Hypertension Treatment Overview

It is important to take steps to keep your blood pressure under control. The treatment goal is blood pressure below 140/90. For people with other conditions, such as diabetes and kidney disease, the treatment goal is blood pressure below 130/80.

Since most persons with hypertension, especially those age >50 years, will reach the diastolic blood pressure goal once systolic is at goal, the primary focus should be on achieving the systolic goal.

Initial Evaluation

Once you’ve been identified as having high blood pressure through blood pressure measurement, your doctor will conduct a full medial examination in order to:

• Assess lifestyle and identify other cardiovascular risk factors or concomitant disorders that may affect prognosis and guide treatment
• Reveal any identifiable causes of high BP
• Assess the presence or absence of target organ damage and cardio vascular disease

The data needed are acquired through medical history, physical examination, routine laboratory tests, and other diagnostic procedures. The physical examination should include an appropriate measurement of blood pressure, with verification in the contralateral arm; examination of the optic fundi; calculation of body mass index (BMI) (measurement of waist circumference also may be useful); auscultation for carotid, abdominal, and femoral bruits; palpation of the thyroid gland; thorough examination of the heart and lungs; examination of the abdomen for enlarged kidneys, masses, and abnormal aortic pulsation; palpation of the lower extremities for edema and pulses; and neurological assessment.

Laboratory Tests and Other Diagnostic Procedures

Routine laboratory tests recommended before initiating therapy include an electrocardiogram; urinalysis; blood glucose and hematocrit; serum potassium, creatinine (or the corresponding estimated glomerular filtration rate [GFR]), and calcium; and a lipid profile, after 9- to 12-hour fast, that includes high density lipoprotein cholesterol and low-density lipoprotein cholesterol, and triglycerides. Optional tests include measurement of urinary albumin excretion or albumin/creatinine ratio. More extensive testing for identifiable causes is not indicated generally unless blood pressure control is not achieved.

Treatment Strategy Overview

Adopting healthy lifestyle habits is an effective first step in both preventing and controlling high blood pressure.

If lifestyle changes alone are not effective in keeping your pressure controlled, it may be necessary to add blood pressure medications.

Once initial drug choices have been prescribed, most patients should return for follow up and adjustment of medications at approximately monthly intervals until the blood pressure goal is reached. More frequent visits will be necessary for patients with stage 2 hypertension or with complicating comorbid conditions. Serum potassium and creatinine should be monitored at least 1–2 times/year.60

After blood pressure is at goal and stable, followup visits can usually be at 3- to 6-month intervals. Comorbidities, such as heart failure, associated diseases such as diabetes, and the need for laboratory tests influence the frequency of visits. Other cardiovascular risk factors should be treated to their respective goals, and tobacco avoidance should be promoted vigorously. Low-dose aspirin therapy should be considered only when blood pressure is controlled, because the risk of hemorrhagic stroke is increased in patients with uncontrolled hypertension.