Hypertension and current treatments

February 10, 2021

4 min read

Almost half of all Americans suffer from high blood pressure or hypertension. Of those, 45 percent with high blood pressure do not have it controlled via treatment. Uncontrolled hypertension may lead to stroke, heart attack, and other cardiovascular issues.

Hypertension Definition

Every heartbeat creates pressure pushing blood through the blood vessels. That blood pressure consists of systolic pressure, which is the force the heart expends on the artery walls every time it beats. Diastolic pressure is the exertion of the heart on these walls between beats.

Blood pressure is measured by measured in millimeters of mercury (mmHg). The systolic pressure is the first number and the diastolic pressure is the second. The former is the number most indicative of risk. When blood pressure is too high, the heart and blood vessels must work harder but do not work as well.

Normal blood pressure is below 120/80 mm Hg. Above that level, blood pressure is considered elevated. Stage 1 hypertension occurs when the systolic pressure ranges between 130 to 139 mm Hg or the diastolic pressure ranges between 80 to 89 mm Hg. The more serious stage 2 hypertension occurs when there is a systolic pressure of 140 mm Hg or more or a diastolic pressure of 90 mm Hg or above. Hypertensive crisis happens when systolic pressure reaches 180 mm Hg or more or diastolic pressure is 120 mm Hg or greater. Emergency medical attention is needed.

High blood pressure is a chronic condition requiring constant vigilance. Unlike other serious health problems, a person with hypertension may not feel any symptoms. Some people with very high blood pressure may develop headaches or nosebleeds, but most will have no symptoms at all until some cardiovascular event strikes.

Lifestyle Changes

Most people with hypertension should make basic lifestyle changes to help keep their blood pressure at acceptable levels. These changes are beneficial for good health overall. They include:

Consuming a healthy diet with little sodium
Regular exercise
Maintaining a healthy weight
Limiting caffeine and alcohol intake
Not smoking
Avoid stress

Check your blood pressure daily with a home blood pressure monitor. Write down the numbers and keep a journal. It is also vital to visit your doctor regularly.

Blood Pressure Medications

Current hypertension treatment revolves around finding the right medication for the individual patient. Most patients are prescribed diuretics to help the kidneys eliminate water and sodium. Diuretics are often referred to as water pills. Expect to urinate more once on these drugs. Common thiazide diuretics used to reduce hypertension include hydrochlorothiazide, marketed under the brand name Microzide, and chlorthalidone.

Diuretics alone are not sufficient to control hypertension in many patients. Other medications are often added to the regimen. These include drugs in the following classes:

Angiotensin-converting enzyme (ACE) inhibitors –These drugs can help relax blood vessels by preventing a hormone that narrows these vessels from forming. They are frequently recommended for those with kidney disease. ACE inhibitors include captopril, sold under the brand name Capoten; benazepril (Lotensin); enalapril (Vasotec), and lisinopril (Zestril).
Angiotensin II receptor blockers (ARBs) –ARBs work by blocking the action of the chemicals narrowing the blood vessels, not the chemical formation per se. They are also recommended for those with kidney disease. This class of drugs includes losartan (Cozaar); candesartan (Atacand), and valsartan (Diovan).
Calcium channel blockers –These drugs relax blood vessel muscles. They may also slow the heart rate. The elderly and those of African descent may find calcium channel blockers are more effective than solely using ACE inhibitors. Examples of calcium channel blockers include amlodipine (Norvasc); Isradipine (DynaCirc), and bepridil (Vasocor).
Central agonists –This class of drugs prevents the brain from signaling to speed the heart rate and narrowing blood vessels. These include clonidine (Catapres); methyldopa (Aldomet), and guanfacine (Tenex).
Vasodilators –By relaxing the muscles in the walls of the blood vessels, vasodilators make blood flow more easily. Examples include minoxidil – which is also marketed topically for hair growth –and hydralazine (Apresoline).

Some of the drugs are combined so that patients may take different types of drugs in one pill or tablet. Although medication adjustment is common, do not change your medication or dosage without consulting your doctor.

Future Treatments

A new approach to managing high blood pressure is currently in the trial stage. Known as renal denervation, the method is under study in the SPYRAL HTN Global Clinical Trial. The process involves inserting a catheter into the groin and continuing through the arteries going to the kidneys. Via a device connected to the catheter, radio wave energy is delivered to nerves affecting blood pressure. These nerves go in and out of the kidneys. Already approved in Europe, renal denervation has had good results with few side effects. After treatment, patients have been able to lower and in some cases stop using medication.