Tuesday, June 30, 2009

What medications are used to treat high blood pressure?

The major types of medication used to control high blood pressure include:

Thiazide diuretics. These water pills act by removing the excess water and salt from the body. These drugs are the first line for treatment of high blood pressure; they are cheap, effective and have minimal side effects. In the majority of individuals are very effective and should be the first line drugs of choice.

Beta blockers. These medications act by decreasing the work of the heart and dilating (opening) up the blood vessels. They have been around for more than 50 years. Unfortunately, they are not very effective in African Americans but otherwise work in all ethnic groups. The side effects include decreased libido and glucose intolerance.

Angiotensin-converting enzyme (ACE) inhibitors. These drugs have today become the gold standard and are very effective in the treatment of high blood pressure. They also protect the heart and are useful in all groups of patients. They are useful in individuals with diabetes, heart failure or those who have angina (chest pain). They are readily available but some are expensive and do have a tendency to produce a persistent dry cough.

Angiotensin II receptor blockers. These latest medications open up the blood vessels and decrease the blood pressure. However they are very expensive and are not first line treatment. They are to be used in individuals who do not respond to the other drug treatments. Some clueless physicians routinely prescribe these drugs as first line therapy for hypertension.

Calcium channel blockers. These drugs have been around for many years and work well in African Americans. They are very effective in the treatment of blood pressure. They are reasonably priced but should not be used in patients with a weak heart. They do tend to cause swelling in the feet.

Renin inhibitors. These are the latest drugs available to treat blood pressure. They act by inhibiting a chemical (renin) which is known to cause high blood pressure. The new drug, Tekturna (aliskiren) is a renin inhibitor. The drug is very expensive and is not a first line drug. The drug is most effective when used in combination with other drugs.

Alpha blockers. These medications have been around for decades but are rarely used to treat high blood pressure because of their side effects

Central-acting agents. There are some medications which act in the brain to decrease the nerve impulses to the blood vessel. They are quite effective in decreasing blood pressure and widely used (e.g. clonidine, Aldomet)

Vasodilators. There are a variety of medications which can open up narrowed blood vessels and decrease blood pressure. These medications are often used intravenously in the ICU for emergent use in the treatment of hypertension.

Once your blood pressure is under control, your doctor may add aspirin and/or a medication to lower your cholesterol to your regimen to further decrease the risk of a heart attack.

Resistant hypertension

In some cases, high blood pressure may be resistant to a single drug and a combination of 2-3 drugs may be required. Many of these combination therapies are done on a trial and error basis. In some cases, the individual will be referred to a heart specialist who deals with blood pressure treatment.

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How is high blood pressure treated? part 1

Once the diagnosis of high blood pressure is made, it is important to start treatment even if one has no symptoms. Because there are no symptoms, many individuals delay treatment and then it is too late to reverse any of the complications. The treatment is life long.

Blood pressure goals aren't the same for everyone. Although everyone should strive for blood pressure readings below 140/90, doctors recommend lower readings for people with certain conditions.

Blood pressure treatment goals

140/90- for the health adult

130/80- for those with chronic kidney disease, diabetes or heart disease

120/80- for those with a weak heart

Drug treatment

The treatment of hypertension is straightforward. Over the last three decades various guidelines have been established. There are also numerous types of drugs used to treat hypertension and which drug the physician selects is based on his/her experience. For most individuals, a single drug may suffice, and in others multiple drugs may be required to control the blood pressure.

Monday, June 29, 2009

How do i treat my high blood pressure? part 2

Avoid stress. For those with high stress, one should try and avoid or decrease the stress levels. Rest, relax and exercise.

Coping skills

There is no cure for high blood pressure and thus life long treatment is required. To help cope with the management of blood pressure, one should do the following:

Home blood pressure monitoring. This is useful tool for home use and one can monitor the treatment and see if the medications are working.

Take the medications regularly. Do not skip medications, sometimes rebound hypertension can occur.

See the doctor regularly. At least once a year, see your physician and get your blood pressure measured and make sure that it is well controlled.

Hypertension is not a fun disorder; it has no symptoms and yet requires life long treatment and there are a lot of Dos and Don’ts associated with this disorder. Many people question why they have to take drugs if they do not have any symptoms plus the medications can be expensive. But on the plus side, well controlled blood pressure will add years to your life. On the negative side, one may end up with one eye, have a weak heart, remain with one kidney and be demented- the choice is very simple- you better take the medications as prescribed and quit complaining.

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How should I manage my high blood pressure? part 1

Compliance

The major problem with the treatment of hypertension is that because individual has no symptoms, he/she refuses to take the medications. Compliance with blood pressure medications is a difficult problem and it is important for the individual to understand the importance of treatment. One may skip a day, but routine skipping of blood pressure medications is only waiting for a disaster to happen.

Self-care

Changes in lifestyle are not only a key to improving blood pressure, but are important for general good health. In addition to losing weight, one should make efforts to control the blood sugar, stop smoking, live an active life style and eat well.

Eat healthy. One should eat healthy and change the diet from eating too much meat to a more vegetable oriented diet. Limiting salt may help some individuals in the control of blood pressure.

Maintain a healthy weight. Make efforts to lose weight. Obesity is associated with other problems besides hypertension also.

Exercise: “Couch potatoes” better move along. Inactivity leads to higher blood pressure and worsens obesity.

Don't smoke. This is the ultimate taboo for many medical disorders. One should try to stop smoking. There are no magical drugs to help one quit smoking- cold turkey is still the best treatment.

Sunday, June 28, 2009

Risk factors for high blood pressure: part 2

Modifiable risk factors:

- Obesity: if there is one risk factor which worsens
hypertension, it is weight gain. The excess weight
means that the heart has to work much harder to pump
blood around the body. By decreasing weight, blood
pressure can be significantly decreased. Weight loss
is one key factor which can help reduce high blood pressure

- Non active lifestyle: Individuals who are not active
or couch potatoes generally tend to develop higher heart
rates and high blood pressure. Physical inactivity also
increase weight and is generally not a recommended life style
goal.

- Smoking is the universal factor for most health problems.
If people stopped smoking, more than 50% of the physicians
would be out of a job. Smoking is bad not only for the
blood vessels, but bad for health in general

- Sodium intake. For some individuals too much intake of salt
(sodium) may cause an increase in blood pressure. Salt
causes water retention which in turn causes an increase
in body fluids. Even though salt induced high blood pressure
is rare, one should avoid too much salt

- Stress is known to be associated with high blood pressure.
Most individuals have different levels of stress and should
try and avoid it.

- Medical conditions: Certain chronic conditions also may
increase your risk of high blood pressure, including high
cholesterol, diabetes, kidney disease and sleep apnea.

- Pregnancy: In some females the blood pressure may increase
during the later part of the pregnancy (eclampsia). This is
a serious condition which needs urgent treatment. The blood
pressure resolves after delivery of the infant

To lower blood pressure, one should make an attempt to lose weight. With weight loss one can also have a lowering of blood sugars and cholesterol. Finally, cessation of smoking is highly recommended. Besides saving you money, quitting smoking will give you a new lease on life.

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What are risk Factors for high blood pressure?

High blood pressure is common in our society. Some individuals have a number of risk factors that increase the risk of developing high blood pressure. The risk factors that may influence blood pressure are categorized into either modifiable or non modifiable.

Not Modifiable Risk Factors

- Age. Blood pressure will occur once all individuals
reach a certain age. Men tend to develop high blood
pressure much earlier than female, but by the 6/7th
decade of life, most elderly people have some degree
of hypertension.

- Race. High blood pressure is particularly more common
among blacks, and occurs at a much earlier age compared
to Caucasians. Serious complications, such as stroke
and heart attack, also are more common in blacks.

- Family history. High blood pressure is more common in
families with a history of hypertension.