Description
Hypertension management involves a multifaceted approach aimed at reducing blood pressure to prevent cardiovascular complications. Treatment algorithms typically begin with lifestyle modifications such as dietary changes, regular exercise, smoking cessation, and limiting alcohol intake. Pharmacological interventions are initiated if lifestyle modifications alone are insufficient. First-line medications often include thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers, or calcium channel blockers, tailored to individual patient characteristics and comorbidities. Combination therapy may be necessary for patients with severe hypertension or multiple risk factors. Treatment algorithms emphasize regular blood pressure monitoring and medication adherence to achieve target blood pressure goals. Additional strategies such as sodium restriction, weight management, and stress reduction techniques complement pharmacotherapy in hypertension management. Patient education on the importance of long-term management and adherence to treatment regimens is essential for successful outcomes. Individualized treatment plans, guided by evidence-based guidelines and risk assessment tools, optimize blood pressure control and reduce the risk of cardiovascular events.
Résumé
- World Hypertension Day emphasizes the need to address this prevalent health issue, acknowledging that many cases remain undiagnosed or improperly managed. Existing guidelines can be confusing, but the International Society of Hypertension guidelines are generally followed. Normal blood pressure is defined as below 140/90 mmHg in a clinical setting, with different thresholds for home and ambulatory monitoring.
- Lifestyle modifications such as weight reduction, DASH diet, regular exercise, and moderation in alcohol are crucial, especially for borderline high or stage one hypertension. However, medications are necessary when comorbidities are present or hypertension is severe. Treatment goals involve lowering blood pressure to below 140/90 mmHg or lower it by 20/10 mmHg.
- Secondary hypertension, though less common, requires consideration. Endocrine disorders like primary hyperaldosteronism, renal artery stenosis, pheochromocytoma, and Cushing's syndrome can cause secondary hypertension, as well as drug-induced hypertension. A detailed patient history and physical exam can help uncover these underlying causes.
- Treatment strategies include starting with a single ARB or calcium channel blocker, followed by adding a thiazide diuretic. If control is still not achieved, a three-drug combination may be required. Resistant hypertension involves non-adherence to medication, secondary causes, and the potential need for spironolactone.
- Hypertensive urgency and emergency are defined by blood pressure exceeding 180/120 mmHg. Hypertensive emergency requires immediate intervention with parenteral medications in an ICU setting due to evidence of target organ damage such as hypertensive encephalopathy, pulmonary edema, or acute kidney injury. Lowering blood pressure too rapidly is not advised in ischemic stroke cases.
- Effective management of hypertension requires long-term commitment from both the physician and the patient. Emphasizing patient education, adherence to medication, regular monitoring, and a healthy lifestyle are essential in preventing serious cardiovascular and renal complications.
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