High Blood Pressure Prevention and Treatment
Prevention and treatment of high blood pressure
Lifestyle modifications refer to certain specific recommendations for changes in habits, diet and exercise. These modifications can lower the blood pressure as well as improve a patient's response to blood pressure medications. In about half of people with high blood pressure, limiting sodium intake by eliminating table salt, cooking salt, and salty and processed foods can reduce blood pressure by 5 mm Hg. Losing weight and doing regular physical activity can reduce the blood pressure further.
The following strategies may help to prevent high blood pressure and organ damage it may cause.
- Eat healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat. Limit the amount of sodium in your diet. Although 2,400 mg of sodium a day is the current limit for otherwise healthy adults, limiting sodium intake to 1,500 mg a day will have a more dramatic effect on your blood pressure.
- Exercise regularly. Being physically active is one of the most important steps you can take to prevent or control high blood pressure. It also helps reduce your risk of heart disease. For example, activities such as jogging, bicycle riding, or swimming for 30 to 45 minutes daily may ultimately lower blood pressure by as much as 5 to15 mm Hg.
- Maintain a healthy weight. Obesity is common among hypertensive patients, and its prevalence increases with age. In fact, obesity may be what determines the increased incidence of high blood pressure with age. Obesity can contribute to hypertension in several ways. It leads to a greater output of blood because the heart has to pump out more blood to supply the excess tissue. The increased cardiac output then can raise the blood pressure. Obese hypertensive individuals have a greater stiffness in their peripheral arteries throughout the body. Obesity may be associated with a tendency for the kidneys to retain salt. Weight loss may help reverse problems related to obesity while also lowering the blood pressure. It has been estimated that the blood pressure can be decreased 0.32 mm Hg for every 1 kg (2.2 pounds) of weight lost down to ideal body weight for the individual.
- Alcohol. Drinking too much alcohol can raise blood pressure. It also can harm the liver, brain, and heart. Alcoholic drinks also contain calories, which matter if you are trying to lose weight. If you drink alcoholic beverages, have only a moderate amount — one drink a day for women; two drinks a day for men. People who drink alcohol excessively (over two drinks per day) have a one and a half to two times increase in the prevalence of hypertension.
- Stop smoking. Smoking injures blood vessel walls and speeds up the process of hardening of the arteries. This applies even to filtered cigarettes. So even though it does not cause high blood pressure, smoking is bad for anyone, especially those with high blood pressure. If you smoke, quit. If you don't smoke, don't start. Once you quit, your risk of having a heart attack is reduced after the first year.
- Get your blood pressure checked periodically. Consider getting an accurate and easy-to-use home monitor.
- Take your blood pressure medications as directed, even if you are feeling fine.
- Reduce stress and practice relaxation. 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. Do it on your own or try device-guided paced breathing. In various clinical trials, regular use of Resperate - an over-the-counter device approved by the Food and Drug Administration to analyze breathing patterns and help guide inhalation and exhalation - significantly lowered blood pressure.
If lifestyle changes alone are not effective in keeping your pressure controlled, it may be necessary to add blood pressure medications. The treatment goal is blood pressure below 140/90 and lower for people with other conditions, such as diabetes and kidney disease.
Diuretics are sometimes called water pills. They are among the oldest known medications for treating hypertension. They work in the tiny tubes (tubules) of the kidneys to remove salt from the body. Water also may be removed along with the salt through urination. Diuretics may be used as single drug treatment (monotherapy) for hypertension. If the desired effects aren't achieved with diuretics alone, low doses of diuretics are used in combination with other anti-hypertensive medications to enhance the effect of the other medications. Some commonly prescribed diuretics include:
- Amiloride (Midamor)
- Bumetanide (Bumex)
- Chlorothiazide (Diuril)
- Chlorthalidone (Hygroton)
- Furosemide (Lasix)
- Torsemide (Demadex)
- Hydrochlorothiazide (Esidrix, Hydrodiuril
- Indapamide (Lozol)
- Spironolactone (Aldactone)
- Metolazone (Zaroxolyn)
- Triamterene and Hydrochlorothiazide (Dyazide)
Some of these drugs may decrease your body's supply of a mineral called potassium. Symptoms such as weakness, leg cramps or being tired may result. Eating foods containing potassium may help prevent significant potassium loss. You can prevent potassium loss by taking a liquid or tablet that has potassium along with the diuretic, if your doctor recommends it. Diuretics such as amiloride (Midamar), spironolactone (Aldactone) or triamterene (Dyrenium) are called "potassium sparing" agents. They don’t cause the body to lose potassium. They might be prescribed alone but are usually used with another diuretic. Some people suffer from attacks of gout after prolonged treatment with diuretics. This side effect isn't common and can be managed by other treatment. In people with diabetes, diuretic drugs may increase the blood sugar level.
Angiotensin-Converting Enzyme (ACE) Inhibitors
The angiotensin converting enzyme (ACE) inhibitors affect the renin-angiotensin hormonal system, which helps regulate the blood pressure. The ACE inhibitors work by blocking (inhibiting) an enzyme that converts the inactive form of angiotensin in the blood to its active form (angiotensin II). The active form of angiotensin constricts or narrows the arteries, but the inactive form cannot. Thus, ACE inhibitors prevent this narrowing, so your blood pressure goes down. Commonly prescribed ACE inhibitors include:
- Benazepril (Lotensin)
- Captopril (Capoten)
- Enalapril (Vasotec)
- Fosinopril (Monopril)
- Lisinopril (Prinivil, Zestril)
- Moexipril (Univasc)
- Perindopril (Aceon)
- Quinapril (Accupril)
- Ramipril (Altace)
- Trandolapril (Mavik)
With an ACE inhibitor as a single drug treatment, 50 to 60 percent of Caucasians usually achieve good blood pressure control. African American patients may also respond, but they require higher doses and frequently do best when an ACE inhibitor is combined with a diuretic.
As an added benefit, ACE inhibitors may reduce an enlarged heart in patients with hypertension. These drugs also appear to slow the deterioration of kidney function in patients with hypertension and protein in the urine (proteinuria). Moreover, they have been particularly useful in slowing the progression of kidney dysfunction in hypertensive patients with kidney disease resulting from Type 1 diabetes.
These drugs, such as captopril, enalapril, lisinopril, may cause a skin rash; loss of taste; a chronic dry, hacking cough; and in rare instances, kidney damage.
Angiotensin-II Receptor Blockers
Angiotensin-II receptor blockers (ARB) have been shown to produce effects similar to those produced by ACE inhibitors. They may be better tolerated because they produce less cough. Rather than lowering levels of angiotensin II (as ACE inhibitors do), angiotensin II receptor blockers prevent this chemical from having any effects on the heart and blood vessels. This keeps blood pressure from rising. Some common products in this category include:
- Candesartan (Atacand)
- Eprosartan (Teveten)
- Irbesartan (Avapro)
- Losartan (Cozaar)
- Olmesartan (Benicar)
- Telmisartan (Micardis)
- Valsartan (Diovan)
In patients who have hypertension in addition to certain second diseases, a combination of an ACE inhibitor and an ARB drug may be effective in controlling the hypertension and also benefiting the second disease. For example, while treating hypertension, this combination of drugs can reduce the loss of protein in the urine in certain kidney diseases and perhaps help strengthen the heart muscle in certain diseases of the heart muscle.
These drugs may cause occasional dizziness.
The sympathetic nervous system is a part of the nervous system that helps to regulate certain involuntary functions in the body such as the function of the heart and blood vessels. The nerves of the sympathetic nervous system extend throughout the body and exert their effects by releasing chemicals that travel to nearby cells in the body, for example, muscle cells. The released chemicals bind to receptors on the surface of the nearby cells and stimulate or inhibit the function of the cells.
In the heart and blood vessels, the receptors for the sympathetic nervous system that are most important are the beta receptors. When stimulated, beta-receptors in the heart increase the heart rate and the strength of heart contractions. Beta blockers decrease the heart rate and cardiac output, which lowers blood pressure. They're also used with therapy for cardiac arrhythmias and in treating angina pectoris. Some commonly prescribed beta blockers include:
- Acebutolol (Sectral)
- Atenolol (Tenormin)
- Betaxolol (Kerlone)
- Bisoprolol/hydrochlorothiazide (Ziac)
- Bisoprolol (Zebeta)
- Carteolol (Cartrol)
- Metoprolol (Lopressor, Toprol XL)
- Nadolol (Corgard)
- Pindolol (Visken)
- Propranolol (Inderal)
- Sotalol (Betapace)
- Timolol (Blocadren)
Acebutolol, atenolol, metoprolol, nadolol, pindolol, propranolol or timolol may cause insomnia, cold hands and feet, tiredness or depression, a slow heartbeat or symptoms of asthma. Impotence may occur. If you have diabetes and you’re taking insulin, have your responses to therapy monitored closely.
Calcium channel blockers, also known as "calcium antagonists," interrupt the movement of calcium into heart and vessel cells. The calcium is needed for these muscles to contract. These drugs, therefore, lower blood pressure by decreasing the force of the heart's pumping action and relaxing the muscle cells in the walls of the arteries. In addition to high blood pressure, they're also used to treat angina (chest pain) and/or some arrhythmias (abnormal heart rhythms).
Three major types of calcium channel blockers are used. One type is the dihydropyridines, which do not slow the heart rate or cause other abnormal heart rates or rhythms. These drugs include mlodipine, ifedipine, felodipine, and nisoldipine. The other two types of calcium channel blockers are referred to as the non-dihydropyridine agents. One type is verapamil and the other is diltiazem.
Some commonly prescribed calcium channel blockers include:
- Amlodipine (Norvasc, Lotrel)
- Bepridil (Vascor)
- Diltiazem (Cardizem, Tiazac)
- Felodipine (Plendil)
- Nicardipine (Cardene)
- Nifedipine (Adalat, Procardia)
- Nimodipine (Nimotop)
- Nisoldipine (Sular)
- Verapamil (Calan, Isoptin, Verelan)
Diltiazem, nicardipine, nifedipine and verapamil may cause palpitations, swollen ankles, constipation, headache or dizziness. Side effects with each of these drugs differ a great deal.
Alpha-blockers lower blood pressure by blocking alpha-receptors in the smooth muscle of peripheral arteries throughout the tissues of the body. The alpha-receptors are part of the sympathetic nervous system, as are the beta-receptors. The alpha-receptors, however, serve to narrow the peripheral arteries. Accordingly, the alpha-blockers cause the peripheral arteries to widen and thereby lower the blood pressure.
Recent evidence, however, suggests that using alpha-blockers alone as a first line drug choice for hypertension may actually increase the risk of heart-related problems, such as heart attacks or strokes. Alpha-blockers, therefore, should not be used as an initial drug choice for the treatment of high blood pressure.
Some commonly prescribed alpha blockers include:
- Doxazosin mesylate (Cardura)
- Prazosin hydrochloride (Minipress)
- Prazosin and polythiazide (Minizide)
- Terazosin hydrochloride (Hytrin)
These drugs may cause fast heart rate, dizziness or a drop in blood pressure when you stand up.
Central alpha agonists are antihypertensive drugs that work centrally, they stimulate alpha-receptors in the brain. The result of this central stimulation is to decrease the sympathetic nervous system outflow and to decrease the stiffness of the peripheral arteries. Central alpha agonists lower the blood pressure by relaxing the peripheral arteries throughout the body. These drugs are useful as a second or third line drugs choice for lowering blood pressure when other anti-hypertensive medications have failed. Some commonly prescribed central alpha agonists include:
- Clonidine hydrochloride (Catapres)
- Clonidine hydrochloride and chlorthalidone (Clorpres, Combipres)
- Guanabenz Acetate (Wytensin)
- Guanfacine hydrochloride (Tenex)
- Methyldopa (Aldomet)
- Methyldopa and chlorothiazide (Aldoclor)
- Methyldopa and hydrochlorothiazide (Aldoril)
Methyldopa may produce a greater drop in blood pressure when you're in an upright position (standing or walking) and may make you feel weak or faint if the pressure has been lowered too far. This drug may also cause drowsiness or sluggishness, dryness of the mouth, fever or anemia. Male patients may experience impotence. If this side effect persists, your doctor may have to change the drug dosage or use another medication.
Clonidine, guanabenz or guanfacine may produce severe dryness of the mouth, constipation or drowsiness. If you're taking any of these drugs, don’t stop suddenly, because your blood pressure may rise quickly to dangerously high levels.
Combined Alpha and Beta Blockers
Alpha-beta blockers reduce nerve impulses to blood vessels the same way alpha blockers do, but they also slow the heartbeat, as beta blockers do. As a result, blood pressure goes down. Examples:
- Carvedilol (Coreg)
- Labetalol hydrochloride (Normodyne)
People taking these drugs may experience a drop in blood pressure when they stand up.
Direct vasodilators are the most potent of the drugs that lower blood pressure by dilating the peripheral arteries. These drugs do not work through the peripheral sympathetic nervous system or through the control center in the brain. They are muscle relaxants that work directly on the smooth muscle of the peripheral arteries throughout the body. Direct vasodilators are used for patients who have not responded to any other medications. They must be combined with a beta-blocker or clonidine to prevent an increase in the heart rate and with a diuretic to prevent retention of fluid. These medications are often given through an IV line in an emergency (that is, in malignant hypertension). Examples:
- Nitroprusside (Nitropress)
- Diazoxide (Hyperstat)
- Hydralazine (Apresoline)
- Minoxidil (Loniten)
Hydralzine may cause headaches, swelling around the eyes, heart palpitations or aches and pains in the joints. Usually none of these symptoms are severe, and most will go away after a few weeks of treatment. This drug isn't usually used by itself. Minoxidil is a potent drug that's usually used only in resistant cases of severe high blood pressure. It may cause fluid retention (marked weight gain) or excessive hair growth.
Combination Therapy – ACE inihibitor/diuretics
- Benazepril and hydrochlorothiazide (Lotensin)
- Enalapril and hydrochlorothiazide (Vaseretic)
- Lisinopril and hydrochlorothiazide (Prinzide and Zestoretic)
- Moexipril and hydrochlorothiazide (Uniretic)
- Quinapril and hydrochlorothiazide (Accuretic)
Combination Therapy – Angiotensin II receptor antagonist/diuretic
- Irbesartan and hydrochlorothiazide (Avalide)
- Losartan and hydrochlorothiazide (Hyzaar)
- Valsartan and hydrochlorothiazide (Diovan HCT)
Combination Therapy – ACE inihibitor/calcium channel blocker
- Amlodipine and benazepril (Lotrel)
- Enalapril and felodipine (Lexel)
- Trandolapril and verapamil (Tarka)
More information about High Blood Pressure:
