Hypertension

What is high blood pressure?

Blood pressure more than 140 mmhg systolic and more than 90 mmhg diastolic is called hypertension

Hypertension is the most common chronic condition treated by family physicians. Elevated blood pressure is associated with an increased risk of heart failure, myocardial infarction, cerebrovascular disease, and death. Treatment of hypertension reduces the risk of these events.

Why is it important to treat high blood pressure?

Treatment is important because having high blood pressure increases your risk of heart attack, stroke, and heart failure.

How is it detected?

Your doctor can measure your blood pressure with a blood pressure cuff that goes around your arm.

What causes it?

No one knows for sure. However, the following factors can increase your risk:

  • Older age. Men older than 55 years and women older than 65 years are at increased risk.
  • Race. Blacks develop high blood pressure more often than other races.
  • A relative with high blood pressure, heart disease, or stroke.
  • Obesity.
  • Not getting enough exercise.
  • Drinking too much alcohol.
  • Using tobacco products.
  • Eating an unhealthy diet. Eating foods that have too much salt (sodium) or not enough potassium can increase your risk of high blood pressure.

How is it treated?

Treating high blood pressure starts with making changes in your lifestyle, such as exercising more, eating healthier food, and, if necessary, losing weight and quitting smoking. If your blood pressure is still too high after you do these things, you might need to take medicine to lower your blood pressure. These medicines need to be taken every day. It is important to get regular checkups so your doctor can make sure the medicines are working.

 

Treatment option:

  1.  lifestyle modifications are associated with improvements in blood pressure, including the Dietary Approaches to Stop Hypertension diet, sodium restriction, regular exercise, and moderate weight loss. There is strong evidence that reducing diastolic blood pressure to less than 90 mm Hg is beneficial in adults older than 30 years. Although there is good evidence to support reducing systolic blood pressure to less than 150 mm Hg in adults older than 60 years, the evidence in younger adults is insufficient to recommend a specific goal.
  2. Medication:• In the general population, pharmacologic treatment should be initiated when blood pressure is 150/90 mm Hg or higher in adults 60 years and older, or 140/90 mm Hg or higher in adults younger than 60 years.• In patients with hypertension and diabetes, pharmacologic treatment should be initiated when blood pressure is 140/90 mm Hg or higher, regardless of age.
  • Not African-american patients: Thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers are the preferred medication.
  • African-american patients : thiazide diuretics and calcium channel blockers are preferred
  •  African-american patients with chronic kidney disease who are treated with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to a blood pressure of less than 140/90 mm Hg experience slower declines in glomerular filtration rates than patients treated with other medications. A blood pressure goal of less than 140/90 mm Hg is recommended in patients with chronic kidney disease and in those with diabetes mellitus.

Types of Medications for Hypertension

There are several categories of hypertension medications. Often, two or more drugs work better than one. The main categories of medications for hypertension include:
 

Angiotensin-Converting Enzyme Inhibitors vs. Angiotensin Receptor Blockers:

Evidence-Based Answer

ACE inhibitors should be used in patients with hypertension because they reduce all-cause mortality, whereas ARBs do not. (Strength of Recommendation [SOR]: A, based on a meta-analysis.) ARBs are preferred for patients who have adverse reactions to ACE inhibitors. (SOR: A, based on a meta-analysis.) ARBs cause less cough than ACE inhibitors, and patients are less likely to discontinue ARBs because of adverse effects. ACE inhibitors and ARBs may be used in patients with vascular disease or diabetes mellitus with end-organ damage because they produce equal reductions in mortality and hospital admissions. (SOR: B, based on a randomized controlled trial [RCT].)

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