The purpose of hypertension clinical guidelines is to provide health-care providers and patients a method of approach for dealing with all aspects of hypertension from diagnosis to treatment and prevention of re-occurrence. These guidelines should cover all aspects of the sickness and make it easier for health-care providers to care for and treat patients.
Prevention
Hypertension plays an important role in the development of cardiovascular and renal diseases and stroke. Various factors that predispose to the development of hypertension have been identified. These include obesity, high salt intake, lack of exercise, excess alcohol intake and inadequate intake of fruits and vegetables. Modification of these factors through community participation and health education can prevent or delay the onset of hypertension.
Classification
The goal of treatment of hypertension is to bring the blood pressure levels to below 140/90 mm Hg. In diabetics and people with renal disease the goal is to have BP below 130/90 mm Hg.
Normal blood pressure in adults is a reading of 120/80 or less. Prehypertension is classified as a systolic pressure of 120 to 139 and a diastolic pressure of 80 to 89. In stage 1 hypertension the blood pressure will be a systolic pressure of 140 to 159 and a diastolic pressure of 90 to 99. In stage 2 hypertension the systolic blood pressure level is 160 or more and the diastolic pressure is 100 or more.
This classification is based on two or more sitting BP readings, on two or more visits.
Prehypertension is not a disease.
Evaluation
Evaluation of hypertensive patients is required to rule out secondary causes for hypertension like kidney diseases, pheochromocytoma and coarctation of aorta, and to assess end organ damage to kidney, retina or other organs that might already have occurred. Evaluations also identify other concurrent risk factors like diabetes, elevated LDL cholesterol, decreased HDL cholesterol, smoking habits, alcohol intake and obesity. Evaluation is done through history, examination and laboratory tests.
Treatment
The goal of therapy is to decrease cardiovascular and renal morbidity and mortality. This is achieved through a combination of lifestyle modifications and pharmacological treatment.
Lifestyle modification includes weight reduction with an emphasis is on maintaining a normal weight.
A diet rich in fruits and vegetables and low in fat and sodium is advocated. The daily intake of salt should be below six grams. Regular physical activity of 30 minutes per day, at least five days a week is recommended. Each individual patient should limit her alcohol intake to an amount detailed by her doctor, but general guidelines are one alcoholic drink per day for women and two alcoholic drinks per day for men.
If life style modification does not achieve the necessary goal pharmacological treatment is initiated. A wide variety of drugs are available for the treatment of hypertension. Numerous trials have shown that all these drugs provide broadly similar cardiovascular protection when lowering the BP. Thus the choice of drugs depends on the patient tolerance and associated illness. Initially, treatment is started with diuretic for stage 1 hypertension and diuretic with one of the other group drugs like beta blockers, calcium channel blockers, ACE inhibitors or others for type 2 hypertension. If the goal is not reached, the dose is adjusted or more drugs are added till the goal is reached.
Benefits
The beneficial effects of lowering blood pressure are numerous. According to an epidemiologist from Oxford University, Sarah Lewington, a reduction in blood pressure by the general public of just a few millimeters could stop 7 percent of fatal coronary heart diseases and 10 percent of deadly strokes.
Patient compliance and active participation in the treatment is important to reach the goal. Hence it is important to educate the patients about the disease and the benefits of controlling it.
Tags: blood pressure, alcohol intake, diastolic pressure, stage hypertension, cardiovascular renal, diastolic pressure stage
