Hypertension - Treatment & Diet

An intermittent or a sustained elevation in diastolic or systolic blood pressure, hypertension occurs as two major types: essential (idiopathic) hypertension, the most common, and secondary hypertension, which results from kidney disease or another identifiable cause. Malignant hypertension is a severe, fulminant form of hypertension common to both types.

Hypertension is a major cause of cerebrovascular accident (CVA), heart disease, and renal failure. The prognosis is good if this disorder is detected early and if treatment begins before complications develop. Severely elevated blood pressure (hypertensive crisis) may be fatal.

Causes

In some people, the system that regulates blood pressure goes awry: arterioles throughout the body stay constricted, driving up the pressure in the larger blood vessels. Sustained high blood pressure - above 140/90 mm Hg , according to most experts - is called hypertension. About 90 percent of all people with high blood pressure have "essential" hypertension - meaning that it has no identifiable cause. In the remaining 10 percent of cases, the elevated blood pressure is due to kidney disease, diabetes, or another underlying disorder.

Risk factors

Family history, race (most common in blacks), stress, obesity, a high intake of saturated fats or sodium, use of tobacco, sedentary lifestyle, and aging are risk factors for essential hypertension.

Signs and symptoms

Hypertension usually doesn't produce clinical effects until vascular changes in the heart, brain, or kidneys occur. Highly elevated blood pressure damages the intima of small vessels, resulting in fibrin accumulation in the vessels, development of local edema and, possibly, intravascular clotting.

Symptoms produced by this process depend on the location of the damaged vessels:

• brain: CVA
• retina: blindness
• heart: MI
• kidneys: proteinuria, edema and, eventually, renal failure.

Hypertension increases the heart's workload, causing left ventricular hypertrophy and, later, left ventricular failure, left- and right-sided heart failure, and pulmonary edema.

Diagnosis

Hypertension may be suspected when the blood pressure is high at any single measurement. It is confirmed through blood pressure measurements that are repeated over time. Blood pressure consistently elevated over 140 systolic or 90 diastolic is called hypertension. Your doctor will look for signs of complications to your heart, kidneys, eyes, and other organs in your body.

Systolic blood pressure consistently between 130 and 139 or diastolic blood pressure consistently between 80 and 89 is called pre-hypertension. Your doctor will recommend and encourage lifestyle changes including weight loss, exercise, and nutritional changes.

Tests for suspected causes and complications may be performed. These are guided by the symptoms presented, history, and results of examination.

Treatment

Secondary hypertension treatment focuses on correcting the underlying cause and controlling hypertensive effects.

The National Institutes of Health recommend the following stepped-care approach for treating primary hypertension:

• Step 1: Help the patient initiate necessary lifestyle modifications, including weight reduction, moderation of alcohol intake, regular physical exercise, reduction of sodium intake, and smoking cessation.
• Step 2: If the patient fails to achieve the desired blood pressure or make significant progress, continue lifestyle modifications and begin drug therapy. Preferred drugs include diuretics and beta blockers. These drugs have proved effective in reducing cardiovascular morbidity and mortality.

If diuretics or beta-adrenergic blockers are ineffective or unacceptable, the doctor may prescribe ACE inhibitors, calcium antagonists, alphat-receptor antagonists, or alpha- and beta-adrenergic antagoists. These drugs, although effective in reducing blood pressure, have yet to prove effective in reducing morbidity and mortality.

• Step 3: If the patient fails to achieve the desired blood pressure or make significant progress, increase the drug dosage, substitute a drug in the same class, or add a drug from a different class.
• Step 4: If the patient fails to achieve the desired blood pressure or make significant progress, add a second or third agent or a diuretic (if one isn't already prescribed). Second or third agents may include directacting vasodilators, alphat-receptor antagonists, and peripherally acting adrenergic neuron antagonists.

Hypertensive emergencies

Examples of hypertensive emergencies include hypertensive encephalopathy, intracranial hemorrhage, acute left-sided heart failure with pulmonary edema, and dissecting aortic aneurysm. Hypertensive emergencies are also associated with eclampsia and severe pregnancy-related hypertension, unstable angina, and acute MI.

Typically, hypertensive emergencies require parenteral administration of a vasodilator or an adrenergic inhibitor or oral administration of a selected drug, such as nifedipine, captopril, clonidine, or labetalol, to rapidly reduce blood pressure.

Hypertension without accompanying symptoms or target organ disease seldom requires emergency drug therapy.

Prevention

Prevention of hypertension centers on avoiding or eliminating known risk factors. Even persons at risk because of age, race, or sex or those who have an inherited risk can lower their chance of developing hypertension.

The risk of developing hypertension can be reduced by making the same changes recommended for treating hypertension:

• reducing salt intake in your diet
• reducing fat intake
• losing weight
• getting regular exercise
• quitting smoking
• reducing alcohol consumption
• managing stress