heart and blood vessel disorders
High Blood Pressure
Treatment of High Blood Pressure
Diet and exercise Medications to lower blood pressure Primary hypertension cannot be cured, but it can be controlled to prevent complications. Everyone with elevated blood pressure or any stage of hypertension should change their lifestyle. The decision to prescribe medications is based on the actual blood pressure level and whether people have atherosclerotic cardiovascular disease (ASCVD) or have a more than 10% risk of developing it in the next 10 years. Doctors often recommend that people with high blood pressure monitor their own blood pressure at home. Self-monitoring probably helps motivate people to follow a doctor's recommendations regarding treatment. The goal for antihypertensive therapy is to decrease blood pressure to below 130/80 mm Hg in most people. However, if decreasing a person's blood pressure to less than 130/80 mm Hg causes symptoms, such as fainting, light headedness, memory loss, or dizziness, doctors may recommend a higher blood pressure goal but not higher than 140/90. For some people, for example, those at high risk of heart disease, a lower systolic goal may be appropriate. Lifestyle changes are important for all people with hypertension. People who are overweight and have high blood pressure are advised to lose weight. Losing as few as 10 pounds (4.5 kilograms) can lower blood pressure. For people who have obesity, diabetes, or high cholesterol levels, changes in diet (to one that is rich in fruits, vegetables, and low-fat dairy products, with reduced saturated and total fat content) are important for reducing the risk of heart and blood vessel disease. People who smoke should Smoking Cessation . Limiting the intake of alcohol and sodium (while maintaining an adequate intake of calcium, magnesium, and potassium) may make medication therapy for high blood pressure unnecessary. Alcohol intake should be no more than 2 drinks (a daily total of 24 ounces [about 1 liter] of beer, 8 ounces [about 240 milliliters] of wine, or 2 ounces [about 60 milliliters] of 100-proof whiskey or other liquor) in men and 1 drink in women. Daily sodium intake should ideally be reduced to less than 1500 milligrams, or less than 3.75 grams ofsodium chloride(salt) intake. Moderate aerobic exercise is helpful. People with primary hypertension do not have to restrict their physical activity as long as their blood pressure is controlled. Regular exercise helps reduce blood pressure and weight and improves the functioning of the heart and overall health (see Benefits of Exercise ). People should get adequate sleep. Getting more than 6 hours of sleep per night may help people maintain control of their blood pressure. (See also Medications for Treatment of High Blood Pressure .) Medications that are used in the treatment of high blood pressure are called antihypertensives. With the wide variety of antihypertensives available, high blood pressure can be controlled in almost anyone, but treatment has to be tailored to the individual. Treatment is most effective when the person and doctor communicate well and collaborate on the treatment program. Different types of antihypertensives reduce blood pressure by different mechanisms, so many different treatment strategies are possible. For some people, doctors use a stepped approach to medication therapy: They start with one type of antihypertensive and add others as necessary. For other people, doctors find a sequential approach is preferable: They prescribe one antihypertensive, and if it is ineffective, they stop it and prescribe another type. For people with blood pressure at or above 140/90 mm Hg, usually two medications are started at the same time. In choosing an antihypertensive, doctors consider such factors as The person's age, sex, and sometimes ethnicity The severity of high blood pressure The presence of other conditions, such as diabetes or high blood cholesterol levels Potential side effects, which vary depending on the medication The costs of the medications and of tests needed to check for certain side effects Many people require two or more medications to reach their blood pressure goal. Most people tolerate their prescribed antihypertensive medications without problems. But any antihypertensive medication can cause side effects. So if side effects develop, a person should tell the doctor, who can adjust the dose or substitute another medication. Usually, an antihypertensive medication must be taken indefinitely to control blood pressure. The cause of the high blood pressure is treated if possible. Treating kidney disease can sometimes return blood pressure to normal or at least lower it, so that antihypertensive therapy is more effective. A narrowed artery to the kidney may be widened by inserting a balloon-tipped catheter and inflating the balloon ( Percutaneous Coronary Intervention ). Or the narrowed part of the artery supplying the kidney can be bypassed. Often the high blood pressure resolves after such surgery. Tumors that cause high blood pressure, such as a If people still have high blood pressure despite taking three different medications, doctors in Europe and Australia sometimes insert a catheter into the artery to each kidney. The catheter produces radio waves that destroy the sympathetic nerves along the renal arteries. It is not clear whether this treatment prevents complications of high blood pressure. This treatment is not available in the United States. Another treatment for high blood pressure is called pacemaker therapy. An electrode is implanted in the neck, where it stimulates certain nerve endings that help regulate blood pressure. This treatment is not available in the United States, but it is available in Europe and Canada. It is not clear whether this treatment should be recommended. In hypertensive emergencies, blood pressure must be lowered rapidly. Hypertensive emergencies are treated in hospital intensive care units. Most medications used to rapidly lower blood pressure, such asfenoldopam, nitroprusside,nicardipine, orlabetalol, are given intravenously. 