Hypertension Management Guide

Hypertension is considered as the biggest single risk factor for deaths worldwide.

According to the World Health Organization (WHO), hypertension causes 7 million deaths every year while 1.5 billion people suffer due to its complications. 

Here in the Philippines, Hypertension remains to be the leading cause of illness and a primary contributor to premature death, projecting around 200,000 deaths yearly in the country attributed directly or indirectly to 

high blood pressure. 

 

QUICK FACT  

Did you know that 1 out of 4 Filipinos are unaware that they are at risk of Hypertension.

 

Based on national surveys, the total number of hypertensive Filipinos is now more than 12 million, with more than half of them are unaware of their condition. 

High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough and it can lead to severe complications and increases the risk of heart disease, stroke, and death.

Blood pressure is the force exerted by the blood against the walls of the blood vessels.  It is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. 

The pressure depends on the work being done by the heart and the resistance of the blood vessels. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

⬆️ Increase in Blood Flow = ⬆️ Increase in Heart work load/ pumping = 

⬆️ Increase in Blood Pressure 

⬆️ Increase in Blood vessels resistance/ Blood vessel constriction = ⬆️ Increase in Blood Pressure

You can have high blood pressure (hypertension) for years without any symptoms . 

Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.  

SIGNS AND SYMPTOMS

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.

A few people with high blood pressure may have headaches, dizziness, shortness of breath or nosebleeds, but these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage.

PATHOPHYSIOLOGY OF HYPERTENSION

ETIOLOGIES (CAUSE) OF HYPERTENSION

There are 2 types of Hypertension

  • Primary (essential) hypertension

For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.

  • Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, see the image below:

Causes of Secondary Hypertension

  • Renal disease. It is the most common cause of Secondary Hypertension.
  • Endocrine disease
  • Pheochromocytoma or Adrenal Gland Tumors
  • Cushing’s SyndromeIt is a condition in which your body is exposed to high levels of the hormone cortisol for a long time. This may be caused by the use of oral corticosteroid medications. It may also be because your body makes too much cortisol.
*Cortisol is the body’s main stress hormone. It works with certain parts of your brain to control your mood, motivation, and fear. It’s best known for helping fuel your body’s “fight-or-flight” instinct in a crisis
  • HyperthyroidismHyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body’s metabolism, causing unintentional weight loss and a rapid or irregular heartbeat.
  • Hyperaldosteronism 
  • Primary aldosteronism (Conn’s Syndrome) is a type of hormonal disorder that leads to high blood pressure. Your adrenal glands produce a number of essential hormones. One of these is aldosterone, which balances sodium and potassium in your blood.

DRUG AND FOOD  INDUCED

  • Sympathomimetic Agents 

Sympathomimetic amines include amphetamines, pseudoephedrine, phenylpropanolamine, and ephedrine. Historically, these compounds were contained in some OTC cough and cold preparations. 

  • NSAIDs and COX-2 Inhibitors 

Nonsteroidal anti-inflammatory drugs (NSAIDs) have potentially adverse effects on blood pressure. Drug-induced hypertension associated with NSAIDs is due to the renal effects of these drugs. Specifically, NSAIDs cause dose-related increases in sodium and water retention. 

  • Corticosteroids 

All corticosteroid drugs, including prednisone, can cause sodium retention, resulting in dose-related fluid retention.

*Fludrocortisone causes significant blood pressure increases and, thus, is useful in treating patients with postural hypotension. 

  • Estrogens and Progestins

Chronic use of oral contraceptives may slightly raise blood pressure in certain women and may have other adverse effects on cardiovascular risk.

  • Dietary Supplements 

Ginseng is generally recognized as safe and has been associated with few serious side effects. Because it can have a mild stimulant effect, use with other stimulants in patients with cardiovascular disease should be cautioned. A type of ginseng abuse syndrome, characterized by diarrhea, hypertension, nervousness, dermatologic eruptions, and insomnia, has been described.This syndrome may be exhibited after single high doses or prolonged periods of use. Other supplements that may increase arterial pressure include natural licorice and yohimbine.

  • Serotonin-Norepinephrine Reuptake Inhibitors/ SNRIs

              Ex. Venlafaxine and Sibutramine

  • Immunosuppressants 

              Ex. Cyclosporine and Tacrolimus

Special Hypertensive Conditions

Hypertension in Pregnancy

3 FORMS 

  • Chronic Hypertension in Pregnancy.

– may occur pre-Pregnancy or before 20 weeks of pregnancy.

– no presence of kidney disease

  • Gestational Hypertension. 

– Hypertension during pregnancy. 

– no presence of kidney disease.

  • Renal Hypertension in Pregnancy.

 – Hypertension before or during Pregnancy.

 – there could be a presence of kidney disease

 – there’s a possibility of having an edema

Hypertensive Crisis 

2 FORMS

  • Hypertensive Urgency 

– asymptomatic / no symptoms

  • Hypertensive Emergency 

 – symptomatic

*Blurring of vision

*Acute heart failure

*Acute renal failure

*Acute stroke

*Encephalopathy

DETERMINANTS OF BLOOD PRESSURE

Hydraulic equation:

BP = CO + SVR

BP (Blood Pressure)

CO (Cardiac Output)

SVR (Systemic Vascular Resistance)

1. CARDIAC OUTPUT

volume of blood pumped out by the heart in 1 minute. 

CO = SVR + HR

2. STROKE VOLUME 

volume of blood pumped out by the heart with every contraction.

DETERMINANTS OF STROKE VOLUME 

  • STRENGTH OF CONTRACTION / INOTROPISM

➕ Inotropism = ⬆️ Increase Stroke Volume

➖ Inotropism = ⬇️ Decrease Stroke Volume,

⬇️ Decrease Cardiac Output = ⬇️ Decrease Blood Pressure

  • CARDIAC PRELOAD (Venous return; Ventricular End Diastolic Volume)
  • Tone of the Veins (Capacitance vessels)

Blood vessels Constricted (Venoconstriction = 

⬆️ Increase Preload

Blood vessels Dilated (Venodilation) = 

⬇️ Decrease Preload = ⬇️ Decrease Stroke Volume = ⬇️ Decrease cardiac Output = ⬇️ Decrease Blood pressure

  • Fluid Content of the Blood 

⬇️ Decrease Fluid (Water + Sodium) = ⬇️ Decrease Blood Pressure

3. SYSTEMIC VASCULAR RESISTANCE (SVR) 

resistance encountered by the heart as it pumps out it’s blood contents

Determinants: 

  • TONE OF ARTERIOLES– Primary resistance vessels

Arteriolar Constriction = ⬆️ Increase SVR = 

⬆️ Increase Blood pressure

Arteriolar Dilation = ⬇️ Decrease SVR = ⬇️ Decrease Blood pressure

Blood Pressure Reading

What do the numbers mean?

SYSTOLIC PRESSURE. refers to the amount of pressure in your arteries during the contraction of your heart muscle. This is the top number.

DIASTOLIC PRESSURE. refers to your blood pressure when your heart muscle is between beats. This is the bottom number.

Both numbers are important in determining the state of your heart health.

Numbers greater than the ideal range indicate that your heart is working too hard to pump blood to the rest of your body.

What’s a normal reading?

For a normal reading, your blood pressure needs to show a top number (systolic pressure) that’s between 90 and less than 120 and a bottom number (diastolic pressure) that’s between 60 and less than 80. The American Heart Association (AHA) considers blood pressure to be within the normal range when both your systolic and diastolic numbers are in these ranges.

Blood pressure readings are expressed in millimeters of mercury. This unit is abbreviated as mm Hg. A normal reading would be any blood pressure below 120/80 mm Hg and above 90/60 mm Hg in an adult.

If you’re in the normal range, no medical intervention is needed. However, you should maintain a healthy lifestyle and healthy weight to help prevent hypertension from developing. Regular exercise and healthy eating can also help. You may need to be even more mindful of your lifestyle if hypertension runs in your family.

Elevated blood pressure

Numbers higher than 120/80 mm Hg are a red flag that you need to take on heart-healthy habits.

When your systolic pressure is between 120 and 129 mm Hg and your diastolic pressure is less than 80 mm Hg, it means you have elevated blood pressure.

Although these numbers aren’t technically considered high blood pressure, you’ve moved out of the normal range. Elevated blood pressure has a good chance of turning into actual high blood pressure, which puts you at an increased risk of heart disease and stroke.

No medications are necessary for elevated blood pressure. But this is when you should adopt healthier lifestyle choices. A balanced diet and regular exercise can help lower your blood pressure to a healthy range and help prevent elevated blood pressure from developing into full-fledged hypertension.

Hypertension: Stage 1

You’ll generally be diagnosed with high blood pressure if your systolic blood pressure reaches between 130 and 139 mm Hg, or if your diastolic blood pressure reaches between 80 and 89 mm Hg. This is considered stage 1 hypertension.

However, the AHA notes that if you get only one reading this high, you may not truly have high blood pressure. What determines the diagnosis of hypertension at any stage is the average of your numbers over a period of time.

Your doctor can help you measure and track your blood pressure to confirm whether it’s too high. You may need to start taking medications if your blood pressure doesn’t improve after one month of following a healthy lifestyle, especially if you’re already at high risk for heart disease. If you’re at lower risk, your doctor may want to follow up in three to six months after you’ve adopted more healthy habits.

If you’re 65 years or older and otherwise healthy, your doctor will likely recommend treatment and lifestyle changes once your systolic blood pressure is greater than 130 mm Hg. The treatment for adults 65 and older who have significant health problems should be made on a case-by-case basis.

Treating high blood pressure in older adults appears to decrease memory problems and dementia.

Hypertension: Stage 2

Stage 2 high blood pressure indicates an even more serious condition. If your blood pressure reading shows a top number of 140 or more, or a bottom number of 90 or more, it’s considered stage 2 hypertension.

At this stage, your doctor will recommend one or more medications for keeping your blood pressure under control. But you shouldn’t rely solely on medications to treat hypertension. Lifestyle habits are just as important in stage 2 as they are in the other stages.

Some medications that can complement a healthy lifestyle include:

  • ACE inhibitors to block substances that tighten blood vessels
  • alpha-blockers used for relaxing arteries
  • beta-blockers to decrease heart rate and block substances that tighten blood vessels
  • calcium channel blockers to relax blood vessels and decrease the work of the heart
  • diuretics to decrease the amount of fluid in your body, including your blood vessels

Danger zone

A blood pressure reading above 180/120 mm Hg indicates a serious health problem. The AHA refers to these high measurements as a “hypertensive crisis.” Blood pressure in this range requires urgent treatment even if there are no accompanying symptoms.

You should seek emergency treatment if you have blood pressure in this range, which may accompany symptoms such as:

  • chest pain
  • shortness of breath
  • visual changes
  • symptoms of stroke, such as paralysis or a loss of muscle control in the face or an extremity
  • blood in your urine
  • dizziness
  • headache

However, sometimes a high reading can occur temporarily and then your numbers will return to normal. If your blood pressure measures at this level, your doctor will likely take a second reading after a few minutes have passed. A second high reading indicates that you’ll need treatment either as soon as possible or immediately depending on whether or not you have any of the symptoms described above.

Blood pressure that’s too low

Low blood pressure is known as hypotension. In adults, a blood pressure reading of 90/60 mm Hg or below is often considered hypotension. This can be dangerous because blood pressure that is too low doesn’t supply your body and heart with enough oxygenated blood.Some potential causes of hypotension can include:

  • heart problems
  • dehydration
  • pregnancy
  • blood loss
  • severe infection (septicemia)
  • anaphylaxis
  • malnutrition
  • endocrine problems
  • certain medications

Hypotension is usually accompanied by lightheadedness or dizziness. Talk to your doctor to find out the cause of your low blood pressure and what you can do to raise it.

Blood Pressure Measurement

To measure your blood pressure, your doctor or a specialist will usually place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge.

A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).

Your doctor will likely take two to three blood pressure readings each at three or more separate appointments before diagnosing you with high blood pressure. This is because blood pressure normally varies throughout the day, and it may be elevated during visits to the doctor (white coat hypertension).

Your blood pressure generally should be measured in both arms to determine if there is a difference. It’s important to use an appropriate-sized arm cuff.

Your doctor may ask you to record your blood pressure at home to provide additional information and confirm if you have high blood pressure.

Your doctor may recommend a 24-hour blood pressure monitoring test called ambulatory blood pressure monitoring to confirm if you have high blood pressure. The device used for this test measures your blood pressure at regular intervals over a 24-hour period and provides a more accurate picture of blood pressure changes over an average day and night. However, these devices aren’t available in all medical centers, and they may not be reimbursed.

If you have any type of high blood pressure, your doctor will review your medical history and conduct a physical examination.

Your doctor may also recommend routine tests, such as a urine test (urinalysis), blood tests, a cholesterol test and an electrocardiogram — a test that measures your heart’s electrical activity. Your doctor may also recommend additional tests, such as an echocardiogram, to check for more signs of heart disease.

Taking your blood pressure at home

An important way to check if your blood pressure treatment is working, to confirm if you have high blood pressure, or to diagnose worsening high blood pressure, is to monitor your blood pressure at home.

Home blood pressure monitors are widely available and inexpensive, and you don’t need a prescription to buy one. Home blood pressure monitoring isn’t a substitute for visits to your doctor, and home blood pressure monitors may have some limitations.

Make sure to use a validated device, and check that the cuff fits. Bring the monitor with you to your doctor’s office to check its accuracy once a year. Talk to your doctor about how to get started with checking your blood pressure at home.

Devices that measure your blood pressure at your wrist or finger aren’t recommended by the American Heart Association.

Changing your lifestyle can go a long way toward controlling high blood pressure. Your doctor may recommend you make lifestyle changes including:

-Eating a heart-healthy diet with less salt

-Getting regular physical activity

-Maintaining a healthy weight or losing weight if you’re overweight or obese

-Limiting the amount of alcohol you drink

But sometimes lifestyle changes aren’t enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure.

BLOOD PRESSURE GOALS 

Your blood pressure treatment goal depends on how healthy you are.

Your blood pressure treatment goal should be less than 130/80 mm Hg if:

You’re a healthy adult age 65 or older

You’re a healthy adult younger than age 65 with a 10 percent or higher risk of developing cardiovascular disease in the next 10 years

You have chronic kidney disease, diabetes or coronary artery disease

Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you need treatment (medications) to reach that level.

If you’re age 65 or older, and use of medications produces lower systolic blood pressure (such as less than 130 mm Hg), your medications won’t need to be changed unless they cause negative effects to your health or quality of life.

The category of medication your doctor prescribes depends on your blood pressure measurements and your other medical problems. It’s helpful if you work together with a team of medical professionals experienced in providing treatment for high blood pressure to develop an individualized treatment plan.

RISK FACTORS OF HYPERTENSION

High blood pressure has many risk factors, it can be either Risk factors that can be controlled and cannot be controlled:

CANNOT BE CONTROLLED:

  • Age. The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
  • Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.
  • Family history. High blood pressure tends to run in families. Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.

CAN BE CONTROLLED 

Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.

Smoking/ Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.

Excessive/ Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.

Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don’t get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.

Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.

If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.

Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.

Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.

Pregnancy. Sometimes pregnancy contributes to high blood pressure, as well.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.

COMPLICATIONS

The excessive pressure on your artery walls caused by hIgh blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.

Aneurysm.  Increased bLood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.

Heart failure.  To pump bloOd against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may haVe a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.

Kidney Disease/ Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally. Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.

Metabolic syndrome. This syndromE is a cluster of disorders of your body’s metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the “good” cholesterol; high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.

Trouble with memory or understanding.  Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding conceptS is more common in people with high blood pressure.

Dementia.   NarroWed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.

Vision Loss/ Hypertensive Retinopathy.  HypertensIon can cause damage to the blood vessels in the retina, the area at the back of the eye where images focus. This eye disease is known as hyPertensive retinopathy. The damage can be serious if hypertension is not treated.

Sexual Dysfunction.  A link between high blood prEssure and sexual problems is proved in men. For women who have decreased sexual satisfaction, it’s not yet proved that high blood pressure is to blame.

Men 

Over time, high blood pRessure damages the lining of blood vessels and causes arteries to harden and narrow (atherosclerosis), limiting blood flow. This means less blood is able to flow to the penis.

For some men, the decreased blood flow makes i

High blood pressure’s effect on sexual problems in women isn’t well-understood. But it’s possible that high blood pressure could aft difficult to achieve and maintain erections — often referred to as erectile dysfunction. The problem is fairly common.

High blood pressure can also interfere with ejaculation and reduce seXual desire. Sometimes the medications used to treat high blood pressure have similar effects.

Women 

High blood pressure’s effect on sexual problems in women isn’t well-understood. But it’s possible that high blood pressure could affect a woman’s sex life.

High blood pressure can reduce blood flow to the vagina. For some women, this leads to a decrease in sexual desire or arousal, vaginal dryness, or difficulty achieving orgasm. Improving arousal and lubrication can help.

Like men, women can experience anxiety and relationship issues due to sexual dysfunction. Women should talk to their doctor if they experience these difficulties.

Disease Management

Non-pharmacologic Treatment

Lifestyle and home remedies

Lifestyle changes can help you control and prevent high blood pressure, even if you’re taking blood pressure medication. Here’s what you can do:

  • Eat healthy foods. Eat a heart-healthy diet. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains, poultry, fish and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and trans fat.
  • Decrease the salt in your diet. Aim to limit sodium to less than 2,300 milligrams (mg) a day or less. However, a lower sodium intake — 1,500 mg a day or less — is ideal for most adults. While you can reduce the amount of salt you eat by putting down the saltshaker, you generally should also pay attention to the amount of salt that’s in the processed foods you eat, such as canned soups or frozen dinners.
  • Maintain a healthy weight. Keeping a healthy weight, or losing weight if you’re overweight or obese, can help you control your high blood pressure and lower your risk of related health problems. In general, you may reduce your blood pressure by about 1 mm Hg with each kilogram (about 2.2 pounds) of weight you lose.
  • Increase physical activity. Regular physical activity can help lower your blood pressure, manage stress, reduce your risk of several health problems and keep your weight under control. Aim for at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity, or a combination of moderate and vigorous activity. For example, try brisk walking for about 30 minutes most days of the week. Or try interval training, in which you alternate short bursts of intense activity with short recovery periods of lighter activity. Aim to do muscle-strengthening exercises at least two days a week.
  • Limit alcohol. Even if you’re healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women, and up to two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
  • Don’t smoke. Tobacco can injure blood vessel walls and speed up the process of buildup of plaque in the arteries. If you smoke, ask your doctor to help you quit.
  • Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation, deep breathing or meditation. Getting regular physical activity and plenty of sleep can help, too.
  • Monitor your blood pressure at home. Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working, and even alert you and your doctor to potential complications. Home blood pressure monitoring isn’t a substitute for visits to your doctor, and home blood pressure monitors may have some limitations. Even if you get normal readings, don’t stop or change your medications or alter your diet without talking to your doctor first. If your blood pressure is under control, check with your doctor about how often you need to check it.
  • Practice relaxation or slow, deep breathing. Practice taking deep, slow breaths to help relax. There are some devices available that promote slow, deep breathing. According to the American Heart Association, device-guided breathing may be a reasonable nondrug option for lowering blood pressure, especially when anxiety accompanies high blood pressure or standard treatments aren’t well-tolerated.
  • Control blood pressure during pregnancy. If you’re a woman with high blood pressure, discuss with your doctor how to control your blood pressure during pregnancy.

Pharmacologic Treatment

Medications to treat high blood pressure

  • Thiazide diuretics. Diuretics, sometimes called water pills, are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first, but not the only, choice in high blood pressure medications. Thiazide diuretics include chlorthalidone, hydrochlorothiazide (Microzide) and others. If you’re not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic. Diuretics or calcium channel blockers may work better for people of African heritage and older people than do angiotensin-converting enzyme (ACE) inhibitors alone. A common side effect of diuretics is increased urination.
  • Angiotensin-converting enzyme (ACE) inhibitors. These medications — such as lisinopril (Zestril), benazepril (Lotensin), captopril (Capoten) and others — help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. People with chronic kidney disease may benefit from having an ACE inhibitor as one of their medications.
  • Angiotensin II receptor blockers (ARBs). These medications help relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) and others. People with chronic kidney disease may benefit from having an ARB as one of their medications.
  • Calcium channel blockers. These medications — including amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others — help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for older people and people of African heritage than do ACE inhibitors alone. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you’re concerned about interactions.

Additional medications sometimes used to treat high blood pressure

If you’re having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:

  • Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels. Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others.
  • Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
  • Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. Beta blockers include acebutolol (Sectral), atenolol (Tenormin) and others. Beta blockers aren’t usually recommended as the only medication you’re prescribed, but they may be effective when combined with other blood pressure medications.
  • Aldosterone antagonists. Examples are spironolactone (Aldactone) and eplerenone (Inspra). These drugs block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to high blood pressure.
  • Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren works by reducing the ability of renin to begin this process. Due to a risk of serious complications, including stroke, you shouldn’t take aliskiren with ACE inhibitors or ARBs.
  • Vasodilators. These medications, including hydralazine and minoxidil, work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
  • Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv, Tenex) and methyldopa.

To reduce the number of daily medication doses you need, your doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often are more effective than one. Sometimes finding the most effective medication or combination of drugs is a matter of trial and error.

References:

https://www.healthline.com/health/high-blood-pressure-hypertension/blood-pressure-reading-explained#hypotension

https://www.medicalnewstoday.com/articles/150109.php

https://www.webmd.com/a-to-z-guides/what-is-cortisol#1

https://www.uspharmacist.com/article/drug-induced-hypertension

https://www.heart.org/-/media/data-import/downloadables/hypertension-guideline-highlights-flyer-ucm_49