TreatmentLifestyle changes can help lower the risk of developing hypertension. In many patients with mild high blood pressure, reaching and maintaining a healthy weight, exercising regularly, limiting dietary alcohol and salt, and stopping smoking can reduce blood pressure levels to normal and may be the only “treatment” required. The risks associated with gender, race and increasing age, however, do not disappear with lifestyle changes and, in many cases, a treatment plan that includes medicines is necessary to control persistently high blood pressure.
There are several classes of drugs available to treat hypertension. Each class works differently, targeting a particular aspect of blood pressure regulation. Frequently, a patient will need to take a couple of different drugs together to achieve blood pressure control. Your doctor will work with you to select the combinations and dose that are right for you. Classes that are available include:
- Diuretics – a commonly used group of drugs that increase the removal of salt and water by the kidneys. This reduces the volume of fluid in circulation and lowers the blood pressure.
- Adrenergic blockers (alpha blockers, beta blockers, alpha-beta blockers) – work to reduce the nervous system’s rapid response to physical and emotional stress.
- ACE (angiotensin-converting enzyme) inhibitors and ARBs (Antiotensin II receptor blockers) – help prevent the constriction of arterioles (small arteries) by blocking the formation and/or action of angiotensin II, an enzyme that the body produces to constrict blood vessels and increase blood pressure.
- Calcium channel blockers – dilate arterioles by decreasing the amount of calcium that enters into the blood vessel walls and the heart muscle.
- Vasodilators – work directly on blood vessels to relax the muscles that constrict and dilate the arteries.
If a condition causing secondary hypertension can be cured (for example, by removing an adrenal tumour) or controlled (for example, by treating diabetes or thyroid disease), then blood pressure levels may fall to normal or near normal. When a cure is not possible and control of the disease consists of minimizing further damage (as may occur with kidney disease), then the hypertension will be controlled with a combination of medicines, and the patient will be monitored closely to help maintain organ function and reduce the likelihood of problems arising.
An asymptomatic blood pressure of more than 180/110 mm Hg must be treated urgently. Higher blood pressures are treated as emergencies and may require admission to hospital so that intravenous drugs can be given.
Pregnant women with pre-eclampsia require rest, close monitoring, and frequent visits to their doctor’s surgery or even admission to hospital. The only real resolution for pre-eclampsia is delivery, but postponing delivery as long as possible allows the foetus more time to mature. This time delay must be balanced against the increasing danger of the development of eclampsia, with seizures and organ damage in the mother, an emergency condition that can be life-threatening for both baby and mother.
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