Treatment of high blood pressure includes both lifestyle modifications and drug therapy.
LIFESTYLE INTERVENTION: In my previous article, I had mentioned about the dietary changes and other measures we must undertake to prevent Hypertension as well as, as adjunct to drugs, which include
- Smoking cessation,
- Maintaining ideal body weight,
- Incorporation of DASH type eating pattern,
- Reduction of salt consumption,
- Controlling blood sugars,
- Regular exercise.
Even if it does not totally alleviate the need for BP medications, it does help in reducing the number of medications or doses required for BP control.
Medications to treat Hypertension:
Drugs are recommended for patients with BP above 140/90 mm Hg. Lowering systolic (upper) BP by 10-12mm Hg and diastolic (lower) BP by 5-6 mm Hg confers relative risk reductions of 35-40% for stroke and 12-16% for cardiac disease within 5 years of initiation of treatment. Risk of Heart failure is reduced by >50%, it is the single most effective intervention for slowing the rate of progression of Hypertension related kidney disease.
There is considerable difference in individual responses to different classes of anti hypertensive agents. Most medications reduce systolic BP by 7-13 mm Hg and Diastolic BP by 4-8 mm Hg. More often than not, combination of agents are required to achieve goal BP reductions.
Selection of drugs and combinations of agents should be individualized, taking into account age, severity of Hypertension, other cardiovascular disease risk factors, and practical considerations related to cost, side-effects and frequency of dosing.
Common classes of drugs used for Hypertension are
- ACE Inhibitors,
- Calcium Channel Blockers,
- Beta Blockers,
- Alpha Blockers and sympatholytic or centrally acting agents.
I would be discussing about medicines in detail in my next article.
After starting your BP medications, you should see your doctor at-least once a month until the BP goal is achieved.
Once or twice a year, your doctor may check the level of potassium, Kidney functions and other tests depending on whether you have other diseases.
Regular BP monitoring and treatment titration as per your physician is a must.
BP Goals of Antihypertensive Therapy:
Maximum protection against Cardiovascular endpoints is achieved with BP<135-140 mm Hg for systolic BP and <80-85 mm Hg for Diastolic BP. More aggressive BP targets for BP control (130/80 mm Hg Or 120/80 mm Hg in some cases) may be appropriate for patients with Chronic Kidney Disease,some cases of Diabetes, Chronic Heart Disease and additional risk factors.
In Diabetics, effective BP control reduces the risk of Cardiovascular events and death as well as risk for microvascular complications of Diabetes like kidney, nerve related and eye related issues.
To achieve recommended BP goals, the majority of patients will require treatment with more than one drug. Three or more drugs are frequently needed in patients with Diabetes and renal insufficiency.