Hypertension, Part One: A Patient Guide

Plotting your blood pressure

The guidelines (JNC 7) in place now will be updated again before the end of the decade. For adult patients (aged 18 years old and over) who have not previously been treated for or been diagnosed as having hypertension, you are considered in one of the following categories:

Depending on your blood pressure certain treatments and management strategies will be chosen. Your category is chosen by the highest category reached. Thus if your blood pressure is 138/98 you have stage 1 hypertension. The goal of each is to get your blood pressure into the best range for you so that you may have the benefit of reduction of your risks toward normal. Treatment does not make you a non-hypertensive though. You will be at higher risk of problems related to hypertension than people without high blood pressure for the rest of your life. This means that you will have to continue to be concerned with your blood pressure for the rest of your life. The goal of the therapy is also to treat this silent problem without causing other problems like unbearable side effects from the medicines.

Lifestyle modification

For almost all people defined as prehypertensive or hypertensive, lifestyle modifications should be recommended. These include reduction of excess salt intake, reduction of weight to the ideal body weight for your height, age and body structure, and an exercise program.

Medications:

Hundreds of different types of medications can be prescribed for high blood pressure. Most patients will several in their lifetime. It is common to initially start with one medication at a time for patients who are prehypertensive. This entails thiazide-type diuretics for most. ACEI (angiotensin converting enzyme inhibitors), ARB (angiotensin type 1 receptor blockers) , BB (beta blocking agents), CCB (calcium channel blocking agents, or combinations are often considered depending upon the patient and presence or absence of other indications. We go more slowly with those at risk for sudden drops in blood pressure, and are more aggressive in those with chronic kidney disease. For most patients with stage 2 hypertension we anticipate that we will require at least a combination  of antihypertensive medications.