Diseases & MedicineHealth Living

Basics about hypertension;diagnosis and treatment

Diagnosis

Your doctor will do a physical examination and ask you questions about your medical history. A doctor, nurse, or other medical assistant will wrap an inflated arm cuff around your arm and use a pressure-measuring gauge to take your blood pressure.

To see if there is a difference in your blood pressure, you should measure it in both arms. It’s critical to utilize an arm cuff that’s the right size.

Blood pressure measurements fall into several categories:

  • Normal blood pressure. Your blood pressure is normal if it’s below 120/80 mm Hg.
  • Elevated blood pressure. Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below (not above) 80 mm Hg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure. Elevated blood pressure may also be called prehypertension.
  • Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg.
  • Stage 2 hypertension. A systolic pressure of 140 mm Hg or higher, or a diastolic pressure of 90 mm Hg or higher, is considered stage 2 hypertension.
  • Hypertensive crisis. A blood pressure reading of more than 180/120 mm Hg is a medical emergency that necessitates immediate medical attention. Wait five minutes and recheck if you receive this result when taking your blood pressure at home. If your blood pressure remains high, see your doctor right away. Call 911 or your local emergency medical number if you have chest discomfort, vision issues, numbness or weakness, breathing difficulty, or any other signs and symptoms of a stroke or heart attack.

The importance of both values in a blood pressure reading cannot be overstated. However, around the age of 50, the systolic measurement becomes even more critical. Isolated systolic hypertension is characterized by a normal diastolic pressure (less than 80 mm Hg) but a high systolic pressure (greater than or equal to 130 mm Hg). This is a kind of high blood pressure that is common in persons over the age of 65.

Because blood pressure varies throughout the day and might rise during a doctor visit (white coat hypertension), your doctor will most likely take numerous blood pressure measurements over three or more encounters before diagnosing you with high blood pressure.

Taking your blood pressure in the comfort of your own home

To provide extra information and clarify if you have high blood pressure, your doctor may urge you to record your blood pressure at home.

Home monitoring is a vital tool for confirming whether or not you have high blood pressure, determining whether or not your blood pressure treatment is effective, and diagnosing worsening high blood pressure.

Blood pressure monitors for home use are readily accessible and affordable, and they do not require a prescription. Home blood pressure monitoring isn’t a replacement for doctor appointments, and certain home blood pressure monitors have restrictions.

Use a verified device and double-check that the cuff fits. Once a year, take the monitor to your doctor’s office to have it checked for accuracy. Consult your doctor about how you might begin monitoring your blood pressure at home.

The American Heart Association does not advocate devices that measure your blood pressure at your wrist or finger since the results can be unreliable.

Tests

If you have high blood pressure, your doctor may suggest testing to confirm the diagnosis and rule out any underlying causes of hypertension.

Monitoring in the ambulatory setting. The purpose of this 24-hour blood pressure monitoring test is to determine if you have high blood pressure. This test’s equipment takes your blood pressure at regular intervals throughout a 24-hour period, giving you a more realistic picture of how your blood pressure changes throughout the day and night. These gadgets, however, are not available in all medical locations, and they may not be covered by insurance.

Lab tests. A urine test (urinalysis) and blood tests, including a cholesterol test, may be recommended by your doctor.

Electrocardiogram (ECG or EKG). The electrical activity of your heart is measured in this quick and painless test.

Echocardiogram. Your doctor may arrange an echocardiography to check for more indicators of heart disease based on your symptoms and test results. Sound waves are used to create images of the heart in an echocardiogram.

Treatment

High blood pressure can be controlled and managed by altering your lifestyle. Your doctor may advise you to adopt the following lifestyle changes:

  • Eating a low-salt, heart-healthy diet
  • Physical activity on a regular basis
  • Maintaining a healthy weight or, if overweight or obese, reducing weight
  • Keeping your alcohol consumption to a minimum

However, lifestyle adjustments aren’t always sufficient. If diet and exercise don’t work, your doctor may prescribe blood pressure medication.

Medications

The sort of high blood pressure medication your doctor recommends is determined by your blood pressure readings and overall health. Two or more blood pressure medications are generally more effective than one. Finding the most effective prescription or drug combination might be a trial and error process.

If you have high blood pressure, your treatment objective should be less than 130/80 mm Hg. if;

  • You’re a 65-year-old healthy adult.
  • You’re a healthy adult under 65 who has a 10% or higher chance of acquiring cardiovascular disease in the following ten years.
  • You have diabetes, chronic renal disease, or coronary artery disease.

Inquire with your doctor about your blood pressure treatment goals. Also, especially if you’re over 65, the recommended blood pressure treatment goal can change with age and other conditions.

The following medications are used to treat high blood pressure:

Diuretics. Diuretics, often known as water pills, are drugs that aid in the removal of sodium and water from the body through the kidneys. These pharmaceuticals are frequently the first line of treatment for excessive blood pressure.

Diuretics are divided into three categories: thiazide, loop, and potassium sparing. Your doctor’s recommendation is based on your blood pressure readings as well as any other medical conditions you may have, such as kidney disease or heart failure. Chlorthalidone, hydrochlorothiazide, and other diuretics are routinely used to treat high blood pressure.

Increased urination is a frequent diuretic side effect, which might lower potassium levels. If you have a potassium deficiency, your doctor may prescribe a potassium-sparing diuretic like triamterene or spironolactone.

Angiotensin-converting enzyme (ACE) inhibitors. These drugs, which include lisinopril, benazepril, captopril, and others, work by preventing the development of a natural substance that constricts blood arteries.

Angiotensin II receptor blockers (ARBs). These drugs widen blood arteries by inhibiting the action, rather than the creation, of a natural substance that narrows them. Candesartan, losartan, and other ARBs are examples.

Calcium channel blockers. These drugs, such as amlodipine, diltiazem, and others, work by relaxing the muscles in your blood vessels. Your heart rate will be slowed by some. Calcium channel blockers may be more effective than ACE inhibitors alone for elderly adults and people of African descent.

When taking calcium channel blockers, avoid eating or drinking grapefruit products. Grapefruit raises the amount of calcium channel blockers in the blood, which can be harmful. If you’re worried about drug interactions, talk to your doctor or pharmacist.

High blood pressure can sometimes treated with additional drugs.

If you’re having problems meeting your blood pressure goals with the meds listed above, your doctor may prescribe:

  • Alpha-blocking agents. These drugs lessen the impact of natural substances that narrow blood arteries by reducing nerve signals to blood vessels. Alpha blockers include doxazosin , prazosin and others.
  • Alpha-beta blockers. Alpha-beta blockers lower the volume of blood that must be pumped through the vessels by blocking nerve signals to the vessels and slowing the heartbeat. Carvedilol and labetalol are two alpha-beta blockers.
  • Beta blockers. These drugs lower your heart’s workload and enlarge your blood arteries, leading your heart to beat more slowly and with less force. Acebutolol, atenolol, and other beta blockers are examples. Beta blockers aren’t normally prescribed as the sole blood pressure medication, but they can be helpful when used in conjunction with other blood pressure medications.
  • Aldosterone antagonists. These medications are also diuretics. Spironolactone and eplerenone are two examples. These medications work by inhibiting the action of a natural chemical that can cause salt and fluid buildup, which can lead to high blood pressure. They could be used to treat hypertension that is resistant to treatment.
  • Renin inhibitors. Aliskiren inhibits the production of renin, a kidney enzyme that initiates a cascade of chemical reactions that raise blood pressure.
  • You should not take aliskiren with ACE inhibitors or ARBs since there is a risk of significant consequences, including stroke.
  • Vasodilators. Hydralazine and minoxidil are two of these drugs. They act directly on the muscles that line the inside of your arteries, preventing them from tightening and narrowing.
  • Central-acting agents. These drugs stop your brain from sending your nervous system to speed up your heart rate and constrict your blood vessels. Clonidine, guanfacine, and methyldopa are other examples.

Treating resistant hypertension

You may develop resistant hypertension if your blood pressure remains stubbornly high despite using at least three different types of high blood pressure medicines, one of which should be a diuretic.

If you have regulated high blood pressure but are using four separate drugs at the same time to attain that control, you’re said to have resistant hypertension. If this is the case, your doctor should look into a secondary reason of your high blood pressure.

Resistant hypertension does not indicate that your blood pressure will never go below a certain level. If you and your doctor can figure out what’s causing your high blood pressure, you can devise a more effective treatment plan to help you reach your target blood pressure.

Many processes may be involved in treating resistant hypertension, including:

  • Changing your high blood pressure meds to see what combinations and doses work best is a good idea.
  • Examining all of your drugs, including ones you take for other reasons or that you bought without a prescription
  • Keeping track of your blood pressure at home to observe if going to the doctor causes it to rise (white coat hypertension)
  • Making healthy lifestyle adjustments such eating a low-salt diet, maintaining a healthy weight, and limiting alcohol consumption
  • Always take your blood pressure medicine as directed. Never miss a dosage or stop taking your blood pressure medication suddenly. Stopping certain blood pressure medications, such as beta blockers, suddenly can result in a significant increase in blood pressure (rebound hypertension).

If you forget to take your meds because you can’t afford them, you have adverse effects, or you simply forget, talk to your doctor about alternatives. Do not alter your treatment without consulting your doctor.

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