How is primary hypertension treated? Home Treatment is defined as the average systolic blood pressure (SBP) or diastolic blood pressure (DBP) that is at or above the 95th percentile for gender, age, and height on three or more occasions. Stage I hypertension is more than 95% to 99% plus 5 mm Hg, and stage II hypertension is more than 99% plus 5 mm Hg. Prehypertension (formerly designated high normal BP) is defined as SBP or DBP levels that are more than the 90th percentile but less than the 95th percentile. White‐coat hypertension refers to patients with BP levels at or above the 95th percentile in a physician’s office or clinic but who are normotensive outside the clinical setting
How is primary hypertension treated
Dietary changes can help control blood pressure. One diet designed to promote lower blood pressure is known as the DASH diet. This stands for Dietary Approaches to Stop Hypertension. The DASH diet recommends eating more vegetables, fruits, whole grains, low-fat dairy products, poultry, nuts, and fish. Red meat, saturated fats, and sweets should be avoided. The DASH diet can lower blood pressure within 2 weeks. It can also help to reduce your intake of sodium. The following is the DASH diet suggested daily intake:
- 7-8 servings of grain
- 4-5 servings of vegetables
- 4-5 servings of fruits
- 2-3 servings of low-fat or fat-free dairy products
- 2-3 servings of fats and oils
- 2 or less servings of meat, poultry, and fish
On the DASH diet, nuts, seeds, and dry beans should be limited to 4-5 servings per week. Sweets should be limited to less than 5 servings per week.
High blood pressure drugs
Beta-blockers are another drug used to treat hypertension. They block the effects of the sympathetic nervous system on the heart. This reduces the workload of the heart by requiring less blood and oxygen, which slows the heart rate. They can be used to treat other conditions as well, including abnormal heart rate (arrhythmia).
Beta-Blocker Side Effects
Side effects of beta-blockers can include the following:
- Cold feet and hands
- Erectile dysfunction
- Slow heartbeat
- Edema (swelling in ankles, feet, or legs)
- Trouble breathing
ACE (angiotensin-converting enzyme) inhibitors are another class of antihypertensive drugs. They reduce the body’s levels of angiotensin II, a substance that narrows blood vessels. This means that arteries are more open (dilated) and the blood pressure is lower. ACE inhibitors can be used alone, or with other medications such as diuretics. Side effects of ACE inhibitors can include skin rash, dry cough, dizziness, and elevated potassium levels. Women who are pregnant, planning to get pregnant, or breastfeeding should not take ACE inhibitors.
Diuretics, sometimes called water pills, help the kidneys get rid of excess water and salt (sodium). This reduces the volume of blood that needs to pass through the blood vessels, and as a result, blood pressure goes down. There are three major types of diuretics defined by how they work. They include:
- thiazide diuretics (Hygroton, Diuril, Lasix)
- potassium-sparing diuretics (Midamor, Aldactone, Durenium)
- loop diuretics (bumetanide, furosemide)
- combination diuretics, which include more than one variety used together
Diuretics in the thiazide group generally have fewer side effects than the others, particularly when taken at the low doses generally used in treating early high blood pressure.
Beta-blockers help the heart beat with less speed and force. The heart pumps less blood through the blood vessels and blood pressure decreases. There are many drugs within this classification, including:
- acebutolol (Sectral)
- betaxolol (Kerlone)
- metoprolol tartrate (Lopressor)
- metoprolol succinate (Toprol-XL)
- penbutolol sulfate (Levatol)
Angiotensin-converting enzyme (ACE) inhibitors
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:
- benazepril hydrochloride (Lotensin)
- captopril (Capoten)
- enalapril maleate (Vasotec)
- fosinopril sodium (Monopril)
- lisinopril (Prinivil, Zestril)
Angiotensin II receptor blockers
This class of drugs also protects the blood vessels from angiotensin II. To tighten blood vessels, the hormone must bind with a receptor site on the blood vessels. These medications keep that from happening. Consequently, blood pressure falls. Angiotensin II receptor blockers include:
- candesartan (Atacand)
- eprosartan mesylate (Teveten)
- irbesartan (Avapro)
- losartan potassium (Cozaar)
- telmisartan (Micardis)
- valsartan (Diovan)
Calcium channel blockers
Movement of calcium into and out of muscle cells is necessary for all muscle contractions. Calcium channel blockers keep calcium from entering the smooth muscle cells of the heart and blood vessels. This makes the heart beat less forcefully and helps blood vessels relax. As a result, blood pressure decreases. Examples of these medications include:
- amlodipine besylate (Norvasc, Lotrel)
- felodipine (Plendil)
- isradipine (DynaCirc, DynaCirc CR)
- verapamil hydrochloride (Calan SR, Covera-HS, Isoptin SR, Verelan)
Your body produces a type of hormone called catecholamine when under stress, or chronically in some disease states. Catecholamine, along with norepinephrine and epinephrine, cause the heart to beat faster and with more force. And they constrict blood vessels. These effects raise blood pressure, and occur when these hormones attach to a receptor.
The muscles around some blood vessels have what are known as alpha adrenergic receptors. When catecholamine binds to an alpha receptor, the muscle contracts, the blood vessel narrows, and blood pressure rises.
Alpha-blockers prevent binding to alpha receptors, so blood is able to flow through the blood vessels more freely, and blood pressure falls. These drugs include:
- doxazosin mesylate (Cardura)
- prazosin hydrochloride (Minipress)
- terazosin hydrochloride (Hytrin)
Alpha-beta-blockers have a combined effect. They block the binding of catecholamine hormones to both alpha and beta receptors. They can decrease the constriction of blood vessels like alpha-blockers, and slow down the rate and force of the heartbeat like beta-blockers. Carvedilol (Coreg) and labetalol hydrochloride (Normodyne) are common alpha-beta-blockers.
Alpha-2 receptor agonists
Like other alpha-blockers, these drugs reduce activity in the sympathetic nervous system, which decreases blood pressure. The main biologic difference between them and other alpha-blockers is they target only one type of alpha receptor.
They are a first choice treatment during pregnancy because they generally pose few risks for the mother and fetus. Methyldopa (Aldomet) is a common form of this type of drug.
These medications keep the brain from sending messages to the nervous system that would release catecholamines and speed up heart rate and tighten blood vessels. The heart doesn’t pump as hard and blood flows more easily, so blood pressure decreases. These include:
- alpha methyldopa (Aldomet)
- clonidine hydrochloride (Catapres)
- guanabenz acetate (Wytensin)
- guanfacine hydrochloride (Tenex)
Peripheral adrenergic inhibitors
This group of drugs works to block certain chemical messengers inside the brain, which keeps the smooth muscles from getting the message to constrict. These medications are generally used only if other medications aren’t effective. They include:
- guanadrel (Hylorel)
- guanethidine monosulfate (Ismelin)
- reserpine (Serpasil)
Vasodilators relax the muscles in the walls of blood vessels, especially small arteries (arterioles). This widens the blood vessels and allows blood to flow through them more easily. Blood pressure falls as a result. Hydralazine hydrochloride (Apresoline) and minoxidil (Loniten) are examples of these.
Renin/angiotensin system antagonists
Angiotensin is a potent vasoconstrictor, but also increases the activity of the sympathetic nervous system by both central and peripheral mechanisms. Fortunately, the renin-angiotensin system provides a series of targets for pharmacological attack by ACEIs, angiotensin type 1 receptor blockers (ARBs), and aldosterone antagonists (spironolactone). ACEIs and ARBs tend to be well tolerated and have few contraindications, the most important of which is renal artery stenosis. It is important to monitor renal function and potassium levels during initiation and maintenance of these agents. ACEIs are contraindicated in women of child-bearing potential and may cause a troublesome cough through their inhibition of the enzyme responsible for bradykinin degradation. First-dose hypotension can be a problem in elderly patients on diuretics, although newer, longer-acting formulations have reduced this concern. ACEIs are lipid-neutral, improve insulin resistance, and may be able to induce regression of LVH.
Alpha1-antagonists (such as doxazosin and prazosin) are becoming more widely used in the treatment of hypertension. They have a good side-effect profile (palpitations and occasional postural hypotension). In addition, they are reported to have beneficial effects on lipid profile and insulin resistance and lack the negative effects on the sexual potency of other antihypertensives, which is a particular advantage for diabetics. They work to reduce total peripheral resistance by blocking the sympathetic activation of α1-receptors on resistance vessels.
Centrally acting sympathomimetics
Clonidine and α-methyldopa, centrally acting α2-adrenoceptor agonists, were once popular choices, but are now less widely initiated outside specialist scenarios such as pre-eclampsia. They carry a risk of rebound hypertension on withdrawal.
Other vasodilators, such as hydralazine and the very potent minoxidil, are mostly used in resistant hypertension when standard agents fail. Use of the latter is generally restricted by unpleasant side effects such as hypertrichosis.
Imidazoline type 1 receptor agonists
The identification of imidazoline receptors has revealed that the effects of older agents on the central nervous system reflect a relatively nonspecific central site of action mediated primarily through α2-adrenoceptor agonism (see Figure 2). It seems that some of the adverse effects of these agents, which are also mediated through this pathway, can be avoided by the use of selective imidazoline type 1 receptor agents. Early results suggest these agents are well tolerated, with a dry mouth being the only frequently reported unwanted effect (13% at 3 weeks, 2% at 12 months).
Lifestyle and home remedies
Lifestyle changes can help you control and prevent high blood pressure, even if you’re taking blood pressure medication. Here’s what you can do:
- Eat healthy foods – Eat a heart-healthy diet. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains, poultry, fish and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and trans fat.
- Decrease the salt in your diet – Aim to limit sodium to less than 2,300 milligrams (mg) a day or less. However, a lower sodium intake — 1,500 mg a day or less — is ideal for most adults.While you can reduce the amount of salt you eat by putting down the saltshaker, you generally should also pay attention to the amount of salt that’s in the processed foods you eat, such as canned soups or frozen dinners.
- Maintain a healthy weight – Keeping a healthy weight, or losing weight if you’re overweight or obese, can help you control your high blood pressure and lower your risk of related health problems. In general, you may reduce your blood pressure by about 1 mm Hg with each kilogram (about 2.2 pounds) of weight you lose.
- Increase physical activity – Regular physical activity can help lower your blood pressure, manage stress, reduce your risk of several health problems and keep your weight under control.Aim for at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity, or a combination of moderate and vigorous activity. For example, try brisk walking for about 30 minutes most days of the week. Or try interval training, in which you alternate short bursts of intense activity with short recovery periods of lighter activity. Aim to do muscle-strengthening exercises at least two days a week.
- Limit alcohol – Even if you’re healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women, and up to two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
- Don’t smoke – Tobacco can injure blood vessel walls and speed up the process of buildup of plaque in the arteries. If you smoke, ask your doctor to help you quit.
- Manage stress – Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation, deep breathing or meditation. Getting regular physical activity and plenty of sleep can help, too.
- Monitor your blood pressure at home –Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working, and even alert you and your doctor to potential complications. Home blood pressure monitoring isn’t a substitute for visits to your doctor, and home blood pressure monitors may have some limitations. Even if you get normal readings, don’t stop or change your medications or alter your diet without talking to your doctor first. If your blood pressure is under control, check with your doctor about how often you need to check it.
- Practice relaxation or slow, deep breathing – Practice taking deep, slow breaths to help relax. There are some devices available that promote slow, deep breathing. According to the American Heart Association, device-guided breathing may be a reasonable nondrug option for lowering blood pressure, especially when anxiety accompanies high blood pressure or standard treatments aren’t well-tolerated.
- Control blood pressure during pregnancy – If you’re a woman with high blood pressure, discuss with your doctor how to control your blood pressure during pregnancy.
Health Tips 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.
Exercise is another lifestyle factor that can lower blood pressure. It’s recommended that adults get about 150 minutes per week of moderate exercise. This can include cardiovascular exercises such as walking, bicycling, gardening, or another aerobic exercise. Muscle-strengthening activities are recommended at least twice a week and stretching makes you more flexible and helps prevent injuries. Check with your doctor if you are currently inactive and want to start exercising. Make exercise fun by doing activities you enjoy or find an exercise buddy to join you!
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