High Blood Pressure - 3

Self-Care at Home

The management and control of high blood pressure involves two major options, lifestyle modification and medication.

Lifestyle Modifications to Manage High Blood Pressure

Weight Control

• Aim for a healthy weight range for your height and body type. Your health care practitioner can help you calculate a healthy target weight.
  
• Even a small amount of weight loss can make a major difference in lowering or preventing high blood pressure.
  
• You must burn more calories than you take in to lose weight.
  
• Crash or fad diets are not helpful and may be dangerous.
  
• Some weight loss medications also carry major risks and may even elevate blood pressure, and great caution is advised in using these drugs. Please ask your health care practitioner or pharmacist for help in deciding if a weight loss medication is appropriate for your situation.

Exercise or Increase Physical Activity

• Physical activity reduces total cholesterol and bad cholesterol (low density lipoprotein or LDL) and raises the good cholesterol (high density lipoprotein or HDL).
  
• Both the American Heart Association (AHA) and the U.S. Surgeon General recommend 30 minutes of physical activity on most days of the week.
  
• Physical activity includes many daily activities such as cleaning the house, raking the lawn, and walking. Other possible sources of activity can include using the stairs instead of an elevator or escalator, walking for errands instead of driving a car, and participating in a sport or social activity such dancing.                                         

• Medical Treatment

  In about half of people with high blood pressure, limiting sodium intake by eliminating table salt, cooking salt, and salty and processed foods can reduce blood pressure by 5 mm Hg. Losing weight and participating in regular physical activity can reduce blood pressure further.
  If these lifestyle changes and choices don't work, medications should be added. The medications have been proven to reduce the risk of stroke, heart disease, and kidney problems. Do not stop taking your medications without talking to your health care practitioner.

  High Blood Pressure Medications

  It may take trial and error to find the proper medication or combination of medications that will help control hypertension in each case. It is important to take the medications as prescribed and only discontinue them on the advice of your health care practitioner.
  Water Pills (diuretics)
  • Diuretics are used very widely to control mildly high blood pressure, and are often used in combination with other medications.
    
  • They increase sodium excretion and urine output and decrease blood volume. The sensitivity to the effect of other hormones in your body is decreased.
    
  • One example of a diuretic is hydrochlorothiazide (HydroDIURIL)
    
  • The most commonly used diuretics to treat hypertension include:
    
    
    • hydrochlorothiazide (HydroDIURIL),
      
    • the loop diuretics furosemide (Lasix) and torsemide (Demadex),
      
    • the combination of triamterene and hydrochlorothiazide (Dyazide), and
      
    • metolazone (Zaroxolyn).
  Beta-Blockers
  • Beta-blockers reduce heart rate and decrease the force of heart contraction by blocking the action of adrenaline receptors. Beta blockers are widely prescribed and effective but can cause increased fatigue and decreased exercise tolerance because they prevent an increased heart rate as a normal response to physical activity.
    
  • They are also prescribed for people who have associated heart disease, angina, or history of a heart attack.
    
  • Examples of beta blockers include, carvedilol (Coreg), metoprolol (Lopressor),atenolol (Tenormin)
  Calcium Channel Blockers (CCBs)
  • Calcium channel blocking agents work by relaxing the muscle in artery walls and by therefore reducing the force of contraction of heart muscle.
    
  • Example of calcium channel blockers include, nifedipine (Procardia), diltiazem Cardizem), verapamil  (Isoptin, Calan), nicardipine (Cardene), amlodipine (Norvasc), and felodipine (Plendil)
  Angiotensin-Converting Enzyme (ACE) Inhibitors
  • ACE inhibitors stop the production in the body of a chemical called angiotensin II, which causes blood vessels to contract. Narrower blood vessels are associated with increased blood pressure. Relaxing artery walls leads to lower blood pressure.
    
  • Examples of ACE inhibitors include Captopril (Capoten), enalapril (Vasotec),lisinopril (Zestril, Prinivil),   quinapril (Accupril), and fosinopril (Monopril)
  Angiotensin Receptor Blockers (ARBs)
  • ARBs work block angiotensin II receptors and prevent vasoconstriction, or narrowing of blood vessels.
    
  • Examples of ARBs include losartan (Cozaar), valsartan (Diovan), candesartan (Atacand), and irbesartan (Avapro)
  Blockers of Central Sympathetic (autonomic nervous) System
  
  • These agents block messages from the brain's autonomic nervous system that contract blood vessels. The autonomic nervous system is the part of the unconscious nervous system of the body that controls heart rate, breathing rate, and other basic functions.
    
  • These medications relax blood vessels, thus lowering blood pressure.
    
  • An example is clonidine (Catapres)
  Direct Vasodilators
  • Direct vasodilators relax (dilate) the blood vessels to allow blood to flow under lower pressure.
    
  • These medications are most often used in times of hypertensive crisis and are injected intravenously to quickly lower blood pressure readings.
    
  • Examples include nitroprusside (Nitropress), and diazoxide (Hyperstat).                                                                 

    Other Therapy

    Alternative therapies may be helpful to people trying to control their blood pressure.
    • Acupuncture and biofeedback are well-accepted alternative techniques that may help some people with high blood pressure.
      
    • Techniques that induce relaxation and reduce stress are recommended. These include meditation, yoga, and relaxation training.
      
    • These techniques alone may not control high blood pressure for many people. They should not be used as a substitute for medical therapy without first consulting with your health care practitioner.
    Dietary supplements and alternative medications and therapies are sometimes recommended for high blood pressure.
    • Examples include vitamins, garlic, fish oil, L-arginine, soy, coenzyme Q10, herbs, phytosterols, and chelation therapy.
      
    • While these substances may be beneficial, the exact nature of their benefits is not known.
      
    • Scientific studies have produced no evidence that these therapies lower blood pressure or prevent the complications of high blood pressure.
      
    • Most of these substances are harmless if taken in moderate doses. Most people can take them without problems.
      
    • Talk to your health care practitioner if you are considering any of these treatments. Substituting these therapies for medical therapies that have been shown to lower blood pressure and the risk of complications may have a harmful effect on your health.
    • (To be continued)