Lifestyle interventions

Healthy diet

Advice from NICE Guidelines (UK) includes:

  • Weight reduction should be suggested if necessary, to maintain an ideal body mass index (BMI) of 18.5-24.9 kg/m2[5]. Offer a diet sheet and/or dietetic appointment. Dietary self-help (eg, dieting clubs, for which there may be local referral options) may be appropriate. Encourage physical activity alongside dietary changes.
  • Use of wholegrain varieties of starchy food (eg, rice, pasta, bread) where possible.
  • Reduction of saturated fats, and increasing mono-unsaturated fats, using olive or rapeseed oils and spreads.
  • Reduction in sugar intake and that of foods containing refined sugars.
  • Eating at least five portions of fruit and vegetables per day.
  • Eating at least two portions of fish per week, including a portion of oily fish.
  • Eating at least 4-5 portions of unsalted nuts, seeds and legumes per week
  • Reducing any excessive caffeine consumption.
  • Low dietary salt (see section below).
  • Keeping alcohol within current national recommended levels. (Currently no more than 14 units per week for men and women, spread through the week, with at least two days alcohol-free[6].)
  • Calcium, magnesium or potassium supplements are not recommended.

Stopping smoking

Patients should stop smoking (offer help ± nicotine replacement therapy).

Encouraging exercise

  • Make physical activities part of everyday life (eg, walk or cycle to work, use the stairs instead of the lift, walk at lunchtime) and build in enjoyable activities to leisure time every week (eg, walking, cycling, gardening, swimming, aerobics, etc).
  • Minimise sedentary activities (eg, limit television watching or sitting at a computer or playing video games).
  • Once more, look for local activities, join a sporting group, take advantage of taster sessions and get used to exercising regularly, ideally several times a week.

Salt

  • Guidelines recommend that we should have no more than 5-6 grams of salt per day.
  • Patients should be advised not to add salt to food and to avoid processed foods.
  • Food labelling is making it easier to determine the salt content of food. 

What are the medication treatment options for high blood pressure?

What medicines are used to lower blood pressure?

There are several medicines that can lower blood pressure. The one chosen depends on such things as:

  • Whether you have other medical problems.
  • Whether you take other medication.
  • Possible side-effects of the medicine.
  • Your age.
  • Your ethnic origin.

Some medicines work well in some people and not so well in others. One or two medicines may be tried before one is found to suit.

How long is medication needed for?

In most cases, medication is needed for life. However, in some people who have made significant changes to lifestyle (such as having lost a lot of weight, or stopped heavy drinking, etc). whose blood pressure has been well controlled for three years or more, medication may be able to be stopped. Your doctor can advise you. If you stop medication, you should have regular blood pressure checks. In some cases the blood pressure remains normal. However, in others it starts to rise again. If this happens, medication can then be started again.

Which medicines are used to lower blood pressure?

There are five main classes of medicines that are used to lower blood pressure. There are various types and brands of medicine in each class. The following gives a brief overview of each of the classes. However, for detailed information about your own medication you should read the leaflet that comes inside the medicine packet.

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors work by reducing the amount of a chemical, called angiotensin II, that you make in your bloodstream. This chemical tends to narrow (constrict) blood vessels. If there is less of this chemical, the blood vessels relax and widen and so the pressure of blood within the blood vessels is reduced.

  • There are various types and brands of ACE inhibitors. Some examples are Perindopril, Enalapril, Lisinopril, and Ramipril

An ACE inhibitor is particularly useful if you also have heart failure or diabetes. They are often used for people with chronic kidney disease. ACE inhibitors are not used in pregnant or breast-feeding women. 

Angiotensin receptor blockers (ARBs)

These medicines are sometimes called angiotensin-II receptor antagonists. There are various types and brands. Some examples are Losartan, Valsartan, Telmisartan

They work by blocking the effect of angiotensin II on the blood vessel walls. So, they have a similar effect to ACE inhibitors (described above).

Calcium-channel blockers

Calcium-channel blockers affect the way calcium is used in the blood vessels and heart muscle. This has a relaxing effect on the blood vessels. Some examples are Amlodipine, Nifedipine, and Verapamil. 

'Water' tablets (diuretics)

Diuretics work by increasing the amount of salt and fluid that you pass out in your urine. This has some effect on reducing the fluid in the circulation, which reduces blood pressure. They may also have a relaxing effect on the blood vessels, which reduces the pressure within the blood vessels. The most commonly used diuretics to treat high blood pressure (hypertension) are thiazides or thiazide-like diuretics - hydrochlorothiazide and indapamide. Only a low dose of a diuretic is needed to treat high blood pressure. Therefore, you will not notice much diuretic effect (that is, you will not pass much extra urine). 

Beta-blockers

Beta-blockers are not usually used for blood pressure treatment alone any more. This is because they have been found to be less effective in preventing strokes and heart attacks than other medication choices. However, sometimes they may be used where there are other conditions present, such as heart failure or atrial fibrillation.

Again, there are various types and brands of beta-blockers. Some common examples are atenolol and bisoprolol

They work by slowing the heart rate, and reducing the force of the heart. These actions lower the blood pressure. Beta-blockers are also commonly used to treat angina and some other conditions. You should not normally take a beta-blocker if you have asthma, chronic obstructive pulmonary disease (COPD), or certain types of heart or blood vessel problems.

What about side-effects?

All medicines have possible side-effects, and no medicine is without risk. However, most people who take medicines to lower blood pressure do not develop any side-effects, or only have mild side-effects. A full list of cautions and possible side-effects is listed on the leaflet inside the medicine packet. The most common ones are:

  • ACE inhibitors - sometimes cause an irritating cough. One would then swop to an ARB.
  • ARBs - sometimes cause dizziness.
  • Calcium-channel blockers - sometimes cause dizziness, facial flushing, swollen ankles, and constipation.
  • 'Water' tablets (diuretics) - can cause gout attacks in a small number of users, or can make gout worse if you already have gout. Erection problems (impotence) develop in some users.
  • Beta-blockers - can cause cool hands and feet, poor sleep, tiredness, and impotence in some users.

If you do develop a side-effect, a different medicine may suit you better. There is a lot of choice so one can usually be found to suit. See your doctor if you develop any problem which you think is due to your medication.

Reference: Patient.co.uk patient leaflets on Hypertension  

 
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Dr Ruth Ward

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