MANAGEMENT FOR HYPERTENSION

MA. FRENE D. MALATE GROUP V

BLOOD PRESSURE TREATMENT GOALS

Your blood pressure treatment goal depends on how healthy you are: 140/90 mm Hg or lower- If you are a healthy adult 130/80 mm Hg or lower- If you have chronic kidney disease, diabetes or coronary artery disease or are at high risk of coronary artery disease 120/80 mm Hg or lower- If your heart isn't pumping as well as it should (left ventricular dysfunction or heart failure) or you have severe chronic kidney disease

LIFESTYLE INTERVENTIONS

Advise lifestyle measures in patients with hypertension and high normal blood pressure (BP), i.e. clinic BP 130-139/85-89 mm Hg. Inform about any local initiatives, and supplement advice with leaflets or audiovisual information.

PREVENTING OR TREATING OBESITY

Weight reduction should be suggested if necessary, to maintain ideal body mass index (BMI) of 20-25 kg/m2.

The National Institute for Health and Clinical Excellence (NICE) recommends basing meals on starchy foods (potatoes, bread, rice and pasta) - using wholegrain bread, and brown rice if possible, but watch the portion size of meals and cut down on snacks. Eat foods rich in fibre, i.e. cereals, pulses (beans, peas, lentils, grains, seeds), fruit and vegetables. Have at least five portions of fruit and vegetables a day.

Select low-fat foods - avoid foods containing a lot of fat and sugar (e.g. fried food, sweetened drinks, crisps, confectionery). Reduce any excessive caffeine consumption and have a low dietary sodium intake (reduce or substitute any sodium salt). Calcium, magnesium or potassium supplements are not recommended. Ensure you eat breakfast. Cut alcohol intake to no more than 21 units (male) or 14 units (female) of alcohol per week. Be careful not to take too many calories in the form of alcohol.

STOPPING SMOKING
Patients should stop smoking!

ENCOURAGING EXERCISE
Make physical activities part of everyday life (e.g. walk or cycle to work, use stairs instead of lift, walk at lunchtime), and build in enjoyable activities to leisure time every week (e.g walking, cycling, gardening, swimming, aerobics, etc.) . Minimize sedentary activities, e.g limit television watching or sitting at a computer or playing video games. Once more, look for local activities, join a sporting group, take advantage of taster sessions and get used to exercising regularly, ideally several times a week.

STARTING TREATMENT
Thiazide diuretics. Diuretics, sometimes called "water pills," are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.

Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action not the formation of a natural chemical that narrows blood vessels. Calcium channel blockers. These medications help relax the muscles of your blood vessels. Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Tekturna works by reducing the ability of renin to begin this process.

OTHER TREATMENTS:

Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels. Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels. Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.

REFERENCES

Hypertension: management of hypertension in adults in primary care, NICE Clinical Guideline (August 2011) Hypertension, NICE Pathway (August 2011) Obesity, NICE Clinical Guideline (2006); Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children DASH (Dietary Approaches to Stop Hypertension) Diet

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