THE TREATMENT OF HYPERTENSION

Hypertension can be treated with your own efforts to work on your lifestyle and taking pharmacological treatment simultaneously.

Lifestyle modification

A better lifestyle contributes in lots of different ways to the treatment of hypertension as it’s one of the antihypertensive treatments. Lifestyle modification helps in following ways:

  • It will delay the risk of high blood pressure.
  • It helps in maintaining the cardiovascular system.
  • Modifying your lifestyle can fasten the effect of antihypertensive treatment.
  • Lifestyle modification leads to behavioral modification.

Seasonal BP Variation 

  • Seasonal BP variations can be seen with lower levels at higher temperatures.
  • It gets higher at lower temperatures. 
  • Such changes can be seen in people traveling from places with cold to hot temperature and vice-versa.
  • Data says BP goes down in summer of 5/3mm Hg (systolic/ diastolic).
  • BP changes are more in treated hypertensive.

Pharmacological treatment

  • Data taken from 100 countries shows the percentage of people taking medication for hypertension.
  • In data, the percentage of adults in some countries receiving medication is less than 50%.
  • In some countries the percentage is more than this.
  • In other countries it is worse.
  • The difference in BP of 20/10 mm Hg is related to a 50% difference in cardiovascular risk.

Adherence to Antihypertensive treatment

We all know what adherence is. It is a behavior to stick to something. 

  • In this case, adherence is a person’s behavior
  • The habit of taking medication, executing lifestyle and going with the diet plan recommended by the healthcare provider. 
  • 10% to 80% patients of hypertension get affected with non-adherence to antihypertensive treatment.
  • Poor adherence to antihypertensive treatment indicates poor prognosis in hypertensive patients.
  • The cause of poor or non-adherence to antihypertensive treatment can be pharmacological therapy, socioeconomic status and association to some healthcare system.

Some suggestion for adherence to antihypertensive therapy:

  • Analyze the treatment every time you visit.
  • Reminder for medications
  • Counseling for self-monitoring.
  • Consider adherence as your daily habit.

Comorbidities and complications of hypertension

  • Cardiovascular risk can be a factor in hypertensive patients.
  • Simultaneously complications increase with age.
  • Some common comorbidities are CAD (coronary artery disease), stroke, CKD, HF, COPD
  • Rare or uncommon comorbidities are rheumatic diseases and psychiatric diseases.

Common comorbidities and complications

  • Hypertension with coronary artery disease:
    • Patients with this comorbidity are suggested to change their lifestyle like smoking cessation, diet and exercise.
    • It is said that if BP is equal or greater than 140/90 mm Hg it should be lower. 
    • Some first-line drugs RAS blocker and beta-blockers.
    • Doctors recommend antiplatelet treatment routinely. 

 

  • Hypertension and previous stroke:
    • Stroke can be delayed by BP control.
    • It is said that if BP is equal or greater than 140/90 mm Hg it should be lower.
    • First-line drugs are RAS blocker, CCBs, and diuretics.
    • Lipid- lowering treatment with LDL-C target less than 70 mg/dL is mandatory.

 

  • Hypertension and chronic kidney disease
    • Hypertension can lead to any type of CKD.
    • When eGFR is low it suggests resistant hypertension.
    • First-line drugs are RAS- inhibitors as they decrease albuminuria.

 

  • Hypertension and chronic obstructive pulmonary disease (COPD)
    • Hypertension is a risk for patients with COPD.
    • Lifestyle changes are mandatory like smoking.
    • Should be aware of the risk of cardiovascular profile.

 

  • HIV /AIDS
    • HIV patients are at high risk of cardiovascular risk.
    • Hypertension management should be the same as with the other hypertensive patients.

 

  • Diabetes
    • The treatment plan will have an RAS inhibitor.
    • Glucose and lipid lowering should be included in the treatment.

 

  • Lipid disorder
    • BP should be lowered like in case of other populations.
    • Lipid lowering treatment includes satins with or without ezetimibe.

Other comorbidities are:

  • Hypertension and inflammatory rheumatic diseases (IRD)
    • IRD is when hypertension is increased and is badly controlled.
    • Rheumatoid arthritis can occur among IRD.
    • Lipid lowering drugs shall be used according to the status of cardiovascular risk.


  • Hypertension and psychiatric diseases
    • Patients with depression and psychiatric disorders are likely to suffer hypertension.
    • Guidelines say psychiatric disorders increase the cardiovascular risk.
    • Other risk factors can be managed according to cardiovascular risk