertensive drugs are summarized in Table 44.7.3. In one meta-analysis by Thomopoulos and colleagues,45 all classes of drugs significantly increased discontinuations for adverse events over those occurring on placebo and ARBs were the only ones to be equivalent to placebo.

Table 44.7.3 More frequent side effects of antihypertensive drugs:

Drug class

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Trials Based On Mortality And Morbidity Endpoints Comparing Treatments Initiated By Different Drug Classes

During the last decade, a large number of controlled randomized trials have compared antihypertensive regimens initiated with different classes of antihypertensive agents, most often comparing older with newer ones , and occasionally comparing newer drug classes. Several trials with over 67,000 randomized patients compared calcium antagonists with older drugs.58 For none of the outcomes considered in this analysis, including all-cause and cardiovascular mortality, all cardiovascular events, stroke, myocardial infarction, and heart failure, did the p-values for heterogeneity reach statistical significance . The pooled odds ratios expressing the possible benefit of calcium antagonists over old drugs were close to unity and non-significant for total mortality, cardiovascular mortality, all cardiovascular events, and myocardial infarction.

Calcium antagonists provided slightly better protection against fatal and non-fatal stroke than old drugs. For the trials combined, the odds ratio for stroke reached formal significance after CONVINCE ,59 the only large trial based on verapamil, was excluded. For heart failure, calcium antagonists appeared to provide less protection than conventional therapy, regardless of whether or not the CONVINCE trial was incorporated in the pooled estimates and this was confirmed in one of the meta-analysis by Thomopoulos and colleagues.3

Overviews Of The Classes Of Blood Pressure Medications

Summaries of some of the major types of commonly prescribed cardiovascular medications are provided here.

• For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking. However, this information does not signify a recommendation or endorsement from the American Heart Association.
• If your prescription medication isnt on this list, remember that your healthcare provider and pharmacist are your best sources of information.
• It’s important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects.
• Never stop taking a medication and never change your dose or frequency without first consulting your doctor.

• Vasodilators

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What Is Hypertension

Abnormally high blood pressure and a combination of high psychological stress are known as Hypertension. These patients suffering from this disorder will have their blood pressure reading greater than 140 over 90 mm.

Hypertension is diagnosed by measuring blood pressure. The Systolic pressure would be the first readings viz. a pressure by which the heart pumps blood through the body, and second readings would be the Diastolic pressure, meaning a pressure at which the heart relaxes and refills the blood.

What Is The Long

Hypertension makes your heart work harder than it needs to, which increases your risk for heart disease, heart failure, and heart attack or stroke. You can also cause brain damage, as your brain relies on oxygen that your heart is pumping round. High blood pressure can cause temporary blockages to the brain, causing brain cells to die.

Hypertension is dangerous but can be treated and managed. The best outlook will come with a healthy diet, exercise, monitoring your blood pressure regularly, and taking medications if needed.

In This Article

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New Developments In Hypertension Research At Georgetown University Hypertension Kidney And Vascular Research Centre

This is a rapidly developing field with extensive research, both by Centre scientists in the laboratory and clinical investigators in patients with hypertension. The following outlines some of the areas of research conducted at the Centre at Georgetown.

Role of Oxidative Stress

Oxidative stress occurs in cells and tissues of the body when oxygen reacts to form toxic molecules called reactive oxygen species . These can inactivate the normal signaling pathways between cells, damage cell membranes and proteins, and alter the DNA that forms the basis of our genes. Therefore, oxidative stress has widespread effects in the body. Increasing evidence suggests that oxidative stress develops progressively as we age. Indeed, almost all the common conditions that afflict us in the second half of life have an origin in oxidative stress. Studies in animal models, and human subjects show that oxidative stress is increased in patients with hypertension, coronary artery disease, heart or kidney failure, dementia and Alzheimerâs disease, Parkinsonâs disease, diabetes mellitus, high blood cholesterol, smokers, obesity, and in post menopausal women. Therefore, we have selected it as the key target for therapy. Unfortunately, clinical trials with âantioxidant vitaminsâ such as vitamin E and C have been disappointing and usually negative. This is explained because these vitamins are very weak antioxidants and have not been given in sufficient dose to affect oxidative stress in the body.

What Causes High Blood Pressure

For most people, there isn’t a single cause of high blood pressure. However there are a number of things that make you more likely to have it. These are called risk factors.

Some risk factors for high blood pressure you can manage, for example when you:

• Smoke or vape with nicotine. When you smoke or vape nicotine your blood pressure goes up. Over time it damages your arteries, increasing your risk of a heart attack or stroke.
• Eat too much processed foods and salt. Many processed foods include a lot of salt. Too much salt makes your body store extra water which raises your blood pressure.
• Drink too much alcohol too often. Drinking alcohol temporarily increases blood pressure. Over time, drinking too much on a regular basis can lead to long-term increases in blood pressure.
• Are overweight. Being overweight increases your risk of having high blood pressure. Even losing just a few kgs can lower your blood pressure.
• Aren’t active enough. Moving more and sitting less will lower your blood pressure.
• Are stressed. The hormones released in your body when youre stressed increase your blood pressure. Researchers are still trying to understand the exact link between long-term high blood pressure and ongoing stress.

Other risk factors include:

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Diagnosis Of High Blood Pressure

The best way to diagnose HBP is to have it measured. A blood pressure reading, given in millimeters of mercury , has two numbers.

• Systolic blood pressure indicates how much pressure your blood is exerting against your artery walls during heartbeats.
• Diastolic blood pressure indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.

Blood pressure measurements fall into four general categories. The American Heart Associations guidelines are as follow:

• Normal blood pressure: A reading of less than 120 and 80
• Elevated blood pressure: A reading ranging from 120 to 129 and below 80
• Stage 1 hypertension: A reading ranging from 130 to 139 or 80 to 89
• Stage 2 hypertension: A reading ranging from 140 or higher or 90
• Hypertensive crisis : A reading higher than 180 and/or 120

*If you have an electronic blood pressure machine and would like to measure your blood pressure at home, please follow The American Heart Associations guidelines:

Medicines For High Blood Pressure

Several types of medicine can be used to help control high blood pressure.

Many people need to take a combination of different medicines.

• if you’re under 55 years of age you’ll usually be offered an ACE inhibitor or an angiotensin-2 receptor blocker
• if you’re aged 55 or older, or you’re any age and of African or Caribbean origin you’ll usually be offered a calcium channel blocker

You may need to take blood pressure medicine for the rest of your life. But your doctor might be able to reduce or stop your treatment if your blood pressure stays under control for several years.

It’s really important to take your medicine as directed. If you miss doses, it will not work as well.

The medicine will not necessarily make you feel any different, but this does not mean it’s not working.

Medicines used to treat high blood pressure can have side effects, but most people do not get any.

If you do get side effects, do not stop taking your medicine. Talk to your doctor, who may advise changing your medicine.

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Treatment Strategy In Resistant Hypertension

Hypertension may be termed resistant or refractory to treatment, when a therapeutic plan that has included attention to lifestyle measures and the prescription of at least three drugs in adequate doses has failed to lower systolic and diastolic BP below 140/90 mmHg. This definition has evolved in recent years including patients with a well-controlled BP but with prescription of four drugs or more. The prevalence of resistant hypertension is highly variable depending on the definition but also on the seriousness of the medical work-up to exclude pseudo-resistance, which is actually more common than true resistant hypertension.

Before modifying therapy, several causes of apparent resistance to treatment should be excluded as illustrated in Table 44.7.7 and Figure 44.7.5. Thus, one should first ascertain that the patient is receiving the appropriate drug doses and that any prescribed drug combination is adequate and effective. In this respect, the place of diuretics is particularly important. Up to 40% of patients with apparent resistant hypertension have a suboptimal medical treatment. Drug interactions, which blunt the efficacy of antihypertensive drugs, should also be carefully investigated. Substances that increase sodium retention such as non-steroidal anti-inflammatory drugs should be withdrawn in case of resistant hypertension.

Table 44.7.7 Potential factors causing apparent or true resistant hypertension

Apparent resistance to treatment

Home Blood Pressure Monitoring

Some people buy their own blood pressure monitor to use at home. This means you can measure your blood pressure on an ongoing basis.

The blood pressure readings you do at home are as good as those done by your doctor.

If you decide to buy one, it’s important to get the correct cuff size. If the cuff is too big or too small, it can give an inaccurate reading.

If you take your own blood pressure and get an unusually high reading, take it a second time after at least five minutes. If it’s still high and you’re worried, contact your nurse or GP.

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Criteria For Considering Studies For This Review

Types of studies

Randomized controlled trials of at least one year duration. The comparative group was a placebo, or an untreated control. We required the following data from the trial: baseline patient characteristics, clearly defined morbidity and mortality endpoints, and outcome data presented using the intentiontotreat principle.

We excluded trials using other than randomized allocation methods, such as alternate allocation, week of presentation, or retrospective controls. We also excluded trials that compared two specific antihypertensive firstline therapies without a placebo or untreated control.

Types of participants

Blood pressure was measured using proper technique at least two times, with the patient resting for at least five minutes. All patients must have had a baseline resting blood pressure of at least 140 mmHg systolic or a diastolic blood pressure of at least 90 mmHg. Trials that included both hypertensive and normotensive patients were acceptable if the majority of patients had elevated blood pressure, or the trial separately reported outcome data on patients with elevated blood pressure. Trials were not limited by any other factor or baseline risk. It was assumed that age and comorbidities did not affect the risk ratio of outcomes associated with drug treatment.

Types of interventions

We classified groups according to the starting dose in the trial:

Highdose thiazide group: starting dose

Lowdose thiazide group: starting dose

Types of outcome measures