If you have been diagnosed with high blood pressure (hypertension) and treatment for it has to be initiated, your doctor will conduct certain tests to look for any secondary causes of hypertension and to see if hypertension has caused any damage to body organs such as the heart and kidneys.
Treatment will then be initiated with the class of drugs that best suit you. Treatment for high blood pressure is lifelong.
High blood pressure will be diagnosed if your blood pressure reading is equal to or greater than 130/80 mm Hg taken on two or more occasions at separate times.
- A blood pressure of 130/80 mm Hg may not require any medication. Your healthcare provider will ask you to follow dietary restrictions and a prescribed lifestyle.
- At a blood pressure between 130/80 to 139/89 mm Hg (stage 1 hypertension), your doctor will ask you to try lifestyle corrections first before starting medication.
- At a blood pressure of 140/90 or higher (stage 2 hypertension), your doctor will likely prescribe drugs and ask you to follow lifestyle corrections.
- Systolic blood pressure above 180 mmHg or diastolic pressure above 120 mmHg is a hypertensive emergency and requires hospitalization.
Before going for a blood pressure check, avoid drinking caffeinated beverages, exercising or doing any physical activity, and smoking cigarettes or using any tobacco products at least 30 minutes prior.
A low-sodium DASH diet prescribed for hypertension will improve your increased blood pressure in a couple of weeks if you are not overweight or obese. A regular exercise regime along with diet will see a good improvement within a couple of weeks if you are not obese.
If you’re overweight, losing even about 2 kilograms can lower your blood pressure. It takes about 1 to 3 months for regular exercise to have a positive effect on blood pressure and this benefit will last only as long as you continue to exercise.
According to American Heart Association Journals,
“The Trial of Hypertension Prevention (TOHP), one of the largest of these studies, included a weight loss intervention arm. In this instance, a 2-kg loss in weight over a 6-month period resulted in a decline of 3.7 mm Hg in systolic and 2.7 mm Hg in diastolic blood pressure.”
Diagnostic tests for high blood pressure
Lab tests, imaging studies, and other tests can assist in the diagnosis of hypertension-associated causes and complications.
Blood Tests
Blood tests will help to determine if your hypertension is secondary or primary (essential). Blood tests that may be requested include:
- Serum electrolyte levels to check for levels of sodium and potassium
- Blood glucose fasting and postprandial to check for the presence of coexisting diabetes
- Thyroid function tests
- Kidney function tests to know levels of BUN and creatinine – to check for kidney function
- Lipid profile to check for levels of cholesterol and triglycerides
Urine Tests
Urine tests can help determine if diabetes or kidney problems are contributing to your high blood pressure. Even small amounts of albumin in the urine can indicate kidney disease.
A urine albumin-to-creatinine ratio test is a common test to look for albuminuria (high albumin levels), especially if you are at high risk for kidney disease due to hypertension or diabetes.
Electrocardiogram (EKG)
An EKG or ECG is a simple noninvasive test that assesses your heart rhythm and function. Abnormalities in heart rhythm can cause high blood pressure and similarly, hypertension can produce cardiac changes that lead to heart rate abnormalities.
Echocardiogram
An echocardiogram is an imaging test that pictures your heart as it expands and contracts. It can detect cardiac complications of hypertension and also heart changes that can cause hypertension.
Ultrasound
An abdominal and pelvic ultrasound is done to assess kidney problems and rule out renal artery stenosis. Especially, those who have high blood pressure that seems resistant to medication and lifestyle changes may be asked to undergo a renal artery ultrasound.
CT Scan or MRI
A tumor of the adrenal glands or kidney can cause secondary hypertension. A CT scan or MRI is an imaging test to diagnose or rule out such a tumor.
Treatment
High blood pressure can lead to serious health problems like heart disease, stroke, and kidney damage if left untreated. Therefore, when detected, prompt medical intervention should be sought.
Management of hypertension must involve a combination of natural lifestyle corrections and medications (if necessary). Sometimes, mild hypertension can be controlled by lifestyle and dietary corrections and medication may not always be necessary.
There are a host of hypertension drugs available and there is no set standard for using them in hypertension treatment. Each individual has his own medical status such as the severity of hypertension, any underlying health issues, and the presence of risk factors and the doctor will prescribe what suits him best.
1. Lifestyle Changes and Home Remedies
For many people, home remedies such as lifestyle corrections are vital in managing their hypertension, and they can often eliminate the need for medication. In people who require medication to control their hypertension, lifestyle changes can help lower their dose of medication.
Key lifestyle changes include:
- The DASH Diet is specially formulated for people with high blood pressure. In brief, the DASH diet focuses on:
- Reduced sodium intake. According to the American Heart Association, you should limit salt consumption to less than 2,300 mg per day, and ideally, those with high blood pressure should aim at an intake of less than 1,500 mg per day.
- Eat a balanced diet. Your diet should focus on fruits, vegetables, whole grains, lean proteins, and low-fat dairy products.
- Increase potassium intake. Potassium helps the kidneys remove excess sodium through the urine and balance out the sodium levels in the body. Potassium also reduces the effect of angiotensin on the blood vessel receptors and causes vasodilation of the blood vessels. All these factors help reduce blood pressure. Foods rich in potassium include bananas, oranges, spinach, and sweet potatoes.
- Limit alcohol and caffeine. Excessive consumption of alcohol and caffeine can raise blood pressure. For the same reason, avoid energy drinks.
- Regular exercise. You should aim for a minimum of 30 minutes of aerobic activity such as brisk walking, along with weight-bearing exercises at least 5 days a week. Besides making your heart stronger, regular exercise benefits on health are tremendous. A stronger heart can then pump more blood with less effort. This decreases the pressure in the arteries and lowers your blood pressure.
- Maintain a healthy weight. Obesity is an independent risk factor for hypertension. If you are overweight or obese, losing just 5 kg of weight will start lowering your blood pressure. It may reduce the dose of blood pressure meds and can even make some people medication-free.
- Manage your stress. Stress increases the levels of hormones like cortisol and adrenaline, which causes an increase in heart rate and constriction of blood vessels thereby increasing blood pressure over time. According to the National Library of Health, there is growing evidence that exposure to chronic mental stress can contribute to the development of hypertension. Manage stress with relaxation techniques like meditation, yoga, and deep breathing.
- Quit smoking. Smoking is also an independent risk factor for hypertension, heart attack, and stroke. It damages the walls of the arteries facilitating the deposit of cholesterol plaques (Atherosclerosis), which causes the lumen of the arteries to narrow, thereby causing the pressure of blood in the arteries to increase. It also increases the risk of blood clot formation. Quitting smoking forms a crucial part of these lifestyle corrections.
2. Medications
Most people suffering from hypertension are required to take drugs to control blood pressure because lifestyle changes alone aren’t enough to do it.
The medication of choice depends on factors like the severity of hypertension, the presence of associated health conditions such as diabetes, obesity, and lipidemia, and the potential side effects of the drugs.
Antihypertensive drugs are classified as follows:
- Diuretics (e.g., hydrochlorothiazide, chlorthalidone). Diuretics, also called water pills, get rid of excess sodium and water from the body, which helps to lower blood pressure. They are often used along with other antihypertensive medications.
- ACE inhibitors (e.g., lisinopril, enalapril). ACE (angiotensin-converting enzyme) inhibitors block the action of angiotensin, which causes the blood vessels to narrow. By blocking the action of angiotensin, ACE inhibitors cause the blood vessels to relax, which causes the blood pressure to lower. They are preferred for use in patients with heart failure or kidney problems.
- Angiotensin II receptor blockers (ARBs) (e.g., losartan, valsartan). ARBs block the action of the hormone angiotensin II, which has a powerful vaso-constritive effect and raises blood pressure. Angiotensin II also increases salt and water retention in the body, which further increases blood pressure. By blocking the action of the hormone angiotensin 2, ARBs have a lowering effect on raised blood pressure.
- Calcium channel blockers (e.g., amlodipine, diltiazem). Calcium causes the heart and arteries to contract with more force. Calcium channel blockers block the movement of calcium into the cells of the heart and blood vessel walls. This corrects the extra-forceful action of the heart and causes the arteries to relax.
- Beta-blockers (e.g., metoprolol, atenolol). Beta-blockers block the effects of the hormone epinephrine (adrenaline). This action causes the heart to beat more slowly and with less force, which causes a lowering of blood pressure.
- Alpha-blockers (e.g., doxazosin). Alpha-blockers block the action of norepinephrine, which causes the tightening of the muscles in the walls of smaller arteries and veins causing vasoconstriction and higher blood pressure. By blocking this action, alpha-blockers are able to relax the blood vessels and lower blood pressure.
- Direct renin inhibitors (e.g., aliskiren). Renin, an enzyme produced by the kidneys, works together with angiotensin and aldosterone to raise blood pressure. It does this by narrowing the blood vessels and causing salt retention. Direct renin inhibitors slow down the production of renin produced by the kidneys. This also causes inhibition of angiotensin and aldosterone production, which produces a drop in blood pressure. Due to the risk of serious complications, renin inhibitors are not used with ACE inhibitors or ARBs.
- Vasodilators (e.g., hydralazine, minoxidil). These drugs have a direct action on the walls of the arteries, which causes them to dilate resulting in blood pressure reduction.
What are the most commonly prescribed blood pressure medications?
The following anti-hypertensive drugs are most effective either alone or if required in combination.
- First-choice options include: Thiazide diuretics and calcium channel blockers
- For people who have kidney disease and heart failure: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs).
- Beta-blockers may also be the drug of choice if you have a history of heart disease.
How to best look after yourself when you are diagnosed with hypertension?
- Firstly, follow the lifestyle corrections regularly and religiously.
- Secondly, stick to the DASH diet as prescribed.
- Thirdly, check your blood pressure regularly. You can do it at home with a digital blood pressure monitor. This is to confirm that the meds you are taking are keeping your blood pressure under control.
- Go for tests, when your doctor asks. This will help confirm the health of the organs such as the heart and the kidneys and whether hypertension has caused any complications.
Combination therapy for hypertension
According to a study, in patients where monotherapy is not effective in giving optimal results, a combination of blood pressure medications is more effective (about five times greater) in lowering a person’s blood pressure than simply doubling the dose of the single medication.
According to The New England Journal of Medicine, the risk of hypertension complications such as stroke, heart attack, and premature cardiovascular death are much reduced with combination therapy when a calcium channel blocker such as amlodipine is used with an ACE inhibitor like benazepril or an ARB.
This combination therapy is facilitated by the availability of many single-pill combinations (single tablets that contain two or more medications).
Furthermore, if the blood pressure remains elevated with combination therapy using a calcium channel blocker plus an ACE inhibitor or ARB drug, a thiazide drug will usually be added as a third drug.
If this three-drug combination fails to control the blood pressure, a fourth drug (usually spironolactone, a non-thiazide diuretic) can be added.