Conventional Treatment of High Blood Pressure

Treating high blood pressure can help prevent serious and life-threatening complications. A doctor also may suggest steps to control conditions that can contribute to high blood pressure, such as diabetes and high cholesterol.

Evidence suggests that reduction of the blood pressure by 5 to 6mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 15-20%, and reduces the likelihood of dementia, heart failure, and mortality from vascular disease.

Blood pressure goals are not the same for everyone. Although everyone should strive for blood pressure readings below 140/90mmHg, doctors recommend lower readings for people with certain conditions. The goal is 130/80mmHg if the patient has or has had chronic kidney disease or diabetes.

Lifestyle changes: Lifestyle changes can help control and prevent high blood pressure. Even if the individual is diagnosed with high blood pressure, lifestyle changes can still help prevent further damage to blood vessels and the heart.

Healthy foods: Experts recommend using the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium (as in bananas and green leafy vegetables such as spinach), which can help prevent and control high blood pressure. Eat less saturated fat (animal fat) and total fat. Limit the amount of sodium (salt) in the diet. Although 2,400 milligrams of sodium a day is the current limit for otherwise healthy adults, limiting sodium intake to 1,500 milligrams a day will have a more dramatic effect on blood pressure. Look at the food labels to determine sodium content. If cooking at home, use less salt or a salt substitute (contains potassium iodide, which does not increase blood pressure).

Healthy body weight: If an individual is overweight, losing even five pounds can lower blood pressure. Eating healthy and exercising regularly can help lower weight. No eating between meals and late at night also help decrease weight gain.

Physical activity: Regular physical activity can help lower blood pressure and keep weight under control. Individuals should strive for at least 30 minutes of moderate physical activity a day.

Alcohol consumption: Alcohol can raise the blood pressure even in a healthy person. If an individual chooses to drink alcohol, they should do so in moderation. One drink a day for women and two drinks a day for men should not be exceeded. Consumption of red wine, which has heart healthy components, is better than other types of spirits.

Smoking cessation: Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. A doctor can help an individual choose the right method of smoking cessation (stopping).

Stress management: Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too. Practice slow, deep breathing. In various clinical trials, regular use of Resperate ®, an over-the-counter device approved by the U.S. Food and Drug Administration (FDA) to analyze breathing patterns and help guide inhalation and exhalation, significantly lowered blood pressure. It is used for fifteen minutes daily several times a week.

Changing the lifestyle can help control high blood pressure. But sometimes lifestyle changes are not enough. In addition to diet and exercise, a doctor may recommend medication to lower blood pressure. Which category of medication the doctor prescribes depends on the stage of high blood pressure and whether there are other medical conditions.

Diuretics: These medications act on the kidneys to help the body eliminate sodium and water, thereby reducing blood volume. Thiazide diuretics, including hydrochlorothiazide (HCTZ or Hydrodiuril ®), is often the first choice of medicine in treating high blood pressure. In a 2006 study, diuretics were a key factor in preventing heart failure associated with high blood pressure. Adverse effects of thiazide diuretics include sexual dysfunction, glucose intolerance, gout, elevated potassium level, and low sodium level (hyponatremia). Other diuretics include loop diuretics such as furosemide (Lasix ®) and bumetanide (Bumex ®), and potassium-sparing diuretics (keep potassium from being depleted from the body) including amiloride (Midamor ®) and triamterene (Maxzide ®).

Beta blockers: These medications reduce the workload on the heart, causing the heart to beat slower and with less force. When prescribed alone, beta blockers don't work as well in African Americans, but they're effective when combined with a thiazide diuretic in these individuals. Beta blockers include propranolol (Inderal ®), metoprolol (Lopressor ®, Toprol ®) or atenolol (Tenormin ®). Side effects associated with the use of beta blockers include nausea, diarrhea, bronchospasm (spasm of the bronchial tubes), dyspnea (difficulty breathing), cold extremities (fingers, toes), bradycardia (slow heat rate), hypotension (low blood pressure), fatigue (tiredness), dizziness, abnormal vision, decreased concentration, hallucinations, insomnia (difficulty sleeping), nightmares, depression, sexual dysfunction (lack of interest in sex), erectile dysfunction (inability to achieve or maintain an erection in men), and/or alteration of glucose and cholesterol metabolism. These drugs may worsen blood glucose control, elevate triglyceride levels, and lower high-density lipoprotein (HDL, or "good" cholesterol).

Angiotensin converting enzyme inhibitors (ACE inhibitors or ACEI): Oral angiotensin converting enzyme inhibitors (ACE inhibitors), including lisinopril (Prinivil ®, Zestril ®), benazepril (Lotensin ®), captopril (Capoten ®), and enalapril (Vasotec ®), dilate blood vessels and increase oxygen to the heart. Angiotensin is made when the kidneys receive a signal to raise blood pressure. ACE inhibitors prevent or reduce the production of angiotensin, which keeps vessels from narrowing and helps them relax. This relaxation lowers blood pressure and increases the supply of blood and oxygen to the heart. ACE inhibitors may be especially important in treating high blood pressure in people with coronary artery disease, heart failure or kidney failure. Like beta blockers, ACE inhibitors do not work as well in African Americans when prescribed alone, but seem to be more effective when combined with a thiazide diuretic such as hydrochlorothiazide. Contra-indications to ACE inhibitor use include hypotension (low blood pressure) and declining kidney function with ACE inhibitor use. The use of an ACE inhibitor four to six weeks after a heart attack is recommended for patients with congestive heart failure, left ventricular dysfunction, hypertension (high blood pressure), or diabetes.

Angiotensin II receptor blockers (ARBs). ARBs work similarly to ACE inhibitors. However, instead of inhibiting the production of the angiotensin enzyme in the kidneys, they block the effects of angiotensin on cell receptor membranes. They are more effective than ACE inhibitors in treating some people who have high blood pressure. They are particularly useful for treating high blood pressure in individuals who cannot tolerate ACE inhibitors well. ARBs include irbesartan (Avapro ®), candesartan (Atacand ®), and losartan (Cozaar ®). Adverse effects of ARBs can include headache, drowsiness, diarrhea, and a metallic or salty taste in the mouth.

Calcium channel blockers (CCBs). CCBs affect the transport of calcium into the cells of the heart and blood vessels, causing blood vessels to relax. This relaxation increases the blood and oxygen supply to the heart, lowers blood pressure, and reduces the heart's workload. CCBs include amlodipine (Norvasc ®), felodipine (Plendil ®), nicardipine (Cardene ®, Carden SR ®), and nifedipine (Procardia ®, Adalat ®). Physicians often recommend CCBs to treat high blood pressure in women who have pregnancy-induced high blood pressure, elderly patients, patients who have a history of angina (chest pain), or patients of African or Caribbean descent. CCBs are not a good choice for patients who have had a heart attack or who have congestive heart failure. Adverse effects of CCBs include constipation, swelling of the lower part of the legs, flushing, or headache.

Alpha blockers: Alpha blockers (also called alpha-adrenergic blocking agents) block alpha receptors in vascular smooth muscle (including blood vessels), preventing the uptake of catecholamines (brain hormones such as epinephrine), which are produced in response to stress. This blocking mechanism permits blood vessel dilation (relaxing) and allows blood to flow more freely. Alpha blockers are not advised for those who have a history of (or are at risk for) congestive heart failure (CHF). Alpha blockers include doxazosin (Cardura ®), prazosin (Minipress ®), and terazosin (Hytrin ®). Alpha blockers tend to interfere with the blood pressure regulating adjustments the body has to make when a person goes from sitting or lying down to standing. Individuals using alpha blockers may experience a drop in blood pressure (called orthostatic hypotension) when they go from sitting or lying down to standing. Other common adverse effects include stuffy nose and dizziness.

Alpha-beta blockers: In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels (acting like both alpha blockers and beta blockers). Alpha-beta blockers include carvedilol (Coreg ®) and labetolol (Normodyne ® and Trandate ®). Side effects include those similar to both alpha and beta blockers.

Centrally acting agents: Central alpha agonists lower blood pressure by stimulating alpha-receptors in the brain that open peripheral arteries easing blood flow. Central alpha agonists include clonidine (Catapres ®), guanabenz (Wytensin ®), and methyldopa (Aldomet ®). Adrenergic neuron blockers decrease the amount of brain neurochemicals (epinephrine, dopamine) available, and include reserpine (Serpasil ®) and guanethedine (Ismelin ®). Both centrally acting drugs are usually prescribed when all other anti-hypertensive medications have failed.

Vasodilators: These medications work directly on the muscles in the walls of the arteries, preventing the muscles from tightening and the arteries from narrowing. Oral vasodilators include hydralazine (Apresoline ®). The vasodilators only used in medical emergency hypertension include sodium nitroprusside (Nipride ®) and nitroglycerin.

Once the blood pressure is under control, a doctor may add low dose aspirin (81 milligrams) to the therapy to reduce the risk of coronary heart disease (CHD). Aspirin is a platelet inhibitor and helps platelets from "clumping" together and blocking blood vessels, which could increase blood pressure.

To reduce the number of doses needed a day, which can reduce side effects, a doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. These are commonly used antihypertensive drugs (such as ACE inhibitor and beta blockers) combined with the thiazide diuretic hydrochlorothiazide (HCTZ). Companies manufacture drugs that combine HCTZ and ACE inhibitors, including prinizide (lisinopril plus HCTZ) and Capozide (captopril plus HCTZ). Studies report that using an antihypertensive drugs combined with a thiazide diuretic reduces costs and may increase effectiveness against high blood pressure.

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