Hypertension (High Blood Pressure) Treatment

What is Hypertension?

Hypertension is another term for high blood pressure.  Blood pressure goals vary depending on your age and presence of other medical conditions.  For example, the current recommendation for adults age > 60, who have no chronic kidney disease or diabetes, is a goal blood pressure below 150/90 mmHg.  For all other adults, including those with chronic kidney disease and diabetes, the goal blood pressure is less than 140/90 mmHg.

Hypertension is exceedingly common in the United States and can lead to heart attack, stroke, kidney disease, and eye disease.  Given the importance of this condition, it is critical for patients to recognize its causes, diagnosis, and treatment.  By the end of this article, you will know the answers to these important questions:

What causes Hypertension?

Hypertension is generally classified as primary hypertension or secondary hypertension.  Primary hypertension – otherwise known as benign essential hypertension – is the most common (> 90% of cases).  We don’t know exactly what causes it, but it is most likely related to genetic (family history) and environmental factors (e.g., high-salt diet).

Secondary hypertension is high blood pressure caused by certain conditions.  These conditions can include:

  • Chronic kidney disease
  • Renovascular hypertension
  • Hyperthyroidism
  • Primary hyperaldosteronism
  • Coarctation of the aorta
  • Chronic alcohol use or illicit drug use
  • Sleep apnea
  • Pheochromocytoma

A diet high in sodium can contribute to high blood pressure.  Paradoxically, your doctor can even cause high blood pressure – this is otherwise known as “white coat hypertension.”  There are also certain medications that can cause high blood pressure, some of which include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Adderall (amphetamine and dextroamphetamine) - for attention deficit hyperactivity disorder (ADHD)
  • Sudafed (pseudoephedrine) - for nasal congestion
  • Corticosteroids (e.g., prednisone) & oral contraceptives
  • Effexor XR (venlafaxine) - for depression

How common is Hypertension?

Hypertension is very common in adults, affecting nearly 30% of the United States adult population.  It is especially prevalent in older adults – more than 65% of adults age 60 years or older have hypertension.

A large part of this high prevalence is likely due to the Western diet and obesity pandemic.  In fact, one important aspect of hypertension management is dieting and exercise.

What are the symptoms and signs of Hypertension?

Hypertension is sometimes referred to as the “silent killer” because it frequently causes no symptoms.  If your blood pressure is significantly elevated, you may develop:

  • Headache
  • Changes in vision
  • Chest pain
  • Leg swelling

And as we mentioned, high blood pressure can result in stroke and heart attack.

Blood pressure goals vary depending on your age and whether you have other medical conditions.  Adults age > 60, who have no chronic kidney disease or diabetes, should have a goal blood pressure below 150/90 mmHg.  For all other adults, including those with chronic kidney disease and diabetes, the goal blood pressure is less than 140/90 mmHg.

How is Hypertension diagnosed?

Hypertension is diagnosed by measuring your blood pressure in both arms.  This is usually done in the physician’s office, but can also be performed by the patient with the use of home automated blood pressure machines.  The problem with blood pressure machines is that sometimes they are not as accurate as manual blood pressure readings with a sphygmomanometer.  This is especially true of wrist blood pressure monitors.

The key to diagnosing high blood pressure is getting multiple blood pressure values and averaging them.  It is best to have your blood pressure check at the same time of the day, preferably in the morning.  You should be in a quiet room and sit and relax for 5 minutes before having your blood pressure checked.  When checking your blood pressure, your arm should be passively held at heart level.

Your doctor will probably order an EKG in addition to blood tests, including a complete blood cell count, comprehensive metabolic panel, thyroid function, cholesterol, and urine analysis.  Another test may be ordered depending on their suspicion for secondary hypertension.

How is Hypertension treated?

The treatment of benign essential hypertension usually begins with dietary and lifestyle changes.  In men, alcohol consumption should not exceed 2 drinks per day, and in women no more than 1 drink per day.  Most nutritionist and doctors recommend that you incorporate fruits and vegetables in the diet and that you limit or reduce your sodium (salt) intake.  Regular exercise, at least 30 minutes of moderate intensity activity, 3 times a week has been associated with blood pressure reduction.

Sometimes diet and exercise are not enough and medications are prescribed to lower your blood pressure.  There are several classes of blood pressure medications, including:

  • Diuretics
    • Hydrodiuril (hydrochlorothiazide)
    • Lasix (furosemide)
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin receptor blockers
  • Calcium channel blockers
    • Norvasc (amlodipine)
    • Adalat (nifedipine)
  • Beta-blockers
    • Lopressor (metoprolol)
    • Coreg (carvedilol)

Beta-blockers are not typically prescribed as a first-line blood pressure medication unless there is another condition that may benefit from its use – such as atrial fibrillation or systolic heart failure.  Beta-blockers have actually been shown to increase the risk for falls in the elderly and should generally be avoided in this population.

 

Hypertension Patient Summary:

Hypertension is an extremely common condition in the United States, particularly in people older than age 60.  Most cases are classified as being benign essential hypertension, which is likely caused by genetic and environmental factors.  Secondary causes of hypertension include chronic kidney disease, renovascular hypertension, hyperthyroidism, primary hyperaldosteronism, and coarctation of the aorta. 

Hypertension is often asymptomatic, but may cause symptoms such as a headache, chest pain, visual changes, and swelling in the legs.  It is also a common risk factor for stroke, heart attack, and kidney disease.  The diagnosis of hypertension is made my measuring blood pressure in both arms in at least two separate occasions.  Blood pressure should ideally be measured after sitting in a quiet room for 5 minutes and having the arm passively held at heart level. 

Adults age > 60, who have no chronic kidney disease or diabetes, should have a goal blood pressure below 150/90 mmHg.  For all other adults, including those with chronic kidney disease and diabetes, the goal blood pressure is less than 140/90 mmHg.

Your doctor may order blood and urine tests, in addition to an EKG.  The treatment of hypertension includes diet and exercise.  Commonly prescribed medications include diuretics, ACE inhibitors, ARBs, calcium channel blockers, and beta-blockers.

References:

  1. Kovell LC, Ahmed HM, Misra S, et al. US Hypertension Management Guidelines: A Review of the Recent Past and Recommendations for the Future. J Am Heart Assoc. 2015 Dec 7;4(12).
  2. Armstrong C. JNC8 guidelines for the management of hypertension in adults. Am Fam Physician. 2014 Oct 1;90(7):503-4.

 

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.