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Hypertension Treatment Overview

Hypertension, or high blood pressure, is dangerous because it can lead to strokes, heart attacks, heart failure, or kidney disease. The goal of hypertension treatment is to lower high blood pressure and protect important organs, like the brain, heart, and kidneys from damage. Treatment for hypertension has been associated with reductions in stroke (reduced an average of 35%-40%), heart attack (20%-25%), and heart failure (more than 50%), according to research.

Hypertension is classified as:

• Normal blood pressure: less than 120/80 mmHg
• Prehypertension: 120-139/80-89 mmHg
• Hypertension: greater than 140/90 mmHg
• Stage 1 Hypertension:140-159/90-99 mmHg
• Stage 2 Hypertension: 160 or greater/ 100 or greater mmHg

 

All patients with blood pressure readings greater than 120/80 should be encouraged to make lifestyle modifications, such as eating a healthier diet, quitting smoking and getting more exercise. Treatment with medication is recommended to lower blood pressure to less than 140/90 mmHg. For patients who have diabetes or chronic kidney disease the recommended blood pressure is less than 130/80 mmHg.

Treating hypertension involves lifestyle changes and drug therapy.

Lifestyle Changes

A critical step in preventing and treating hypertension is a healthy lifestyle. You can lower your blood pressure with the following lifestyle modifications:

• Losing weight if you are overweight or obese.
• Quitting smoking.

Hypertension, Kicking the Habit- Smoking

Did you know that smoking and heart disease are related? Or that smoking increases blood pressure? Most people associate cigarette smoking with breathing problems and lung cancer. But did you know that people who smoke are more likely to develop hypertension and heart disease?

About 30% of all deaths from heart disease in the U.S. are directly related to cigarette smoking. That's because smoking is a major cause of coronary artery disease especially in younger people.

A person's risk of heart attack greatly increases with the number of cigarettes he or she smokes and the longer a person smokes, the greater their risk of heart attack. People who smoke a pack of cigarettes a day have more than twice the risk of heart attack than non-smokers. Women who smoke and also take birth control pills increase several times their risk of heart attack, stroke and peripheral vascular disease.

How Does Smoking Increase Heart Disease Risk?

The nicotine present in smoke causes:

• Decreased oxygen to the heart.
• Increased blood pressure and heart rate.
• Increase in blood clotting.
• Damage to cells that line coronary arteries and other blood vessels.

How Can Quitting Smoking Be Helpful?

If you quit smoking, you will:

• Prolong your life
• Reduce your risk of disease (including heart disease, heart attack, high blood pressure, lung cancer, throat cancer, emphysema, ulcers, gum disease and other conditions).
• Feel healthier. After quitting, you won't cough as much, you'll have fewer sore throats and you will increase your stamina.
• Look better. Quitting can help you prevent face wrinkles, get rid of stained teeth and improve your skin.
• Improve your sense of taste and smell.
• Save money.

How to Quit?

There's no one way to quit smoking that works for everyone. To quit, you must be ready both emotionally and mentally. You must also want to quit smoking for yourself, and not to please your friends or family. It helps to plan ahead. This guide may help get you started.

What Should I Do First?

Pick a date to stop smoking and then stick to it.

Write down your reasons for quitting. Read over the list every day, before and after you quit. Here are some other tips.

• Write down when you smoke, why you smoke and what you are doing when you smoke. You will learn what triggers you to smoke.
• Stop smoking in certain situations (such as during your work break or after dinner) before actually quitting.
• Make a list of activities you can do instead of smoking. Be ready to do something else when you want to smoke.
• Ask your doctor about using nicotine gum or patches. Some people find these aids helpful.
• Join a smoking cessation support group or program. Call your local chapter of the American Lung Association.
• Talk to your physician who may recommend medications to help combat nicotine craving and also help with information on using nicotine substitutes, such as a patch or gum.

How Can I Avoid Relapsing?

• Don't carry a lighter, matches or cigarettes. Keep all of these smoking reminders out of sight.
• If you live with a smoker, ask that person not to smoke in your presence.
• Don't focus on what you are missing. Think about the healthier way of life you are gaining.
• When you get the urge to smoke, take a deep breath. Hold it for 10 seconds and release it slowly. Repeat this several times until the urge to smoke is gone.
• Keep your hands busy. Doodle, play with a pencil or straw, or work on a computer.
• Change activities that were connected to smoking. Take a walk or read a book instead of taking a cigarette break.
• When you can, avoid places, people and situations associated with smoking. Hang out with non-smokers or go to places that don't allow smoking, such as the movies, museums, shops or libraries.
• Don't substitute food or sugar-based products for cigarettes. Eat low-calorie, healthful foods (such as carrot or celery sticks, sugar-free hard candies) or chew gum when the urge to smoke strikes so you can avoid weight gain.
• Drink plenty of fluids, but limit alcoholic and caffeinated beverages. They can trigger urges to smoke.
• Exercise. It will help you relax.
• Get support for quitting. Tell others about your milestones with pride.

• Work with your doctor to develop a plan using over-the-counter or prescription nicotine-replacement aids.

• Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy products, less saturated and total fat).

Hypertension: The DASH Diet

One step to lower high blood pressure -- incorporate the DASH diet into your lifestyle. Doctors recommend:

• Eating more fruits, vegetables, and low-fat dairy foods
• Cutting back on foods that are high in saturated fat, cholesterol, and total fat
• Eating more whole grain products, fish, poultry, and nuts
• Eating less red meat and sweets
• Eating foods that are rich in magnesium, potassium, and calcium

The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is an example of such an eating plan. In studies, patients who were on the DASH diet reduced their blood pressure within two weeks. Another diet -- DASH-Sodium -- calls for reducing sodium (salt) to 1,500 mg a day (about 2/3 teaspoon). Studies of patients on the DASH-Sodium plan significantly lowered their blood pressure.

Implementing the DASH Diet

The DASH diet calls for a certain number of servings daily from various food groups. The number of servings you require may vary, depending on your caloric need. When beginning the diet, start slowly and make gradual changes. Consider adopting a diet plan that allows 2,400 milligrams of salt per day (about 1 teaspoon) and then once your body has adjusted to the diet further lower your salt intake to 1,500 mg per day (about 2/3 teaspoon). These amounts include all salt consumed, including that in food products, used in cooking, and added at the table.

Here are some tips to get you started:

• Add a serving of vegetables at lunch and at dinner.
• Add a serving of fruit to your meals or as a snack. Canned and dried fruits are easy to use.
• Use only half the butter, margarine, or salad dressing, and use low-fat or fat-free condiments.
• Drink low-fat or skim dairy products three times a day.
• Limit meat to six ounces a day. Try eating some vegetarian meals.
• Add more vegetables, rice, pasta, and dry beans to your diet.
• Instead of typical snacks (chips, etc.), eat unsalted pretzels or nuts, raisins, graham crackers, low-fat and fat-free yogurt and frozen yogurt; unsalted plain popcorn with no butter, and raw vegetables.
• Read food labels carefully to choose products that are lower in sodium.

Staying on the DASH Diet

The following is a list of food groups and suggested serving amounts for the DASH diet:

• Grains: 7-8 daily servings
• Vegetables: 4-5 daily servings
• Fruits: 4-5 daily servings
• Low-fat or fat-free dairy products: 2-3 daily servings
• Meat, poultry and fish: 2 or less daily servings
• Nuts, seeds, and dry beans: 4-5 servings per week
• Fats and oils: 2-3 daily servings
• Sweets: try to limit to less than 5 servings per week

How Much Is a Serving?

When you're trying to follow a healthy eating plan, it may help to know how much of a certain kind of food is considered a "serving." The following table offers some examples.

 

SERVING SIZES

Food/amount

1/2 cup cooked rice or pasta

1 slice bread

1 cup raw vegetables or fruit

1/2 cup cooked vegetables or fruit

8oz. of milk

1 teaspoon olive oil

3 ounces cooked meat

3 ounces tofu

 

 

• Reducing the amount of sodium in your diet to 2,300 milligrams (about 1 teaspoon of salt) a day or less.
• Getting regular aerobic exercise (such as brisk walking at least 30 minutes a day, several days a week).
• Limiting alcohol to two drinks a day for men, one drink a day for women.

In addition to lowering blood pressure, these measures enhance the effectiveness of antihypertensive medications.

Medications

There are several types of drugs used to treat hypertension, including:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin || receptor blockers (ARBs)
• Diuretics
• Beta-blockers
• Calcium channel blockers

Diuretics are usually recommended as the first line of therapy for most people who have hypertension. If one drug doesn't work or is disagreeable, other types of diuretics are available.

However, your doctor may start a medicine other than a diuretic as the first line of therapy if you have certain medical problems. For example, ACE inhibitors are often a good choice for a people with diabetes.

If your blood pressure is more than 20/10 mmHg higher than it should be, your doctor may consider starting you on two drugs.

Follow-Up

After starting antihypertensive drug therapy, you should see your doctor at least once a month until the blood pressure goal is reached. Once or twice a year, your doctor will check your serum potassium (diuretics can lower this, and ACE inhibitors and ARBs may increase this) and magnesium and BUN/creatinine levels (to check the health of the kidneys).

After the blood pressure goal is reached, you should continue to see your doctor every three to six months, depending on whether other diseases such as heart failure are present.

Hypertension, When to Call Your Doctor

Hypertension symptoms – often there aren’t any. Hypertension is often called the "silent" disease because it may have no noticeable symptoms. If undetected and untreated, hypertension can cause heart disease (including congestive heart failure and heart attack), stroke, and kidney disease. That's why it is important to have regular physical examinations to make sure your blood pressure is within the normal range. This is especially important if your blood pressure has ever been high, if you have a family history of hypertension, or if you are gaining weight.

If you are being treated for hypertension, your doctor can answer any questions or concerns you may have during your regular visits. However, there may be situations that warrant a call to your doctor. For example:

• If you aren't responding to the treatment your doctor prescribed and your blood pressure is still high.
• If you have certain symptoms, including fatigue, nausea, shortness of breath, lightheadedness, headache, excessive sweating, problems with your vision, or confusion. These may be serious and should warrant prompt medical attention. They could be from uncontrolled hypertension or from medication side effects.

Remember, your doctor is there to help you. If you have any concerns about your condition, don't hesitate to call your doctor.

 

 

 

So here it goes in this series about the various aspects of treatment and other aspects of hypertension. Signing off today. Your suggestions and feedback are welcome. People interested in knowing about other diseases are free to write to me in the comment column.

 

Till then ciao…

 

 

 dr do little