If you have high blood pressure (hypertension), it is important to attempt to identify and exclude reversible (secondary) causes.
High blood pressure guidelines
140/90 or above
120/80 to 139/89
119/79 or below
- Over 91% of adult hypertension has no clear cause and is therefore called essential/primary hypertension. Often, it is part of the metabolic “syndrome X” in patients with insulin resistance: it occurs in combination with diabetes mellitus (type 2), combined hyperlipidemia and central obesity.
- Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension.
Tests are undertaken to identify possible causes of secondary hypertension, and seek evidence for end-organ damage to the heart itself or the eyes (retina) and kidneys. Diabetes and raised cholesterol levels being additional risk factors for the development of cardiovascular disease are also tested for as they will also require management.
Tests commonly performed include:
- Chest X-ray
The major goal of high blood pressure (antihypertensive) therapy is the reduction of cardiovascular disease (including stroke). In most persons with hypertension, especially those age >50 years, the primary focus should be on achieving a blood pressure <140/90 mmHg since that is directly associated with a decrease in CVD complications. In patients with hypertension and diabetes or renal disease, the BP goal is <130/80 mmHg.
If you fall into the prehypertension range (120–139/80–89), your doctor will likely recommend lifestyle changes, including:
- Lose excess weight
- Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
- Cut back on salt.
- Quit smoking.
- Follow the Dietary Approaches to Stop Hypertension (DASH) diet.
The DASH eating plan is a low-fat and low-saturated-fat diet that emphasizes eating more fruits, vegetables, whole grains, and low-fat dairy foods.
Adoption of healthy lifestyles by all persons is critical for the prevention of high BP and is an indispensable part of the management of those with hypertension. Major lifestyle modifications shown to lower BP include weight reduction in those individuals who are overweight or obese, and includes adoption of a diet rich in potassium and calcium, dietary sodium reduction, increased physical activity and moderation of alcohol consumption.
There is evidence that reduction of the blood pressure by 5-6 mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 15-20%, and reduces the likelihood of dementia, heart failure, and mortality from vascular disease.
Treatment for Hypertension with medications
Blood pressure drugs are prescribed to help lower blood pressure when appropriate diet and regular physical activity alone have not succeeded. They do this by helping relax and relax (dilate) blood vessels, allowing blood to flow more easily, or by acting on the kidneys to help increase urination. Some of the more common blood pressure drugs include diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin-2 receptor blockers (ARB), beta-blockers (BB) and calcium channel blockers (CCB). Some of these may also be prescribed for heart failure and arrhythmia patients.
A healthcare provider will take several factors into account when determining which antihypertensive drug should be tried first. In addition to considering the effectiveness and potential side effects, he or she will consider the person’s general health, sex, age, and race; the severity of the high blood pressure; any additional, underlying medical conditions; and whether particular drugs should not be used.
Certain antihypertensive drugs are specifically recommended for the treatment of particular conditions, even if the person does not have high blood pressure. In many cases, a person with one of these conditions also has high blood pressure. As examples:
- An ACE inhibitor is recommended for people with diabetes mellitus who have increased levels of protein in the urine (proteinuria), heart failure, or a prior heart attack.
- Beta blockers are recommended for people with heart failure or a prior heart attack.
- Beta blockers or calcium channel blockers are recommended to control symptoms in people with angina pectoris, which is temporary chest pain caused by an inadequate oxygen supply to heart muscle in patients with coronary artery disease.
There are also certain antihypertensive agents that are not recommended in some people. Some examples include:
- ACE inhibitors and ARBs (and many other medications not used to treat high blood pressure) are not recommended during pregnancy.
- Beta blockers may not be recommended for people with asthma or chronic lung disease and as primary therapy for high blood pressure, particularly in patients over age 60.
Finally, certain underlying medical conditions may be worsened by treatment with particular high blood pressure medications. As an example, diuretics can worsen gout.
Thus, it is important to mention all current and previous medical problems to the healthcare provider to determine which medication is best.
The Best Drug is the One that Works!
The “best” drug for you is the one that is most effective at lowering your blood pressure without causing unwanted side effects. There are various specific reports about the benefits and potential harms of each of the specific classes of blood pressure medicines, but there is a huge volume of evidence supporting the fact that high blood pressure is deadly, and that lowering blood pressure saves lives. In the end, that is the true goal.