High Blood Pressure Treatment (cont.)
In this Article
How is high blood pressure treated?
Goals of treatment
Keep in mind that high blood pressure is usually present for many years before its complications develop. Ideally, hypertension is treated early, before it damages critical organs in the body. Increased public awareness and screening programs to detect early, uncomplicated hypertension are keys to successful treatment. By treating high blood pressure successfully early enough, you can significantly decrease the risk of stroke, heart attack, and kidney failure.
The goal for patients with combined systolic and diastolic hypertension is to attain a blood pressure of 140/85 mm Hg. Bringing the blood pressure down even lower may be desirable in African American patients, and patients with diabetes or chronic kidney disease. Although life style changes in pre-hypertensive patients are appropriate, it is not well established that treatment with medication of patients with pre-hypertension is beneficial.
Starting treatment for high blood pressure
Blood pressure persistently higher than 140/ 90 mm Hg usually is treated with lifestyle modifications and medication. More aggressive treatment may be recommended in certain circumstances if the diastolic pressure remains at a borderline level (usually less than 90 mm Hg, yet persistently above 85). These circumstances include borderline diastolic pressures in association with end-organ damage, systolic hypertension, or factors that increase the risk of cardiovascular disease, such as age over 65 years, African American decent, smoking, hyperlipemia (elevated blood fats), or diabetes.
Any one of the several classes of medications may be started, except the
alpha-blocker medications. The alpha-blockers are used only in combination with
another anti-hypertensive medication in specific medical situations. (See the
next section for a more detailed discussion of each of the several classes of
anti-hypertensive medications.)
In some situations, certain classes of anti-hypertensive drugs are preferable to others as the first line (preferred first choice) drugs. Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blocking (ARB) drugs are the drugs of choice in patients with heart failure, chronic kidney failure (in diabetics or non-diabetics), or heart attack (myocardial infarction) that weakens the heart muscle (systolic dysfunction). Also, beta-blockers are sometimes the preferred treatment in hypertensive patients with a resting tachycardia (racing heart beat when resting) or an acute (rapid onset, current) heart attack.
Patients with hypertension may sometimes have a co-existing, second medical condition. In such cases, a particular class of anti-hypertensive medication or combination of drugs may be chosen as the first line approach. The idea in these cases is to control the hypertension while also benefiting the second condition. For example, beta-blockers may treat chronic anxiety or migraine headache as well as hypertension. Also, the combination of an ACE inhibitor and an ARB drug can be used to treat certain diseases of the heart muscle (cardiomyopathies) and certain kidney diseases where reduction in proteinuria would be beneficial.
In other situations, certain classes of anti-hypertensive medications should not be used (are contraindicated). Dihydropyridine calcium channel blockers used alone may cause problems for patients with chronic renal disease by increasing proteinuria. However, an ACE inhibitor will blunt this effect. The non-dihydropyridine type of calcium channel blockers should not be used in patients with heart failure. However, these drugs may be beneficial in treating certain arrhythmias. Some drugs, such as minoxidil, since it is so powerful, usually are relegated to second or third line choices for treatment. Clonidine is an excellent drug but has side effects such as fatigue, sleepiness, and dry month making it a second or third line choice. See the section below on pregnancy for the anti-hypertensive drugs that are appropriate or inappropriate for use in pregnant women.
Next: Treatment with combinations of drugs for high blood pressure »
- ACE Inhibitors - Read about ACE inhibitors like Altace, lisinopril, enalapril, ramparil, Zestril and more. Information includes side effects, drug interactions, and pregnancy safety information.
- Congestive Heart Failure - Read about congestive heart failure symptoms like fatigue, abdomen, leg and ankle swelling, shortness of breath, sleeplessness, increased urination, nausea, abdominal pain, and decreased appetite.
- Beta Blockers - Learn more about Beta Blockers, a drug that treats angina and other heart rhythm disorders, migraines, high blood pressure, panic attacks, and tremors. Generic and brand names are included in the article.
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