Management of Hypertension

Management of hypertension / Treatment of hypertension

Life style modifications in hypertension:

First of all, all patients should be advise life style modifications.

What is Dash?

Dash is dietary approach to stop hypertension. Diet should be rich in 

• vegetables
• Fruits
• Seeds
• Beens
• Legumes
• Mg and K+ intake
• Salt intake should be low . But not stop completely.
• Alcohol not more than 2 drinks for male and 1.5 drink for female.
• Avoid red meat
• Brisk volume 30 minutes, 3 miles 5-7 days in a week.
• More physical activities
• BMI to the normal
• Manage stress

Management of stage 1 hypertension:

In stage 1 hypertension the blood pressure is 140-159 / 90-99. Start the pharmacotherapy if other risk factors are present otherwise wait 3-6 months to observe the impact of lifestyle to control , if not controlled in 3-6 months then start pharmacotherapy.

Management of stage 2 hypertension:

In stage 2 hypertension blood pressure is equal to or more than 160/100. Immediately start the pharmacotherapy.

Pharmacotherapy for hypertension:

Single pill combination (SPC) therapy for hypertension:

Single pill therapy is ideal because

• Multiple drug in single pill
• One daily dose
• To reduce non adherence

Step 1 of pharmacotherapy for hypertension:

Start with dual therapy with low doses (half of maximum recommended doses).

Start with (A+C)

A= Angiotensin converting enzyme inhibitors OR Angiotensin receptor blockers

plus

C= calcium channel blockers (dihydophyridine calcium channel blockers) e.g. nifedipine , isradipine

If patient is black hypertensive patient the give (C+D)

C= dihydophyridine calcium channel blockers

plus

D= thiazide like diuretics e.g. idapamide

If post stroke patient or heart failure patient give (A+D) but should started with low doses.

We want < 140/90 blood pressure.

If patients have other risk factor like cardiovascular diseases etc the we want < 130/ 80 blood pressure but should not be bellow > 120 / 70 not less than this.

If weak older patient not compulsory to start with dual therapy initiates with monotherapy.

If not controlled by step 1 go to step 2.

Step 2 of pharmacotherapy for hypertension:

Dual therapy with maximum tolerated dose.

(A+C)

A= Angiotensin converting enzyme inhibitors OR Angiotensin receptor blockers

plus

C= calcium channel blockers (dihydophyridine calcium channel blockers) e.g. nifedipine , isradipine

We want that blood pressure should be achieve in 3 months. If still not controlled then we go for step 3.

Step 3 of pharmacotherapy for hypertension:

Triple therapy combination

(A+C+D)

A= Angiotensin converting enzyme inhibitors OR Angiotensin receptor blockers

plus

C= calcium channel blockers (dihydophyridine calcium channel blockers) e.g. nifedipine , isradipine

D= thiazide like diuretics e.g. idapamide

After using this patient achieve blood pressure control . If still not controlled then patient is suffering from resistant hypertension.

Pharmacotherapy for resistant hypertension:

A + C + D + spironolactone (12.5 - 50mg OD) if issue with spironolactone then give alpha or beta blockers.

Causes of resistant hypertension:

The major cause of resistant hypertension is poor compliance. Assure the following steps;

1. Increase the adherence
2. Replace the hydrochlorothiazide with indapamide
3. Add spironolactone
4. In resistant hypertension check serum potassium level.

Pharmacotherapy for pre eclampsia:

Aspirin (62.5 - 150mg) and calcium supplements (up to 2.5 g / day).

Clinical features of eclampsia:

• Hypertension
• Seizures
• Headache
• Nausea

Pharmacotherapy for eclampsia:

Methyldopa or labetalol with magnesium supplements.  If pulmonary oedema then give nitroglycerin with these.

For diagnosis of hypertension click here 

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