Blood Pressure Disorders: Management & Treatment Menu

Management of Blood Pressure Disorders

The most conservative approach is usually the first treatment strategy:

  • lifestyle changes
  • Low salt diet
  • Potassium supplementation
  • Quit smoking, if a smoker
  • Weight loss via caloric restriction and nutritional counseling
  • Exercise to address a sedentary lifestyle, especially in sedentary occupations
  • Alcohol restriction (avoid excesses)
  • Psychological counseling to identify stressors and to develop coping skills to handle them
  • CPAP for obstructive sleep apnea, which is associated with hypertension

Pharmacologic Therapy

When conservative measures fail or when a patient is non-compliant with them, pharmacologic therapy is indicated, which can reduce heart failure by 50%, stroke by 30-40%, and myocardial infarction by 20-25%.

Drug therapy is typically begun when the out-of-office mean BP is ≥130 systolic or ≥80 diastolic. These same criteria apply even when there are no out-of-office data, but the ≥130/≥80 criteria are met with office BP readings in patients who have one or more of the following:

  • Age >65
  • Any cardiovascular disease
  • Type 2 diabetes
  • Chronic kidney disease

Monotherapy

Depending on age, race, and/or the presence of diabetes (DM), initial therapy begins with one of 4 medications:

  • Thiazide diuretics
  • Calcium channel blockers
  • ACE (angiotensin-converting enzyme) inhibitors
  • ARBs (angiotensin II receptor blockers)

Combination Therapy

When monotherapy fails to achieve a target BP (the “goal” BP), a combination of an ACE inhibitor or ARB with a calcium channel blocker can be tried. (Alternately, the ACE inhibitor or ARB can also be used with a thiazide diuretic). When this fails, an ACE inhibitor or an ARB in combination with both a calcium channel blocker and the diuretic.

If a patient cannot tolerate the typical combination therapeutic choices, a beta blocker, alpha blocker, or arterial vasodilator can be used.

When results are good and a normal BP remains stable for a few years, the dose and number of antihypertensive agents can be reduced as a trial, as many patients maintain their normal BPs off medications for years, especially if they have lost weight.

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This information is provided by Vascular Health Clinics and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.

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