Hypertension or high blood pressure is a long-term common condition affecting almost 1 in 4 Canadians. Unattended hypertension is dangerous as it can cause heart attack, stroke, kidney disorders, or heart failure. More than 50% of hypertensive patients are at risk of heart disorders. Unquestionably, hypertension should be treated as soon as it is diagnosed.

The goal of hypertension treatment is to lower blood pressure and protect vital organs such as the heart, brain, and kidneys from damage. It is seen that hypertension treatment lowers the risk of stroke by 35% – 40%, heart failure by 50%, and heart attack by 20% – 25%.

The hypertension treatment plan usually includes a combination of lifestyle changes and medications to prevent or lower the risk of health problems. On the whole, if your blood pressure is high, consult your physician who will help you manage hypertension and its effects.

Hypertension Test

To diagnose blood pressure, your physician will place an inflatable cuff over your arm and check blood pressure using a pressure-measuring gauge. Hypertension Canada recommends the use of validated equipment and measurement techniques for diagnosing blood pressure.

There are two main types of blood pressure measurements:

• Office blood pressure measurement: It involves measuring blood pressure at the doctor’s office. Your doctor will likely take two or three readings at separate appointments before confirming the diagnosis of hypertension. 
• Home blood pressure measurement: It includes checking blood pressure home. Your doctor might ask you to check blood pressure at home to get additional information before confirming hypertension.

Blood pressure readings involve two numbers, upper (systolic) and lower (diastolic). The normal blood pressure reading is less than 120 (upper reading)/80 (lower reading) mm Hg.

Hypertension is diagnosed if your upper level is ≥130 mmHg and/or lower reading is ≥80 mmHg.

In addition to measuring blood pressure, your doctor may also recommend the following tests to determine the risk of hypertension-related disorders:

• Lipid profile
• Electrocardiogram
• Urinalysis
• Blood chemistry including potassium, creatinine, and sodium
• Blood glucose levels

Hypertension Treatment Guidelines

Hypertension Canada treatment guidelines recommend a combination of lifestyle changes and medications to manage high blood pressure.

Lifestyle Changes

A healthy lifestyle is a first-line treatment for managing hypertension

Habits that help are:

• Being physically active
• Maintaining a healthy weight
• Eating a healthy diet
• Eating less salt
• Lowering stress levels
• Quitting smoking
• Avoiding excess alcohol consumption
• Limiting caffeine intake

Hypertension Medications

In some people, only lifestyle changes might not be sufficient to control their blood pressure levels.

According to Hypertension Canada, medications should be used in the following cases:

• The upper level of ≥160 mmHg and/or lower level of ≥100 mmHg in individuals without risk factors for vital organ damage or cardiovascular disorders.
• The upper level of ≥140 mmHg and/or lower level of ≥90 mmHg in individuals with risk factors for vital organ damage or cardiovascular disorders.

Risk factors for hypertension associated conditions include:

• Diabetes
• Sedentary lifestyle
• Higher-than-normal body weight
• Long-term kidney disorders
• History of heart attack
• Family history of heart disorders
• Smoking
• Excessive alcohol consumption
• Unhealthy eating habits

So, based on the factors mentioned above, your doctor might decide to put you on medications.

There are various types of blood pressure medications with different modes of action. If one medicine fails to lower blood pressure, adding another might do the job. So, in some people, a combination of two or more drugs may be needed to control their blood pressure levels.

Here are different categories of hypertensive drugs based on how they work:

Diuretics

Diuretics, or water pills, cause the loss of excess water and salt through the kidneys. This loss of water reduces the blood volume passing through blood vessels. As a result, your blood pressure decreases.

Three major types of diuretics are:

• Potassium-sparing diuretics, such as Aldactone, Amiloride, and Dyrenium
• Thiazide diuretics, such as Microzide, Chlorthalidone, and Diuril
• Loop diuretics, such as Furosemide and Bumetanide

Besides, your doctor might also use combination diuretics, where more than one diuretic type is used.

Diuretics belonging to the thiazide group have fewer side effects than those in the other groups and are thus commonly used in managing high blood pressure.

Beta-blockers

This medicine causes the heart to beat with less force and speed. The heart thus pumps lesser blood, reducing blood pressure. Some commonly used beta-blockers are:

• Propranolol
• Metoprolol succinate
• Carvedilol
• Propranolol
• Metoprolol tartrate

Alpha-1 Blockers

Your body releases certain hormones, such as epinephrine, under stress, or in certain health conditions. The hormones constrict blood vessels and cause the heart to beat faster. These effects increase your blood pressure when they attach to a receptor.

The muscles surrounding certain blood vessels have alpha-1 receptors. When the hormones mentioned above attach to the receptors, the muscle contracts, narrowing blood vessels, and increasing blood pressure.

Alpha-1 blockers bind to the receptors, preventing the hormones from attaching. This prevents constriction of blood vessels, and thus the blood can flow through them more freely, and blood pressure lowers.

While alpha-1 blockers are commonly used to treat non-cancerous enlargement of the prostate in men, they can also treat hypertension.

Some commonly used medicines are:

• Prazosin hydrochloride
• Doxazosin mesylate
• Terazosin hydrochloride

Alpha-Beta Blockers

Alpha-beta-blockers are a subclass of beta-blockers. Certain chemicals, such as epinephrine and norepinephrine, bind to alpha and beta receptors. Attaching of these chemicals to alpha receptors results in constriction, while that with beta receptors increases the heart rate.

Alpha-beta-blockers prevents the natural body chemicals from attaching to both alpha and beta receptors. This, in turn, prevents the narrowing of blood vessels and slows down the force and rate of heartbeat, lowering blood pressure.

Some common medicines belonging to this class of drugs are:

• Labetalol hydrochloride
• Carvedilol

Alpha-2 Receptor Agonists

Activation of alpha-2 receptors prevents the release of the hormone norepinephrine, which constricts blood vessels. Alpha-2 receptor agonist activates alpha-2 receptors. Lesser norepinephrine means lesser constriction of blood vessels and lower blood pressure.

Some common examples include:

• Methyldopa
• Guanabenz acetate
• clonidine hydrochloride
• Guanfacine hydrochloride

Angiotensin Converting Enzyme (ACE) Inhibitors

Your body produces the hormone angiotensin II, which constricts blood vessels. ACE inhibitors lower the production of angiotensin II and thus help blood vessels to expand. As blood can pass through them more easily, blood pressure reduces.

Some examples include:

• Captopril
• Fosinopril sodium
• Benazepril hydrochloride
• Enalapril maleate
• Lisinopril

Angiotensin II receptor blockers (ARBs)

While ACE inhibitors prevent the production of the hormone angiotensin II, ARBs block its action. ARBs attach themselves to the angiotensin II receptors and prevent them from constricting, lowering blood pressure.

Some commonly used ARBs are:

• Eprosartan mesylate
• Losartan potassium
• Valsartan
• Candesartan
• Irbesartan
• Telmisartan

Calcium Channel Blockers

Movement of calcium in and out of the muscle cells is essential for muscle contraction.

Calcium channel blockers prevent the entry of calcium in the smooth muscle cells of blood vessels and the heart. All this helps blood vessels to widen and causes the heart to beat less forcefully. These changes ultimately lower blood pressure.

Some examples include:

• Felodipine
• Isradipine
• amlodipine besylate
• diltiazem
• verapamil hydrochloride

Vasodilators

These medications help the muscles of blood vessels to relax, especially smaller blood vessels. Vasodilators thus widen blood vessels and make blood flow through them easier. As a result, blood pressure reduces.

Some examples include:

• Minoxidil
• Hydralazine hydrochloride

Hypertension Treatment Algorithm

In the majority of the cases, a single antihypertensive medicine can control blood pressure levels. However, some patients need two or more antihypertensive drugs to manage hypertension

Your treating physician will decide the number and types of drugs based on the hypertension treatment algorithm (Image 1).

Image Source: Hypertension Treatment Algorithm

CV events include coronary artery disease and metabolic syndrome.

BP: Blood pressure; CCB: Calcium channel blocker; CV: Cardiovascular events; RAS: Renin-angiotensin system.

Final Thoughts

Hypertension is a chronic condition, which, if left unattended, may result in cardiovascular diseases, stroke, and kidney disorders. Treating hypertension as soon as it is diagnosed is thus essential to prevent these complications.

The treatment of high blood pressure usually includes lifestyle changes and/or medications. Lifestyle changes include a healthy lifestyle, being active, lowering stress levels, and maintaining a normal weight. There are various medicines with different actions, and your doctor will prescribe single or more than one medication based on your condition.

So, if your blood pressure levels are high, make sure to consult a physician who will help you manage it and prevent the risk of hypertension-related complications.