Hypertension

Treatment :

There is no cure for primary hypertension, but blood pressure can almost always be lowered with the correct treatment. The goal of treatment is to lower blood pressure to levels that will prevent heart disease and other complications of hypertension. In secondary hypertension, the disease that is responsible for the hypertension is treated in addition to the hypertension itself. Successful treatment of the underlying disorder may cure the secondary hypertension.

Guidelines advise that clinicians work with patients to agree on blood pressure goals and develop a treatment plan for the individual patient. Actual combinations of medications and lifestyle changes will vary from one person to the next. Treatment to lower blood pressure may include changes in diet, getting regular exercise, and taking antihypertensive medications. Patients falling into the pre-hypertension range who don't have damage to the heart or kidneys often are advised to make needed lifestyle changes only. A 2003 report of a clinical trial showed that adults with elevated blood pressures lowered them as mush as 38% by making lifestyle changes and participating in the DASH diet, which encourages eating more fruit and vegetables.

Lifestyle changes that may reduce blood pressure by about 5 to 10 mm Hg include:

• reducing salt intake
• reducing fat intake
• losing weight
• getting regular exercise
• quitting smoking
• reducing alcohol consumption
• managing stress

Patients whose blood pressure falls into the Stage 1 hypertension range may be advised to take antihypertensive medication. Numerous drugs have been developed to treat hypertension. The choice of medication will depend on the stage of hypertension, side effects, other medical conditions the patient may have, and other medicines the patient is taking.

If treatment with a single medicine fails to lower blood pressure enough, a different medicine may be tried or another medicine may be added to the first. Patients with more severe hypertension may initially be given a combination of medicines to control their hypertension. Combining antihypertensive medicines with different types of action often controls blood pressure with smaller doses of each drug than would be needed for just one.

Antihypertensive medicines fall into several classes of drugs:

• diuretics
• beta-blockers
• calcium channel blockers
• angiotensin converting enzyme inhibitors (ACE inhibitors)
• alpha-blockers
• alpha-beta blockers
• vasodilators
• peripheral acting adrenergic antagonists
• centrally acting agonists

Diuretics help the kidneys eliminate excess salt and water from the body's tissues and the blood. This helps reduce the swelling caused by fluid buildup in the tissues. The reduction of fluid dilates the walls of arteries and lowers blood pressure. New guidelines released in 2003 suggest diuretics as the first drug of choice for most patients with high blood pressure and as part of any multi-drug combination.

Beta-blockers lower blood pressure by acting on the nervous system to slow the heart rate and reduce the force of the heart's contraction. They are used with caution in patients with heart failure, asthma, diabetes, or circulation problems in the hands and feet.

Calcium channel blockers block the entry of calcium into muscle cells in artery walls. Muscle cells need calcium to constrict, so reducing their calcium keeps them more relaxed and lowers blood pressure.

ACE inhibitors block the production of substances that constrict blood vessels. They also help reduce the build-up of water and salt in the tissues. They often are given to patients with heart failure, kidney disease, or diabetes. ACE inhibitors may be used together with diuretics.

Alpha-blockers act on the nervous system to dilate arteries and reduce the force of the heart's contractions.

Alpha-beta blockers combine the actions of alpha and beta blockers.

Vasodilators act directly on arteries to relax their walls so blood can move more easily through them. They lower blood pressure rapidly and are injected in hypertensive emergencies when patients have dangerously high blood pressure.

Peripheral acting adrenergic antagonists act on the nervous system to relax arteries and reduce the force of the heart's contractions. They usually are prescribed together with a diuretic. Peripheral acting adrenergic antagonists can cause slowed mental function and lethargy.

Centrally acting agonists also act on the nervous system to relax arteries and slow the heart rate. They are usually used with other antihypertensive medicines.