Hypertension: Treatments and Prevention

Treatments for hypertension

Lifestyle changes are important for both treatment and prevention of high blood pressure, and they can be as effective as a drug treatment. These lifestyle changes can also have wider benefits for heart health and overall health.6

The lifestyle measures shown to reduce blood pressure and recommended by experts include:6

• Salt restriction - typical salt intake is between 9 and 12 g a day and modest blood pressure reductions can be achieved even in people with normal levels by lowering salt to around 5 g a day - the greatest effects are seen in people with hypertension
• Moderation of alcohol consumption - expert guidelines say moving from moderate to excessive drinking is "associated both with raised blood pressure and with an increased risk of stroke"
• High consumption of vegetables and fruits and low-fat - people with, or at risk of, high blood pressure are advised to minimize intake of saturated fat and total fat and to eat whole-grain, high-fibre foods, at least 300 g of fruit and vegetables a day, beans, pulses, and nuts, and omega-3-rich fish twice a week
• Reducing weight and maintaining it - hypertension is closely correlated with excess body weight, and weight reduction is followed by a fall in blood pressure
• Regular physical exercise - guidelines say "hypertensive patients should participate in at least 30 min of moderate-intensity dynamic aerobic exercise (walking, jogging, cycling or swimming) on 5 to 7 days a week"
• Stress reduction - avoiding sources of stress, where possible, and developing healthy coping strategies for managing unavoidable stress can help with blood pressure control, especially as many people turn to alcohol, drugs, smoking and unhealthy foods or overeating to cope with stress.

Smoking can also raise blood pressure, and because of its wider effects on heart health and the rest of the body, giving up smoking is highly recommended for people with high blood pressure.

                                

The DASH diet

The US National Heart Lung and Blood Institute recommends the DASH diet for people with high blood pressure.4,8

Standing for Dietary Approaches to Stop Hypertension, DASH has been specially formulated to help people lower blood pressure. It is a flexible and balanced eating plan based on research studies sponsored by the institute, which says the diet:8

• Lowers high blood pressure
• Improves levels of blood lipids (fats in the bloodstream)
• Reduces the risk of developing cardiovascular disease.

There is a National Institute cookbook called Keep the Beat Recipes with cooking ideas to help achieve these results.

There is some evidence that probiotic supplements may be beneficial for people with hypertension. A review of studies found that people taking a multistrain probiotic formula containing at least 10 billion colony-forming units every day for at least 8 weeks had significant decreases in systolic and diastolic blood pressure, with the greatest effects seen in people with hypertension at the beginning of the study.

No significant effects were seen when people took probiotics for less than 8 weeks, however.

              

Drug treatments for hypertension

Lifestyle measures are standard first-line treatment for hypertension, although doctors will prescribe medication alongside lifestyle measures to lower blood pressure in people with a level above 140 over 90.4

Drugs are usually started as monotherapy (just one drug) and at a low dose.4 Side-effects associated with antihypertensive drugs are usually minor.7

A number of different classes of drug are available to help lower blood pressure:4,6,7

• Diuretics (including thiazides, chlorthalidone and indapamide) - a cornerstone of treatment since 1977
• Beta-blockers (and alpha-blockers)
• Calcium-channel blockers
• Central agonists
• Peripheral adrenergic inhibitors
• Vasodilators
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers.

                      

The choice of drug depends on the individual and any other conditions they may have. While a single drug is usually tried in monotherapy first, a combination of at least two antihypertensive drugs is usually required.6

Anyone taking antihypertensive medications should be sure to carefully read labels before taking any over-the-counter medications such as decongestants as these may interact with medications used to lower blood pressure.

                        

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Hypertension: Causes and Symptoms

What is hypertension (high blood pressure)?
Hypertension is defined as having a blood pressure higher than 140 over 90 mmHg, with a consensus across medical guidelines.
Hypertension is defined as having a blood pressure higher than 140 over 90 mmHg, with a consensus across medical guidelines.


The blood flowing inside vessels exerts a force against the walls - this is blood pressure.

This view has led the American Heart Association (AHA), for example, to define the following ranges of blood pressure (in mmHg):

• Normal blood pressure is below 120 systolic and below 80 diastolic
• Prehypertension is 120-139 systolic or 80-89 diastolic
• Stage 1 high blood pressure (hypertension) is 140-159 systolic or 90-99 diastolic
• Stage 2 high blood pressure (hypertension) is 160 or higher systolic or 100 or higher diastolic
• Hypertensive crisis (a medical emergency) is when blood pressure is above 180 systolic or above 110 diastole.

SYMPTOMS OF HYPERTENTION:

Symptoms of hypertension

High blood pressure itself is usually asymptomatic, meaning that patients do not experience any direct symptoms of the condition. This is why hypertension is often referred to as "the silent killer," as it can quietly causes damage to the cardiovascular system.4,7

Hypertension can also lead to problems in the organs affected by high blood pressure. Long-term hypertension can cause complications through arteriosclerosis, where the formation of plaques results in narrowing of blood vessels.

                  

The complications associated with hypertension-related arteriosclerosis can include:4,7

• An enlarged or weakened heart, to a point where it may fail to pump enough blood (heart failure)
• Aneurysm - an abnormal bulge in the wall of an artery (which can burst, causing severe bleeding and, in some cases, death)
• Blood vessel narrowing - in the kidneys this can lead to possible kidney failure; in the heart, brain and legs, this can lead to heart attack, stroke or the need for amputation, respectively
• Blood vessels in the eyes my rupture or bleed, leading to vision problems or blindness (hypertensive retinopathies - classified by worsening grades one through four).

Diagnosis and tests for hypertension

Diagnosis of hypertension is made by measuring blood pressure over a number of clinic visits, using a sphygmomamometer - the familiar upper-arm cuff device. An isolated high reading is not taken as proof of hypertension. Rather, diagnosis can be made after elevated readings are taken on at least three separate days.4

Measurements may be taken at the doctor's office while a patient is seated and after standing; this helps the doctor to look for orthostatic or postural hypotension.6

Blood pressure is measured by sphygmomanometry.

The reliability of blood pressure readings may be improved by having a patient or someone else take a series of measurements outside the doctor's office using standardized devices.6

We have more detailed information about measuring blood pressure.

In addition to measuring blood pressure using sphygmomanometry, a doctor will take a history (ask questions, such as about cardiovascular problems) and do a physical examination before diagnosing hypertension.4

These questions and additional tests can help to identify the cause of high blood pressure and determine whether there have been any complications. Such tests may include urine tests, kidney ultrasound imaging, blood tests, an electrocardiogram (ECG) and/or an echocardiograph.

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