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Treatment Options For High Blood Pressure (Hypertension)
Hypertension increases your risk of heart attack and stroke. A variety of treatments can help you manage your blood pressure, including lifestyle changes and medications.
Treatment for high blood pressure typically involves a combination of medication and lifestyle changes. The goal is to get your blood pressure into its optimal range.
Elevated blood pressure doesn't necessarily raise your risk of heart attack or stroke. But without attention, it can progress to high blood pressure — which definitely does raise your risk.
Read on to learn more about lifestyle changes and medication options for high blood pressure.
A healthy lifestyle is the first line of defense against high blood pressure. Habits that help manage blood pressure include:
Learn more lifestyle strategies and habits for lowering blood pressure.
Some people find that lifestyle changes alone are not enough to manage high blood pressure. In these cases, many types of blood pressure medications with different modes of action can help.
For some people, a combination of two or more drugs may be needed to manage their blood pressure. Your doctor can recommend the right medication protocol for you.
High blood pressure medications can be divided into the categories listed below, based on how they work. The drugs in each section are just a sampling of what's available.
DiureticsDiuretics, sometimes called water pills, help the kidneys get rid of excess water and salt. This reduces the volume of blood that needs to pass through the blood vessels, resulting in lower blood pressure.
There are four major types of diuretics defined by how they work. They include:
Diuretics in the thiazide group generally have fewer side effects than the others, particularly when taken at low doses. If you have early stage high blood pressure, lower doses are recommended.
Beta-blockersBeta-blockers help the heart beat with less speed and force. The heart pumps less blood through the blood vessels with each beat, so blood pressure decreases. Some examples of beta-blockers include:
Alpha-beta-blockersAlpha-beta-blockers have a combined effect. They're a subclass of beta-blockers that block the binding of catecholamine hormones to both alpha and beta receptors.
They can decrease the constriction of blood vessels like alpha-1 blockers, slowing the rate and force of the heartbeat like beta-blockers. Examples include:
ACE inhibitors help the body produce less of a hormone called angiotensin II, which causes blood vessels to narrow. These medications decrease blood pressure by helping blood vessels expand and let more blood through.
Some ACE inhibitors include:
ARBs block the action of angiotensin II directly on the blood vessels. It attaches at the receptor site on the blood vessels and keeps them from narrowing. This causes blood pressure to fall.
Some examples include:
Calcium channel blockers limit calcium from entering the smooth muscle cells of the heart and blood vessels. This makes the heart beat less forcefully with each beat and helps blood vessels relax, lowering blood pressure.
Examples of these medications include:
Your body produces types of hormones called catecholamines when it experiences stress. Catecholamines, such as norepinephrine and epinephrine, cause the heart to beat faster and with more force. They also constrict blood vessels, raising blood pressure.
The muscles around some blood vessels have alpha-1 or alpha-adrenergic receptors. When a catecholamine binds to an alpha-1 receptor, the muscle contracts, the blood vessel narrows, and blood pressure rises.
Alpha-1 blockers bind to alpha-1 receptors, blocking catecholamines from attaching. This keeps them from narrowing blood vessels so blood is able to flow through the blood vessels more freely, and blood pressure falls.
Examples of these drugs include:
When an alpha-2 receptor is activated, the production of norepinephrine is blocked. This decreases the amount of norepinephrine produced. Less norepinephrine means less constriction of blood vessels and lower blood pressure.
Since alpha-2 receptor agonists can work in the brain and central nervous system, they're also known as central agonists. This makes these medications useful for treating a large range of health conditions beyond high blood pressure.
Examples include:
VasodilatorsVasodilators relax the muscles in the walls of blood vessels, especially small arteries, called arterioles. This widens the blood vessels and allows blood to flow through them more easily. Blood pressure falls as a result.
Examples include:
Treatment for high blood pressure includes ongoing care as well as individual treatments tailored for specific situations and younger age groups.
Ongoing medical careTo make the most of your treatment, it's vital to get regular medical checkups and blood pressure tests. Regular checkups allow your doctor to monitor how well your treatment is going and make any necessary adjustments to your treatment plan.
If your blood pressure starts inching back up, your doctor can respond promptly. Doctors' visits also give you an opportunity to ask questions and bring up any concerns.
Treatment for specific situationsAdditional treatment options may be needed in certain situations, like resistant hypertension or secondary hypertension.
Resistant hypertension refers to blood pressure that remains high after trying at least three different types of blood pressure medications. Someone whose high blood pressure is controlled by taking four different kinds of medication is considered to have resistant hypertension.
Even such hard-to-treat cases can often be managed successfully. Your doctor might prescribe a different medication, dose, drug combination, or more aggressive lifestyle changes.
Secondary hypertension is high blood pressure that's directly caused by another health condition or drug side effect. Blood pressure often drops substantially or even goes back to normal once doctors diagnose and treat the root cause.
Treatment options for children and teensThe first line of treatment for children and teens with high blood pressure is a healthy lifestyle. This includes:
Children may take the same blood pressure medications as adults when necessary. For children with secondary hypertension, blood pressure often returns to normal once the underlying condition is treated.
High blood pressure treatment usually involves a combination of lifestyle changes and medication. Sometimes, lifestyle changes are enough to return your blood pressure to normal levels. These changes may include diet, exercise, and weight loss.
If your high blood pressure continues, be sure to consult a doctor who can prescribe the appropriate medication.
Can I Lower My Blood Pressure Naturally?
High blood pressure - the medical term for which is 'hypertension' - is a major risk factor for heart disease and the major risk factor for stroke. While the conventional medical approach to hypertension revolves around prescription drugs, there is scientific evidence that individuals can often successfully withdraw from their blood pressure medication, as long as positive lifestyle changes.
One of the most important factors in terms of its impact on blood pressure is salt. Excessive salt consumption is clearly linked with high blood pressure in Western societies. One study published in the Lancet in 1989 found that individuals consuming 3 or 6g of salt each day had significantly lower blood pressure than those consuming 12g of salt a day (average intake in the UK is about 10g per day). Bearing in mind these findings, I suggest you might do well to avoid adding salt during cooking or at the table. Also, processed and packaged foods should be avoided, as these tend to be rich in salt.
Weight loss generally helps to reduce blood pressure. Rather than strict dieting, this is generally best achieved through a balanced, nutritious diet in conjunction with a sensible exercise regime. Exercise on its own is known to help reduce blood pressure. Regular aerobic exercise (e.G. Jogging, fast walking, swimming, cycling, rowing, aerobics) for four weeks or more has been found to bring about significant reductions in blood pressure.
Apart from reducing salt, other dietary interventions have been found to be very effective in reducing blood pressure. One study found that individuals eating a diet rich in fruits and vegetables, low-fat dairy products, nuts, fibre, and low in fat, cholesterol, sugar and meat experienced dramatic drops in blood pressure, with some gaining benefit in as little as two weeks.
Several natural supplements have been used with some success in treating high blood pressure. You have asked about co-enzyme Q10. A couple of studies show that this may be of some benefit at a dose of 50 mg, twice a day. Another commonly used and often effective remedy for high blood pressure is the mineral magnesium. At a dose of 350-500 mg per day, magnesium has been shown to reduce blood pressure significantly. Quite how magnesium helps to control blood pressure is not known for sure, although it is thought to help relax the muscle contained in the walls of the arteries. Theoretically, this effect should increase the size of the blood vessels and reduce blood pressure as it does this.
Another useful natural treatment for hypertension is vitamin C. Studies show that individuals with the highest levels of vitamin C in the blood streams generally have the lowest blood pressures. Also, vitamin C supplementation (500 - 1000mg per day) has been shown to reduce blood pressure in a significant number of individuals. One other natural remedy for hypertension is garlic (Allium sativum). At a dose of 600-900 mg per day, garlic has been shown to bring about very significant reductions in blood pressure in individuals suffering from hypertension.
Please note: no changes to blood pressure medication should be made without consultation with a doctor.
{"status":"error","code":"499","payload":"Asset id not found: readcomments comments with assetId=69234, assetTypeId=1"}High Blood Pressure In The Hospital: What Doctors Should Know
High blood pressure, also known as hypertension, is one of the biggest risk factors for severe health consequences such as kidney disease, heart attack, and stroke.
If high blood pressure is detected during a primary care visit, many effective therapies are available, including oral antihypertensive medicines. But when someone in the emergency room or the hospital has high blood pressure without signs of acute organ damage, the best course of action is much less clear.
Now, Adam Bress, PharmD, associate professor and vice chair of research for population health sciences in the Spencer Fox Eccles School of Medicine at the University of Utah, has chaired an American Heart Association Scientific Statement to guide how doctors can best take care of people who have high blood pressure while they're in the hospital. It has been published in the journal Hypertension.
Aggressive treatment of high blood pressure without evidence of target organ damage for hospitalized patients may do more harm than good, the statement says, and doctors should avoid starting an intensive anti-hypertensive treatment regime unless necessary.
Context mattersPart of the issue, Bress explains, is that people in an acute care setting experience a lot of factors that could make their blood pressure higher. "When you're in the hospital, you're usually there for an acute process, like pneumonia or a blood clot, and you're subject to abnormal living conditions—sleep and diet and stress—which can affect blood pressure."
What's more, health risks occur when blood pressure is consistently high over a long period of time, so elevated blood pressure during a short hospital stay might not indicate a chronic health concern.
It's important for doctors to be cautious, because overly aggressive antihypertensive treatment can lead to serious health consequences, Bress says.
According to a study published by another of the statement's authors, treatment with intravenous antihypertensive medication was associated with higher risks of dangerously low blood pressure, as well as kidney dysfunction and stroke. Bress explains that blood pressure is sensed and regulated by several organs in the body, and a sudden change in either direction can be dangerous.
Evidence-based recommendationsWith that in mind, the new statement highlights that care providers use caution in their response to a high blood pressure reading in the hospital, and to start by ruling out and addressing common causes of a high blood pressure reading. "Check the measurement, check for reversible causes, and be judicious about starting or intensifying new medications," Bress says.
While treatment plans for high blood pressure in outpatient settings are well-established to help patients, much more research is needed to figure out how to best help people whose blood pressure is high during a hospital visit, Bress adds. That includes people who don't have a primary care provider, for whom acute care visits may be the only point of contact with the medical system.
In the meantime, clinicians should avoid "treating the number" when acute care patients have high blood pressure, especially if someone's high blood pressure isn't causing immediate symptoms.
For patients, Bress recommends getting a sense of one's own everyday blood pressure over time, which can be measured at home with validated devices. "It's simple, it's easy to do, and it provides clinicians with a lot of important information."
More information: Adam P. Bress et al, The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association, Hypertension (2024). DOI: 10.1161/HYP.0000000000000238
Citation: High blood pressure in the hospital: What doctors should know (2024, June 7) retrieved 3 July 2024 from https://medicalxpress.Com/news/2024-06-high-blood-pressure-hospital-doctors.Html
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