Hypertension is a serious chronic disease that affects 45.4% of the US population, which is to say, a very large number (1). I hardly know a family that's free of this disease, including mine. As serious as it is, the dangers of hypertension can be controlled and reduced with the proper treatment plan and a healthy lifestyle.
In this article, I will share with you all that's related to the management of hypertension, whether that was pharmacological or non-pharmacological.
What Exactly is Hypertension?
First things first, before we talk about the management of hypertension, we need to understand what it is first. Blood pressure is the measurement of the force that the blood exerts on blood vessels as it moves through your body. It's measured in two numbers that you probably hear a lot about as a patient of hypertension, those are: systolic (the pressure when your heart contracts and pushes blood to the vessels) over diastolic (the pressure when your heart is filling between beats).
Hypertension is generally diagnosed when your blood pressure consistently measures 140/90 mmHg or higher (2).
Why is Hypertension a Problem?
You might wonder why high blood pressure is such a big deal, especially when you don't even feel it most of the time. But the truth is, when you have hypertension, your heart works more than it should. The high blood pressure on your vascular system forces your heart to work harder to push against that pressure.
Risk Factors for Hypertension
Although we don't know the exact cause of blood pressure, there are, however, several factors can increase your risk of developing hypertension, such as
Age: As you get older, the risk of developing hypertension increases (74.5% of patients are 60 and over).
Family history: If hypertension runs in your family, meaning if one or two of your parents have it, you’re more likely to develop it.
Diet: A diet high in salt also increases the risk of hypertension (3).
Lifestyle: Lack of physical activity, smoking, and excessive alcohol consumption are major contributors.
Weight: Another risk factor is being overweight or obese.
A look at those risk factors is enough to show you how a healthy lifestyle is important both in preventing and in managing hypertension.
It's also worth mentioning that hypertension affects black people more than it affects white people.
Symptoms of Hypertension
As I mentioned before, hypertension is mostly asymptomatic, a lot of people who have it don't even know. This is why some call it the "silent killer”. If you are at a risk, then regular check up is important, as it allows you to catch the disease in the beginning before it causes further complications.
But, when symptoms do occur, they might include:
Headaches
Dizziness
Chest pain
Difficult in breathing
Nosebleed
The symptoms become more severe during a hypertension crisis.
Non-Pharmacological (Lifestyle) Treatments
What's good is that with some lifestyle modifications, you can reduce the risk of developing hypertension, and if you already have it, then a proper lifestyle is what you exactly need to manage it.
1. Dietary Changes
A heart-healthy diet is one of the most effective ways to lower your blood pressure. Organizing a diet is hard. Usually you would need a dietitian to guide you through this, until you have a grip on it.
One of the recommended diets is the DASH diet (Dietary Approaches to Stop Hypertension). This diet recommends the following:
Fruits, vegetables, and whole grains.
Lean proteins: fish, chicken, lean meat, beans, and nuts.
Healthy fats.
Limiting sugar, sweetened food, and beverages.
Limiting salt intake.
This diet usually targets a daily calories intake of 2000. Also, the recommended daily intake of sodium is 1500 mg or less.
2. Regular Physical Activity
Regular physical activity is effective in reducing blood pressure, much to the degree that it's now considered a promising therapeutic approach for resistant hypertension (hypertension that doesn't respond to medication).
The exercise doesn't need to be extensive, just a brisk walk for 30 minutes every day can have a huge effect on your blood pressure (4).
3. Weight Management
As you already know now, weight is one of the risk factors for developing hypertension. It's not a wonder, then, that losing weight will help you manage and control your hypertension better.
4. Stress Reduction
Stress and hypertension are tightly related. A friend of mine who has hypertension tells me that whenever she is stressed, she can feel the vessels pulsing in her head. Her blood pressure always shoots off when she is stressed. This is the story for a lot of people. When you get diagnosed with hypertension, one of the first things that your doctor will tell you is to stay away from pressure as much as possible.
This could be the hardest thing to control, because life can not be controlled or tamed. Stress will find its way to you. But that doesn't mean that you cannot try to make it less. Engaging in activities that reduce stress, such as reading, walking, or going on a picnic in a nice place, can have a great effect in reducing stress.
5. Quitting Alcohol and Smoking
Pharmacological Treatments (Medications)
The decision of whether to add medication or not depends on your doctor. Your doctor decides whether you should start a medication and decides which one you should take according to your case. For some people, especially those who acquired the disease recently, lifestyle modifications and follow up might be enough. But, others need both to achieve a blood pressure that is close to normal as much as possible.
Below are the most common medications used in the treatment of hypertension.
1. Diuretics (Water Pills)
Diuretics help your kidneys remove excess sodium and water from your body, reducing by that the volume of the blood. This, in turn, lowers your blood pressure.
Common diuretics include hydrochlorothiazide (commonly used for hypertension), chlorthalidone, and furosemide .
2. ACE Inhibitors
ACE inhibitors (Angiotensin-Converting Enzyme inhibitors) work by blocking angiotensin 2, a hormone that causes blood vessels to constrict. Blocking the synthesis of angiotensin 2 prevents it from exerting its vasoconstricting effect. This allows the vessels to dilate and relax, thus reducing blood pressure.
Examples include enalapril, lisinopril, and ramipril .
3. ARBs (Angiotensin II Receptor Blockers)
ARBs are not much different from ACE inhibitors, while the latter prevents the synthesis of angiotensin 2, ARBs prevent it from binding to its receptor and exerting its effect. Common angiotensin 2 receptor blockers include valsartan, losartan, and candesartan .
4. Calcium Channel Blockers
Calcium channel blockers (CCB) are considered by some the first line of treatment for black hypertensive patients, because they respond better to this class of medication. CCB block the entry of calcium to the cells of your heart or your blood vessels (according to the drug) thereby either reducing the force of contraction of the heart or causing dilation of the vessels, or both, leading to a decreased blood pressure.
Examples include amlodipine, diltiazem, and verapamil .
5. Beta-Blockers
Beta blockers work in the heart. They block beta-1 receptors in the heart, leading to a decrease in heart rate and force of contraction. Beta blockers are not the first choice, especially for black patients, but they might be considered as an addition or when other medications don't work.
Common beta-blockers include atenolol, metoprolol, and propranolol .
6. Renin Inhibitors
Renin is an enzyme produced by the kidney when the blood flow to the kidney is less. This enzyme leads to the synthesis of angiotensin 1 from which angiotensin 2 is produced. Inhibiting renin leads to a reduction in blood pressure.
Aliskiren is an example of a renin inhibitor.
7. Alpha-Blockers
Alpha blockers work by blocking the action of norepinephrine on the vessels, thus causing vasodilation. They are not commonly used, but can be considered if the other options don't work.
Examples are doxazosin and prazosin are examples of alpha-blockers .
Combining Medications
Sometimes your doctor might decide that you need more than one medication. This depends on the readings of your blood pressure and other things, for example, if you have diabetes or a kidney disease.
Monitoring and Adjusting Your Treatment
Monitoring is important, even crucial. Checking your blood pressure at home and following up with your doctor are important. This way you will have a better chance of preventing further complications, such as heart failure and cardiovascular diseases.
The Importance of Adherence
Many patients stop taking their medications once they feel better. Others tell themselves that as long as they don't feel any symptoms, then they must be fine. You do not want to be that person. Lack of adherence to your medications will result in a flocculating and unstable blood pressure, which might eventually harm you.
Balance Between Medications and Lifestyle
Medications are important for managing hypertension. There is no doubting or arguing about that. But they work best when you combine them with lifestyle modifications. Even if you’re on medication, continuing to eat a healthy diet, exercising regularly, managing stress, and avoiding smoking and alcohol will help you to keep your blood pressure controlled and improve your overall health .
Takeaway
Hypertension is a serious condition. It requires attention and proper management. And with the right combination of lifestyle changes and medications, you can control your blood pressure and reduce the risk of complications. Keep in mind that managing hypertension is a lifelong commitment.
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