Why Do I Have Hypertension?
Because of the spectrum of cardiovascular disorders to which hypertension (high blood pressure) belongs and to which it contributes, treatment is indicated as soon as the diagnosis is made to prevent or keep at a minimum its risk of comorbidities:
- Heart disease
- Kidney failure
- Thromboembolic disease
- Circulatory problems
- Myocardial ischemia and infarction
Hypertension is treated via nonpharmacologic and pharmacologic protocols.
The nonpharmacologic protocols involve alterations in lifestyle:
- Weight management
- Smoking cessation
- Mitigation of a sedentary lifestyle or occupation by frequent ambulation
- Diet alteration to include salt restriction and lipid considerations
- If diabetic, strict glycemic control and maintenance of a target hemoglobin A1c of <7-8%
The pharmacologic approach to hypertension involves the following types of antihypertensive medications, initially only one, in what is called monotherapy.
- Calcium channel blockers (dihydropyridines)
- ACE (angiotensin-converting enzyme) inhibitors
- ARBs (angiotensin II receptor blockers)
Diuretics diminish intravascular volume, which lowers the pressure head against the arterial walls. Calcium channel activity increases heart contractility and vascular smooth muscle contractility, so that blocking these will create vasodilation (again, lowering the pressure head against the arterial walls); this can be achieved without an increase in cardiac contractility if the dihydropyridine type is used.
Angiotensin converting enzyme is part of the renin-angiotensin system in the kidneys which impacts blood pressure by a conversion of angiotensin I to angiotensin II, a potent vasocontrictor (increases the pressure head against the arterial walls). ACE inhibitors block this conversion and the ARBs block the receptors that turn on when filled with angiotensin II. Either way, the vasoconstrictive effects from the kidneys are aborted, lowering blood pressure.