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LAST week, we covered the basics of blood pressure awareness and control and the factors that raise the risk of developing hypertension, as well as its complications.

This week, we will deal with the therapeutic goals and methods in the management of hypertension.

Typically, hypertension is treated with a combination of lifestyle changes and medications.

The treatment goal for most adults is to reach and then maintain a blood pressure reading below 140/90 mm Hg.

However, in adults who have diabetes or chronic kidney disease, the goal usually is a blood pressure below 130/80 mm Hg.

Still, depending on factors such as your age and other health conditions, your doctor may set target blood pressure goals that differ from standard guidelines, explains the health letter.

If you’ve been diagnosed with prehypertension or hypertension, the health letter offers a list of measures to help lower your blood pressure:

1) Lifestyle changes:

Follow a healthy-eating plan — Without depriving yourself, the best type of diet for just about everyone puts emphasis on fresh fruits and vegetables, whole grains and low-fat dairy foods and limits unhealthy fats, added sugars and sodium...for instance, the Dietary Approaches to Stop Hypertension (DASH) diet combines all of these elements.

Maintain a healthy weight — For overweight and obese individuals, reducing their weight by 7 to 10 percent can help lower their blood pressure and risk of complications related to hypertension.

Engage in regular physical activity — Aim for at least 30 minutes of moderate-intensity activity on most days of the week, including brisk walking, dancing, riding a bike, gardening and housecleaning and try more-intense activities, such as jogging, swimming and playing sports.

If you’ve been inactive or have health issues that limit your activity, check with your doctor about what’s best for you.

Don’t smoke — If you smoke, consult your doctor who can help you choose what program and products might work best for you in trying to stop the habit.

If you don’t smoke, try to limit your exposure to secondhand smoke.

Limit alcohol — If you drink, do so only in moderation...for women, that means no more than one drink a day; for men, it’s no more than two drinks a day.

One drink means a 12-ounce beer, a 5-ounce glass of wine, 1.5 ounces of 80-proof liquor, or 1 ounce of 100-proof liquor.

Manage stress — Getting regular physical activity and a good night’s sleep can help relieve daily pressures.

Studies have shown that activities such as yoga, tai chi and meditation also can be beneficial.

While each of these lifestyle changes can be helpful on their own, they produce better results when combined.

Some individuals can control their blood pressure with lifestyle changes alone but many need to take medication as well.

If your doctor prescribes medication, you should not consider healthy habits to be less important in controlling blood pressure and keeping complications at bay.

2) Medications...they work in different ways — some remove excess fluid and salt from your body to lower blood pressure, while others slow your heartbeat or relax and widen your blood vessels.

It’s now common for doctors to prescribe a combination of low-dose medications rather than large doses of a single drug.

Medications include:

Diuretics — Known sometimes as water pills, diuretics help your kidneys to rid your body of excess water and salt and cause blood vessels to relax (widen), which reduce overall fluid and blood pressure.

Beta blockers — These medications cause your heart to beat slower and with less force...some beta blockers also cause blood vessels to relax.

Angiotensin-converting enzyme (ACE) inhibitors — They prevent your body from making angiotensin II, a hormone that narrows vessels and triggers the release of aldosterone, a hormone that retains sodium and water in the body, allowing your blood vessels to relax and maintain better blood flow.

Angiotensin II receptor blockers — Like ACE inhibitors, these medications help relax the blood vessels, but instead of preventing the formation of angiotensin II, they block the action of this hormone.

Calcium channel blockers — These drugs keep calcium from entering cells in your heart and blood vessels, allowing blood vessels to relax.

Renin inhibitors — These medications slow the production of rennin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases your blood pressure.

Currently, only one rennin inhibitor, known as aliskiren (Tekturna), is used to treat hypertension.

Alpha blockers — These medications reduce the effect of nerve impulses that narrow blood vessels, causing them to relax and widen.

Alpha-beta blockers — These combine the effects of alpha blockers and beta blockers, slowing the heart rate, as well as reducing the effect of nerve impulses that constrict the blood vessels.

Central nervous system inhibitors — These medications lower blood pressure by reducing nerve impulses that increase heart rate and cause blood vessels to narrow.

Direct vasodilators — These drugs act directly on blood vessels to cause them to relax.

Like all medications, these drugs have potential side effects.

If you develop noticeable problems after being prescribed a certain drug, notify your doctor (who may be able to adjust the dose or switch you to another medication), but don’t ever stop taking any of these medications on your own, because stopping your blood pressure medications may result in a sudden and severe rebound increase in blood pressure that can have serious consequences, such as heart attack or stroke.

At times, hypertension can be stubbornly resistant to the usual interventions.

Thus, if you can’t get your blood pressure under control, despite taking at least three different medications in full doses, you are considered to have resistant hypertension.

This doesn’t mean your situation can’t get better, but you do have to work with your doctor to try to identify the cause of the problem, such as:

1) The medications and doses you’re taking to control your blood pressure may not be appropriate for you — Different combinations and doses of medications may have to be tried to find what will work best for you.

2) Other medications you’re taking for other conditions, supplements and foods, as well as some of your daily habits can either worsen hypertension or keep drugs designed to lower blood pressure from working effectively.

3) Secondary causes of hypertension, such as narrowing of the arteries that carry blood to the kidneys (renal artery stenosis) and sleep apnea may have to be ruled out with special tests.

4) You may not have been taking your blood pressure medications as prescribed. or else, you may have been skipping doses or letting too much time go by before refilling prescriptions, all of which can contribute to poor blood pressure control.

Thus, since lifestyle changes and medications can effectively lower blood pressure, but can’t cure hypertension, if you don’t have high blood pressure, you can prevent hypertension by adopting the same lifestyle measures recommended for those with the condition; but if you do have hypertension, you’ll need treatment...both in order to and after you get your blood pressure under control.

Also, regular checkups allow your doctor to see how well your treatment is working, or to make changes in your treatment if needed, concludes the health letter.

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