| Primary hypertension cannot be cured but can be treated to manage the condition and prevent complications. Treatment of hypertension usually follows a progressive (stepped-care) approach; each step being slightly more aggressive than the previous one until blood pressure is controlled.
The first step includes lifestyle modifications such as losing weight (especially in the abdominal area), increasing exercise, moderating alcohol and caffeine intake, stopping smoking, and making dietary changes that include a reduction in salt intake, saturated fat, and cholesterol while increasing consumption of fruits, vegetables, and whole grains. The DASH (Dietary Approaches to Stop Hypertension) diet is low in saturated fat, rich in whole grains, fruits and vegetables, and contains modest amounts of protein, preferably from fish, poultry, low-fat dairy, or soy products. This diet contains more than twice the amounts of potassium, calcium, and magnesium than the average American diet. If blood pressure is not controlled with lifestyle modifications, the individual will proceed to drug therapy in step 2. The individual will be advised to continue lifestyle modifications throughout all steps of therapy. Drug therapy at step 2 usually begins with a thiazide diuretic to remove excess fluid or a beta-blocker (alpha blockers are not considered appropriate initial therapy because of the increased risk for heart failure). Beta-blockers reduce blood pressure by blocking beta-adrenergic substances such as adrenaline, thereby blocking the action of the involuntary nervous system on the heart. The desired result is to slow the heartbeat, reduce the strength of heart muscle contractions, and reduce blood vessel contractions throughout the body. In studies, however, diuresis has proven to have better results as initial therapy than alpha-blockers, ACE inhibitors, or calcium antagonists. If blood pressure is still not adequately controlled at step 2, the individual proceeds to the third step.
In the third step, treatment will involve increasing the drug dosage, substituting a drug in the same class, or switching to a drug in a different class. If blood pressure is still not controlled, the individual proceeds to step 4.
The fourth step involves combination drug therapy, adding a second or third agent to the drug regimen. A diuretic will likely be included, if not already used, or drugs such as vasodilators, alpha-1 antagonists, peripherally acting adrenergic neuron antagonists, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists (ARBs), or calcium channel blockers. |
Source: Medical Disability Advisor