Sunday, May 19, 2013

High Blood Pressure - Treatment

Table of Contents

Treatment


Patients with hypertension should work with their doctors to set blood pressure goals based on individual risk factors. Lifestyle changes are important for everyone, and patients should routinely monitor their blood pressure at home. Drug treatment needs to be planned on an individual basis. About 30% of patients with hypertension are not treated at all, and less than 50% have adequately controlled blood pressure.

It is not always clear when drugs should be started, particularly for people with prehypertension or mild high blood pressure. To help make treatment choices, the U.S. National Heart, Lung, and Blood Institute has created categories (groups A, B, and C) according to a patient's risk factors for heart disease. Applying these categories to the severity of hypertension helps determine whether lifestyle changes alone or medications are needed.

Treatment Recommendations by Stage and Risk Groups

Risk Groups

Blood Pressure Stages (Systolic/Diastolic)

Prehypertension

(120 - 139/80 - 89)

Mild (Stage 1) Blood Pressure

(140 - 159/90 - 99)

Moderate-to-Severe (Stage 2) Blood Pressure

(Systolic pressure over 160 or diastolic pressure over 100)

Risk Group A

Have no risk factors for heart disease.

Lifestyle changes only. (Exercise and dietary program with regular monitoring.)

Year trial of lifestyle changes only. If blood pressure is not lower at 1 year, add drug treatments.

Lifestyle changes and medications.

Risk Group B

Have at least one risk factor for heart disease* (excluding diabetes) but have no target organ damage (such as in the kidneys, eyes, or heart, or existing heart disease).

Lifestyle changes only.

6-month trial of lifestyle changes only. If blood pressure is not lower at 6 months, add drug treatments.

Medications considered for patients with multiple risk factors.

Lifestyle changes and medications.

Risk Group C

Have diabetes with or without target organ damage and existing heart disease (with or without risk factors for heart disease).

Lifestyle changes and medications.

Lifestyle changes and medications.

Lifestyle changes and medications.

Drug Treatment

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Review Date: 04/06/2010
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)