If hypertension is considered primary hypertension, that is, without an identifiable cause, management of the blood pressure is based on:
- Lifestyle changes
- Change in medications to equally effective ones that do not have hypertension as a side effect
- Weight management and obesity reduction to impact metabolic syndrome
- Diet/nutritional counseling for both salt restriction and to impact dyslipidemia (cholesterol) as part of a metabolic syndrome. Statin medication is prescribed when conservative and lifestyle changes fail
The DASH diet (Dietary Approaches to Stop Hypertension) is high in vegetables, fruits, whole grains, poultry, fish, nuts and low-fat dietary products; it is low in sweets, red meats, and sweetened beverages.
- Smoking cessation
- Stress reduction via counseling to identify stressors in a patient’s life and strategies to deal with them
- Antihypertensive medication when conservative and lifestyle changes fail
If hypertension is considered secondary to some other cause, management requires treatment for that cause in attempts to either mitigate its negative influence, eliminate it via reversing it, or delay its hypertensive tendencies. Antihypertensive medication is also used.
Goals in the Management of Hypertension
Blood pressure goals are an essential part of the management of hypertension. A goal of <130/<80 is often set first. Some physicians move these numbers a few mm of mercury lower, based on physician preference, reasonable expectations, and comorbidities. Other goals, in those conditions that contribute to hypertension–diabetes, metabolic syndrome, obesity, smoking, inactivity, etc.–need to be established as well.
- Thiazide diuretics, which decrease intravascular volume
- Calcium-channel blockers (long acting)
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), which step in to lessen the renal impact of hypertension
Choice of medications or combinations can be decided upon based on monotherapy treatment success or failure, race, side effects, and the presence of diabetes or ischemic heart disease.