Majority of people with high blood pressure have no symptoms in the initial stages. They might be asymptomatic for many years or even decades before the symptoms due to one or more complications of the hypertension start appearing. This is why hypertension is referred to as ‘silent killer’. The control of high blood pressure is very important in the initial asymptomatic stages because it can delay or prevent the development of many complications of the hypertension.
Most of the people with high blood pressure have primary hypertension or essential hypertension, i.e. no obvious primary cause of hypertension could be identified after evaluation. However, a minor fraction of people with high blood pressure have hypertension secondary to some other disease condition. Treatment of high blood pressure in such cases focuses on treating the underlying cause of the hypertension. Successful treatment of primary cause can completely cure the high blood pressure in such cases.
Essential hypertension is controlled by antihypertensive medications and by non-pharmacological lifestyle modifications. Although the ideal blood pressure goal is systolic blood pressure less than 120 mm of Hg and diastolic blood pressure less than 80 mm of Hg, this is not always a realistic goal in hypertension. The exact target goal is variable depending on presence of other disease conditions and risk factors. Anti-hypertensive drugs are currently not recommended for prehypertension and the blood pressure control in this case should be done with various lifestyle modifications only. People with prehypertension can achieve systolic and diastolic blood pressure below 120 and 80 mm of Hg respectively by adequate lifestyle modifications.
The table given below summarizes various lifestyle modifications strategies suggested for control of high blood pressure in. Lifestyle modifications are the only treatment recommended for people with prehypertension. In hypertension, lifestyle modifications are recommended as an adjunctive therapy to the antihypertensive medications. Adopting a healthier lifestyle is recommended for everyone, and not just those with high blood pressure. It reduces the risk of future development of hypertension in people who have normal blood pressure.
Table 1: Lifestyle Modifications Recommended for High Blood Pressure
| Reduced salt intake | Reduce daily dietary intake of common salt to less than 6 g per day. (<2400 mg/day in terms of Sodium) |
| Lower body weight | Target goal should be to achieve a BMI of less than 25 kg/m2. |
| Exercises | Daily 30 Minutes of aerobic exercises are recommended. |
| Dietary Modifications | Adopting the DASH-type dietary plan (Rich in fruits, vegetables, and low-fat dairy products with reduced content of saturated and total fat) |
| Reduce Alcohol Consumption | Men should not drink more than 2 drinks per day. Women should not drink more than 1 drink per day. (1 drink = ~ 14 g alcohol) |
| Smoking Cessation | Complete smoking cessation is recommended |
| Relaxation to alleviate Stress | Relaxation techniques and other measures to reduce stress and anxiety can be tried. |
The table given below lists the major classes of the drugs used to treat hypertension. More detailed description and side effects of the drug are described in High Blood Pressure Medication.
The compliance with the antihypertensive medications regimen is very important. Not taking the medications regularly or stopping them without physician’s advice results in poor control of the high blood pressure.
Table 2: Anti-hypertensive Drugs for High Blood Pressure
| Diuretics | Thiazide Diuretics - Hydrochlorothiazide, Chlorthalidone Loop Diuretics - Furosemide, Ethacrynic acid Potassium Sparing Diuretics - Amiloride, Triamterene Aldosterone-receptor blockers - Spironolactone, Eplerenone |
| Beta-blockers | Propranolol, Metoprolol, Atenolol |
| Combined alpha and beta blockers | Carvedilol, Labetalol |
| ACE (Angiotensin-converting enzyme) inhibitors | Captopril, Lisinopril, Ramipril |
| Angiotensin II Receptor Antagonists | Losartan, Valsartan, Candesartan |
| Calcium Channel Blockers | Nifedipine, Verapamil, Diltiazem |
| Other Drugs | Alpha Blockers - Prazosin, Terazosin, Doxazosin Direct Vasodilators - Hydralazine, Minoxidol Renin Inhibitors - Aliskiren Centrally acting Sympatholytic Drugs - Clonidine, Methyldopa, Reserpine |
Regular monitoring of blood pressure readings is very important in the management of high blood pressure. Every individual is different and same therapy may result in different response in two persons with same high blood pressure readings. More aggressive management of hypertension is required by either adding more drugs or increasing the dose of current drugs if the high blood pressure is not adequately controlled by a prescribed regimen of medications.
If possible, people with high blood pressure should keep a properly calibrated blood pressure measuring machine at home for regular monitoring of their blood pressure. This is helpful in increasing the compliance with the therapy (both medications and lifestyle modifications) and also helps in early detection of inadequate control of blood pressure by current therapy.