Index
The nonpreventable causes of this disease include genetics, race, sex, and age.
Many different factors often combine to cause hypertension.
Some of these factors can be prevented, and others can not.
Hypertension is twice as likely to occur in individuals with one or both parents with hypertension.
High blood pressure is more likely and more severe in African-Americans.
Men are more likely than women to develop hypertension, and increasing age is also a risk factor.
Many other factors are entirely avoidable.
These include obesity, smoking, excessive alcohol consumption, physical inactivity, and a diet high in salt.
Smoking and alcohol consumption causes the blood vessels to constrict or become smaller, which causes the pressure to increase.
Diets rich in salt cause water retention, increasing the volume of blood moving through the body and increasing pressure.
Obesity causes hypertension in many ways, increasing the surface on which blood must circulate and making the heart work harder.
Hypotension or low blood pressure is a medical condition.
A blood pressure reading of less than 90/60 indicates hypotension.
Although it is not generally considered a severe problem, it can cause dizziness, nausea, fatigue, fainting, blurred vision, and other symptoms.
Chronic hypotension can also be a sign of more serious medical conditions.
Treatment focus
The main objective of the treatment is to reduce the risk of cardiovascular and renal mortality and morbidity.
It has been established that the goal should be less than 140/90 mmHg for adults between 18 and 59 years, including those with diabetes or chronic kidney diseases, and less than 150/90 mmHg in the geriatric population from 60 years.
Treatments to reduce high blood pressure
There are many medications available for the treatment of blood pressure.
While the first medication you test may cause unwanted side effects or may not be effective.
The doctor usually tests treatments until they find the best medication for the patient.
Adopting a healthier lifestyle is also significant for controlling high blood pressure.
Some of these lifestyle changes are more difficult than others, but they will all make a positive difference.
Changes in lifestyle
The initial approach for a newly diagnosed patient should include a comprehensive explanation of the risks associated with hypertension and the need for adequate control and treatment adherence.
The initial therapeutic measure should be a modification of the lifestyle.
Tobacco
Smoking is a factor that contributes to high blood pressure and other health conditions.
The cessation of smoking should be an immediate priority when receiving treatment for high blood pressure.
Alcohol
Limited consumption or eliminating your alcohol intake can also help decrease blood pressure.
Diet
For patients with high blood pressure, diet adjustments are needed.
It is recommended to reduce the intake of salty foods (Sodium reduction of less than 1.5 g per day) and add potassium supplements (3.5 to 5.0 g per day).
Preferably through the consumption of a diet rich in potassium, unless contraindicated by chronic kidney diseases or medications that reduce the excretion of potassium.
A diet of dietary approaches is generally recommended to stop hypertension that allows 8 to 10 servings of daily fruits and vegetables, poultry, fish, nuts, whole grains, low-sodium, low-fat proteins, and the elimination of sugary foods and beverages very processed.
This diet has a positive impact on blood pressure and overall health.
Weightloss
Along with changes in diet, weight loss is one of the best ways to control high blood pressure.
Per kilograms of weight lost, blood pressure is also decreased.
The waist circumference should be less than 102 cm for men and less than 88 cm for women, with weight loss at a body mass index of approximately 25 kg / m².
Exercise
Regardless of weight loss, exercise is another excellent tool to control hypertension.
Forty minutes of aerobic exercise three to four times a week can reduce blood pressure by six points.
Incorporating weight training can reduce it by three more points.
An increase in physical activity is recommended: at least 30 minutes of moderate-intensity dynamic aerobic exercise (walking, jogging, biking, or swimming) 5 days a week for 150 minutes per week.
Medicines
Combined hypertension therapy with separate agents or a fixed-dose combination pill offers the possibility of reducing the blood pressure more quickly, obtaining the desired blood pressure, and decreasing adverse effects.
Antihypertensive agents of different classes can compensate for adverse reactions to each other, such as a diuretic that decreases the edema that occurs after treatment with a calcium channel blocker.
Most patients with hypertension require more than a single antihypertensive agent, especially if they have comorbid conditions.
Although diuretic therapy is recommended as the initial pharmacological agent for most patients with hypertension, “convincing indications” may prompt treatment with antihypertensive agents that demonstrate a particular benefit in primary or secondary prevention.
Combination therapy is treatment with two or more agents administered separately or in a fixed-dose combination pill. It is required by most patients with hypertension to achieve the desired blood pressure.
In many cases, combination therapy improves blood pressure control rates. It requires less time to reach the target blood pressure with a tolerance equivalent to or better than the highest monotherapy dose.
Patients with comorbidities can benefit from the effects of different antihypertensive medications and are considered for combination therapy.
For example, a patient with hypertension and diabetes, heart failure, or kidney disease may benefit from a diuretic and an angiotensin-converting enzyme inhibitor.
Also, when monotherapy does not achieve blood pressure, combination therapy is an alternative to increasing the dose of a single agent.
Choice of agents
The characteristics of the patient guide the choice of antihypertensive agents.
Antihypertensive agents can have complementary effects and can help counteract the adverse effects of others.
Combination therapies that demonstrate synergistic or complementary mechanisms of action include beta-blocker-diuretic and angiotensin-diuretic receptor blockers.
Also, the angiotensin-diuretic-converting enzyme inhibitor, calcium channel blocker-angiotensin-converting enzyme inhibitor, calcium channel blocker-diuretic, and a thiazide diuretic plus a potassium-sparing diuretic.
Fixed-dose combination agents
Fixed-dose combination therapies offer several potential benefits, including simplifying the treatment regimen, convenience, and cost reduction.
The choice of combination agents can be used to minimize the adverse effects of each agent.
An example is the combination of a thiazide diuretic with an angiotensin-converting enzyme inhibitor.
Disadvantages include initial doses that are often lower than those initiated with monotherapy, potentially making it more challenging to achieve the desired amount and the risk of causing orthostatic hypotension in older patients and patients with diabetic neuropathy.
Patients’ concerns about switching from combination therapy to a fixed-dose combination include a change in an established routine, ability to achieve the same medications and dose in a combined pill, increased cost, and inability to easily adjust the quantity and size of the tablet.
Initial management of hypertension with combination therapy
Approximately 70 percent of patients with hypertension will require two or more agents to achieve their target blood pressure.
The use of combination therapy for initial treatment offers the possibility of reaching blood pressure with fewer adverse effects because lower doses of each agent can be used.
Potential economic benefits include less need to change medications and better long-term results secondary to better blood pressure control.
Initial treatment with combination therapy should be considered in any patient whose blood pressure is more significant than 20 mm Hg above the systolic goal or 10 mm Hg above the diastolic goal.
Special populations
Heart failure
Diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone antagonists (aldosterone antagonists include eplerenone and spironolactone) are recommended in the treatment of hypertensive patients with heart failure.
These drugs have been shown to reduce morbidity and mortality in patients with heart failure.
Aldosterone antagonists are beneficial in treating moderate to severe heart failure but may not offer the same benefit to patients with less severe heart failure or significant renal failure.
The choice of agents is based on the severity of the heart failure, the ejection fraction of the left ventricle, and the history of myocardial infarction.
Post myocardial infarction
It is recommended that the treatment of patients with hypertension who have had a myocardial infarction include an angiotensin-converting enzyme inhibitor.
Angiotensin receptor blocker for patients intolerant to angiotensin-converting enzyme inhibitors, a beta-blocker, and an aldosterone antagonist for patients with symptomatic heart failure without hyperkalemia or significant renal failure.
Blockers of short-acting calcium channels are not recommended for the treatment of hypertension in patients with myocardial infarction.
High risk of coronary heart disease
In patients with hypertension at high risk of coronary heart disease, diuretics, calcium channel blockers, beta-blockers, and angiotensin-converting enzyme inhibitors are recommended.
Diabetes mellitus
Patients with hypertension and diabetes have lower blood pressure control rates and often require combination therapy.
An angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker is recommended if an angiotensin-converting enzyme inhibitor is not tolerated or is contraindicated for these patients.
Common combinations include an angiotensin-converting enzyme inhibitor, an angiotensin receptor blocker, a calcium channel blocker, or a diuretic.
Given the low cost and proven benefits of a diuretic to reduce cardiovascular and all-cause mortality, the combination of a diuretic and an angiotensin-converting enzyme inhibitor is a good starting point if combination therapy is chosen.
The combination of the calcium channel blocker inhibitor has shown a reduction in upper blood pressure compared to monotherapy with angiotensin-converting enzyme inhibitors in patients with hypertension and diabetes.
The renoprotection achieved in these patients through the use of treatment with inhibitors of the angiotensin-converting enzyme reflects the action of the angiotensin-converting enzyme inhibitor and the decrease in blood pressure.
Chronic kidney disease
Diabetes and hypertension are the two leading causes of end-stage renal disease.
Hypertension can cause or worsen kidney disease, which can also be caused by kidney disease.
Combination therapy is often necessary to effectively reduce blood pressure to target levels in patients with kidney disease because monotherapy seldom reaches the level of blood pressure decrease required to decrease glomerular filtration rate.
The first-line therapy for proteinuric kidney disease includes an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. It often requires the addition of a diuretic or a calcium channel blocker.
In patients with hypertension and non-diabetic proteinuric renal disease, adding a calcium channel blocker to an angiotensin-converting enzyme inhibitor significantly reduces blood pressure. Still, it does not offer an advantage in decreasing the progression of renal disease terminal.
Thiazide diuretics are recommended in patients with a glomerular filtration rate greater than or equal to 40 ml per minute, and loop diuretics are recommended in patients with a glomerular filtration rate less than or equal to 40 ml per minute.
The combination of an angiotensin-converting enzyme inhibitor and an angiotensin receptor blocker may be beneficial compared to any agent alone in certain patients with chronic kidney disease.
