30 May 2007

How is Hypertension (High Blood Pressure) treated

How is Hypertension (High Blood Pressure) treated?

The overall goal in treating hypertension is to prevent other health related complications and death from hypertension related complications. Treating and controlling your hypertension can help prevent damage to your heart, brain, kidneys, blood vessels, and eyes. For individuals who don't have other medical or health conditions such as diabetes or heart failure, typically the goal is to lower systolic blood pressure to less than 140 and the diastolic blood pressure to less than 90 ("less than 140 over 90"). For individuals with other medical conditions, blood pressure goals are lower and are determined by your doctor. For instance, the blood pressure goal for most people with diabetes is a systolic less than 130 and a diastolic less than 80 (“less than 130 over 80”).

For individuals who have pre-hypertension, it is critical to adopt a healthy lifestyle to prevent high blood pressure. These lifestyle modifications include weight reduction, eating a healthy diet (called the “DASH" eating plan), increasing your amount of physical activity, and limiting alcoholic beverages. You can get more information about lifestyle modifications in the Helping Yourself section above.

For individuals with hypertension, lifestyle modifications as mentioned above are important but many times, medications will also be needed to adequately manage blood pressure. Many types of drugs are used to lower blood pressure. The initial drug choice is determined by your stage of hypertension (or how high your blood pressure is) and whether you have other health conditions that would affect the drug choice. (See the table below titled “Options for Individualizing Antihypertensive Therapy”for more information.)

Options for Individualizing Antihypertensive Drug Therapy

If you have:

Then your doctor may prescribe one of the following:

Diabetes mellitus ACE Inhibitors, ARBs, Diuretics, Beta Blockers, Calcium Channel Blockers
Heart failure
Diuretics, Beta Blockers, ACE Inhibitors, ARBs, spironolactone
Heart attack Beta Blockers, ACE Inhibitors, spironolactone
Isolated systolic hypertension (elevated systolic only) Diuretics, certain Long-acting Calcium Channel Blockers
Kidney Disease ACE Inhibitors, ARBs
Recurrent Stroke Prevention Diuretics, ACE Inhibitors

* You can learn more about the drug classes listed in the above table by clicking on the drug class links at the bottom of the page.

For hypertension that isn't controlled by diet and exercise, new treatment guidelines for hypertension recommend that most patients be started on a thiazide-type diuretic, unless there is a compelling need for a different class of medications (for example, if another health condition is present, that would affect drug choice as listed above).

Thiazide diuretics are useful in achieving blood pressure control. They have been proven to enhance effectiveness of other antihypertensive medications when used in combination, and are typically more affordable than other antihypertensive medications.

Patients with Stage 1 hypertension are generally started on a thiazide-type diuretic, but ACE Inhibitors, angiotensin II receptor blockers (ARBs), beta blockers, calcium channel blockers, or combinations of different classes can also be considered. Patients diagnosed with Stage 2 hypertension typically need a combination of two drugs usually consisting of a thiazide diuretic along with an ACE Inhibitor, an ARB, a beta blocker or a calcium channel blocker to adequately lower their blood pressure. However, the treatment guidelines are meant only to be a guide. Your healthcare provider is in the best position to design a drug therapy regimen to manage your hypertension.

If the initial drug regimen does not achieve the goal blood pressure, your healthcare provider may change your regimen by increasing your dosage or by adding additional antihypertensive medications until your goal blood pressure is achieved. Many patients eventually require two or more drugs to effectively control their blood pressure. Some patients may even require four or five medications to control their blood pressure.

It is important to remember that everyone can respond to antihypertensive medications differently. What works for others may not work for you and vice versa. It is sometimes necessary for a doctor to prescribe different antihypertensive medications until the best regimen for you is found.

More severe hypertension may require the use of drugs called "vasodilators", which widen arteries, allowing blood to flow more easily and thus, lowering blood pressure. Oral vasodilators, such as hydralazine and minoxidil, are often used together with diuretics and other drugs that reduce fluid retention. Clonidine, another type of antihypertensive, may also be utilized.

Hypertension is typically a lifelong condition. However, in some patients-- especially those who have made lifestyle modifications such as losing weight-- may be able to modify their antihypertensive medication regimen after hypertension has been controlled for at least one year. In so-called "Step-Down" therapy the number of drugs being used, their dosages, or both are gradually reduced to see if blood pressure can remain controlled. The goal is to maintain blood pressure control using the lowest dosage of the least number of medications possible. The key though is to keep blood pressure at or under goal. Not all patients are able to "Step Down" from their antihypertensive therapy. Making lifestyle changes (see "Helping Yourself" above) may help increase the likelihood of successful "Step Down" therapy.

Drug classes used to treat Hypertension (High Blood Pressure)

ACE-Inhibitor and Calcium Channel Blocker Combination

ACE-Inhibitor and Diuretic Combination


Alpha Blockers

Alpha-2 Agonists

Angiotensin II Receptor Blocker and Diuretic Combinations

Angiotensin II Receptor Blockers

Beta Blockers

Calcium Channel Blockers

Combined Alpha and Beta Blockers




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