If you have been diagnosed with hypertension, or high blood pressure, it is important for you to establish a reasonable goal for treating hypertension, and then take the necessary steps to achieve that goal.
Keep in mind that, most often, achieving your blood pressure goal will only be accomplished after a series of steps – one step at a time. After each step, you and your doctor will determine whether the goal — reaching your “target” blood pressure without significant side effects — has been achieved.
Typical Treatment Steps for Essential Hypertension
Treating Hypertension often depends on the “stage” of your hypertension, which is determined by your systolic and diastolic blood pressure.
- Stage 1 hypertension: systolic 140 – 159 mmHg, OR diastolic 90 – 99 mmHg
- Stage 2 hypertension: systolic greater than 159 mmHg, OR diastolic greater than 99 mmHg
If your hypertension is relatively mild (Stage 1 hypertension), your doctor may begin by advising lifestyle changes. Lifestyle changes that may help to reduce your blood pressure include:
- Adopting a diet for hypertension
- Adopting salt restriction
- Adopting a regular exercise program
- Quitting smoking
If you are successful at adopting these lifestyle changes but your blood pressure still has not reached your goal (or if you are a more typical human, and your efforts at diet and exercise still fall somewhat short of what the experts recommend) your doctor will recommend drugs for treating hypertension
Five major classes of medications are used to treat hypertension:
- Thiazide diruetics
- ACE inhibitors
- Calcium blockers
- Beta blockers
- Angiotensin receptor blockers, ARBs
Several specific drugs have been marketed for hypertension within each of these classes, and several prescription medications contain a combination of these drugs.Remember to consult your physician before self-medicating.
If you have Stage I hypertension, the odds are good that your blood pressure can be brought to target levels with a single drug. If you have Stage 2 hypertension, single drug therapy rarely is effective enough, and your doctor may want to begin right away with a combination of drugs.
If single drug therapy (or monotherapy) is chosen, it appears best to begin with either a thiazide diuretic, a long-acting calcium blocker, or an ACE inhibitor. Young patients often respond well to ACE inhibitors; black patients and elderly patients tend to do better with thiazide diuretics or calcium channel blockers.
If the first try at monotherapy is insufficiently effective or poorly tolerated, switching to another single drug, and then to a third if necessary, is generally recommended as the next step.
If three or more attempts at monotherapy have not worked well enough, the next step is to try combination therapy with two or more drugs. While numerous combinations are possible, recent evidence suggests that using a calcium blocker together with an ACE inhibitor or ARB may be the most effective and best-tolerated combination. Most doctors will now try this combination first, even if the monotherapy was with a thiazide diuretic.
With these step-wise manoeuvres, the large majority of patients with hypertension will reach their target blood pressure levels with minimal side effects. Keep in mind that finding successful therapy for hypertension often requires several weeks or months, and several drug trials. But it is important for you to stick with the program. Getting your blood pressure to target levels, and keeping it there, will give you a very large payout for your efforts — a greatly reduced risk of heart attack and stroke. PharmEasy lets you order prescribed medication and schedule diagnostic tests.