High Blood Pressure Treatment (cont.)
John P. Cunha, DO, FACOEP
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
In this Article
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 descent, smoking, hyperlipemia (elevated blood fats), or diabetes.
Any one of several classes of medications may be started, except the alpha blocker medications, which are used only in combination with another antihypertensive medication in specific medical situations. (See the next section for a more detailed discussion of each of the several classes of antihypertensive medications.)
In some situations, certain classes of antihypertensive 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 nondiabetics), 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) heart attack.
Patients with hypertension may sometimes have a co-existing second medical condition. In such cases, a particular class of antihypertensive 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 protein in the urine would be beneficial.
In other situations, certain classes of antihypertensive medications should not be used. 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, may be relegated to second- or third-line choices for treatment. Clonidine is an excellent drug but has side effects such as fatigue, sleepiness, and dry mouth making it a second- or third-line choice. See the section below on pregnancy for the antihypertensive drugs that are used in pregnant women.
Reviewed by Jay W. Marks, MD on 10/11/2012
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