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Dr Narender Goel MD (Internal Medicine and Nephrology)
Financial Disclosure: None, Conflict of Interest: None
What is Blood pressure?
While heart contracts blood is pumped in to major arteries. Thereby a pressure in
exerted on vessel wall which is also known as systolic blood pressure; represented by
upper number in a blood pressure reading. While heart relaxes, volume of blood present
in the circulation exerts pressure on vessel wall which is also known as diastolic blood
pressure; represented by lower number in a blood pressure reading.
What is Hypertension?
High blood pressure also known as hypertension (HTN) is very common in western
countries. It is estimated that one in every 3 adult person in the United States has HTN.
Blood pressure is checked manually using sphygmomanometer or using electronic
machines. Most instruments use arm or wrist cuff. HTN is defined as blood pressure
≥140/90 mmHg (measured at rest) measured over 3 consecutive visits.
What are stages of HTN?
7th Joint national committee has proposed and revised stages of HTN in 2003
Why it is important to be aware about HTN?
It is a very common condition in western adult population, patients with chronic kidney
disease, end-stage renal disease on dialysis or kidney transplantation. It is 2nd most
common cause of end-stage renal disease. HTN is also significantly associated with
stroke, peripheral vascular disease, congestive heart failure, heart attack and death.
Patients often don’t feel any symptoms from HTN unless BP is very high which can
cause headache, chest pain, shortness of breath; which could be signs of life
Untreated and undiagnosed HTN is detrimental to health and early intervention can
reduce the risk of associated complications (KNOW YOUR BLOOD PRESSURE).
What are the causes of HTN?
It is not very clear that what causes hypertension. It appears that multiple factors
contribute to development of HTN such as genetic predisposition; impaired handling of
sodium and chloride by kidney and environmental factors, sedentary lifestyle and aging
further contributes. Chronic kidney disease, excess hormones, over the counter and
herbal medications containing mahuang, ephedra, amphetamines, pseudoephedrine
and licorice (mulethi) can cause HTN. Substance abuse with cocaine, amphetamines
What are the tests usually done for patients with HTN?
Your doctor will first attempt to identify any reversible or curable causes of HTN such as
hormonal excess which can be evaluated using several different blood tests.
Besides urinalysis, complete blood count, kidney function test and electrolytes should
be routinely checked. Eye examination (fundoscopy) can suggest extent of HTN
damage. Electrocardiogram and echocardiogram may show changes of HTN on heart.
How can HTN be managed?
First step is lifestyle modifications which include weight loss, exercise (for 30 minutes
for 5 times per week), smoking cessation, moderation of alcohol consumption and low
DASH (dietary approach to stop hypertension) is known to be the best dietary regimen
to reduce blood pressure. Components of DASH diet are
2) Diet rich in fiber, vegetables, whole grains and low fat dairy products
Learn more about DASH diet at U.S Department of Health and Human Services.
What are different classes of medications which can be used?
There are several classes of medications which can be used to control blood pressure.
It is very common for patients to need 2-3 medications to control blood pressure.
Compliance to medication and low salt diet is of utmost importance. Taking medications
at bedtime instead of in morning has been shown to achieve better blood pressure
control. Choice of medication will depend upon clinical status, level of kidney function,
electrolytes and other medical conditions.
1) ACE Inhibitors:
There are several medications belonging to this class such as
ramipril, lisinopril, fosinopril, captopril etc. (note: all name ends in pril
). These are very
good and effective antihypertensive medications and often a leading choice medication.
Major adverse effects are as follows: rise in serum potassium, dry cough, temporary &
slight decrease in kidney function, serious allergic reaction causing tongue and lip
You must stop ACE Inhibitors and immediately report to healthcare provider if you
2) Angiotensin receptor blockers (ARB):
There are several medications belonging
to this class such as valsartan, telmisartan, losartan, olmesartan etc. (note: all name
ends in sartan
). These are very good and effective antihypertensive medications and
often a leading choice medication along with ACE Inhibitors.
Major adverse effects are as follows: rise in serum potassium, temporary & slight
decrease in kidney function, serious allergic reaction causing tongue and lip swelling
You must stop ARB and immediately report to healthcare provider if you develop
Combination of ACE Inhibitors and ARB is harmful and should be avoided.
3) Diuretics or water pill:
These medications help your kidney to excrete excess
water and salt in to the urine. Hydrochlorothiazide (HCTZ), furosemide (Lasix),
metolazone, triamterene, spironolactone and amiloride are commonly used
Discuss individual medication adverse effects with your doctor.
4) Calcium Channel Blockers (CCB):
Commonly used medications among this class
are amlodipine (Norvasc), nifedipine XL, diltiazem and verapamil.
These are also among preferred class of prescribed antihypertensive.
Amlodipine can cause ankle swelling while diltiazem and verapamil can slow down your
Discuss individual medication adverse effects with your doctor.
5) Beta blockers:
Commonly used medications among this class are atenolol,
metoprolol (Lopressor, Toprol XL), carvedilol, nevibolol, bisoprolol (note: all name ends
This class is commonly prescribed for patients with heart failure or coronary
It is suggested that this class of medication be used with caution in patients with
asthma, peripheral vascular disease or diabetics.
6) Clonidine, Hydralazine and minoxidil are less commonly used medications
It would be helpful to have some information about these medications as it will enable
you to have an informed discussion with your healthcare providers.
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