Question

Hypertension

1. What is the treatment?

2. What is the prognosis?

Answer 1

Hypertension, also known as high blood pressure, is a chronic condition in which the blood pressure in the arteries is persistently elevated. According to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines,

(i) Elevated BP - with a systolic pressure (SBP) between 120 and 129 mm Hg and diastolic pressure (DBP) less than 80 mm Hg

(ii) Stage 1 hypertension - with an SBP of 130 to 139 mm Hg or a DBP of 80 to 89 mm Hg

1.Treatment  

The treatment of hypertension included lifestyle modifications and pharmacological interventions. Patients who are initially diagnosed with elevated BP should be advised lifestyle modifications before beginning pharmacotherapy with anti-hypertensive drugs. The various suggested lifestyle modifications are:

• Changes in diet - Low sodium diet. The AHA recommends that the daily consumption of sodium chloride should not exceed 6g. Other modifications include higher amounts of fresh fruits and green leafy vegetables. Abstinence from alcohol and smoking also plays a significant role in controlling hypertension.
• Weight loss and exercise - Weight loss can significantly reduce blood pressure in overweight and obese individuals. This is also effective against insulin resistance. Activities like brisk walking for 30 minutes a day, 5 days per week may help in controlling BP. More intense workouts of longer durations 3-4 times a week will yield better results and also promote weight loss.

Pharmacological therapy:

Various classes of drugs are prescribed for the treatment of hypertension. In more than 50% of the cases, the single-drug regimen is not sufficient. A second drug is eventually required for the effective control of BP. According to the Joint National Committee (JNC 8) guidelines, in non-black populations, angiotensin-converting enzyme inhibitors [ACEIs] /angiotensin receptor blockers [ARBs], calcium channel blockers [CCBs], and thiazide diuretics are equally efficacious. CCBs and thiazide diuretics are favored in black patients with hypertension.

Patients with heart failure respond well to diuretics, beta-blockers, ACEI/ARB and aldosterone antagonists. Post myocardial infarction, beta-blockers, and ACEI are recommended. ACEI/ARB are the drugs of choice in hypertensive patients with diabetes or chronic kidney disease.

2. Prognosis:

In most hypertensive patients, blood pressure continues to rise as they grow older. Hypertension is a risk factor for chronic kidney disease, heart disease, and stroke. One of the most common complications of untreated hypertension is chronic kidney disease. Renal function gradually worsens due to volume overload and persistent high blood pressure; which eventually leading to end up in end-stage renal disease. Hemodialysis is required in these patients. Dialysis related complications further add to the morbidity.  Patients may develop ocular complications like hypertensive retinopathy and macular degeneration. Hypertensive crisis often leads to cerebrovascular accidents. Depending on the severity of the stroke, various motor and cognitive functions in the brain may be impaired. Thus, is can be noted that untreated hypertension leads to a wide variety of complications which significantly lower the quality of life and increase the risk of mortality.