Treating High Blood Pressure

Treatment of hypertension generally begins with non-pharmacological therapy, including dietary sodium restriction, weight reduction in the obese, avoidance of excess alcohol, and regular aerobic exercise.

There is a clear evidence of benefit of anti-hypertensive drugs for people who have a diastolic blood pressure persistently 90 mmHg or more and systolic pressure 140 mmHg or more. "Persistent" elevation is generally considered to be such higher values recorded on at least three different occasions by a health care personnel

Step 1

Even though there is no universal agreement on which anti hypertensive drugs should be given for initial therapy, the most commonly used ones are:

*Thiazide-type diuretics (water pill) such as Hydrochlorthiazide (HCTZ)
*Angiotensin converting enzyme (ACE) inhibitors (lisinopril, enalapril)
*Angiotensin II receptor blockers (ARBs) (losartan, candesarta)
*Calcium channel blockers (nifidipine, amlodipine)
*Beta blockers (metoprolol, atenolol)

Step 2

Choice of anti-hypertensive medication:

Your doctor should take several factors into consideration while determining which anti-hypertensive medication should initially be prescribed. Your general health, sex, age and race also need to be considered while making such decisions. Other important factors are the severity of the hypertension; any underlying health conditions that are present; and whether particular drugs are contraindicated.

Step 3

The Joint National Committee (JNC 7) report recommend a thiazide diuretic as a first-line drug for initiating therapy in uncomplicated hypertensive patients. This is based upon a very popular anti-hypertensive medication study (ALLHAT). Diuretics, however, can worsen gout and therefore should be avoided in those patients.

Step 4

An ACE inhibitor is given to patients with diabetes mellitus who have increased levels of protein in the urine (proteinuria), heart failure, or a prior heart attack. ACE inhibitors should not be given during pregnancy.

Step 5

Beta blockers are given to patients with heart failure or a prior heart attack. However they may worsen symptoms in people with asthma or chronic obstructive lung disease (chronic bronchitis, emphysema).

Step 6

Calcium channel blockers and beta blockers are good for patients with angina pectoris, (chest pain caused by an inadequate oxygen supply to heart muscle in patients with coronary artery disease).