Hypertension - (commonly referred to as high blood pressure) is an epidemic in the developed world. If undetected, it can lead to strokes, heart attacks and even kidney failure.

Genetics and family history are important determinants of hypertension However, obesity, too much salt in the diet, excessive alcohol consumption and stress are all risk factors of modern day society that can increase blood pressure.

When hypertension is suspected, blood pressure should be checked on at least two separate occasions. There are two components of blood pressure: the upper reading, referred to as the systolic, and the lower reading, referred to as the diastolic.

In adults, a diastolic pressure below 85 mm Hg is considered normal; 85 to 89 high normal; 90 to 99 mild hypertension; 100 to 109 moderate hypertension; 110 or greater is severe hypertension.

When the diastolic pressure is below 90 mm Hg, a systolic pressure below 140 mm Hg indicates normal blood pressure; 140 to 159 is mild systolic hypertension; 160 to 179 moderate hypertension; 180 or higher is severe hypertension.

The treatment of hypertension depends on its severity. If it is borderline or mild, then measures such as maintaining ideal body weight, following a low-salt diet, exercising regularly, reducing stress and limiting alcohol consumption may suffice to keep blood pressure within the normal range.

If blood pressure does not return to normal with the above measures, or if the initial blood pressure is found to be very high, then the addition of drug treatment is indicated. These days, blood pressure can often be controlled by taking long acting medication (e.g. on a once daily basis).

MEDICATION

There are four major groups of blood pressure drugs.

1. Diuretics, often referred to as fluid pills, work by inducing the kidneys to excrete additional water and salts. They are effective in reducing blood pressure and accumulated date has demonstrated their safety and benefit in reducing stroke and heart disease. Possible side effects include muscle weakness and cramps, excessive loss of potassium, elevation of blood sugar, elevation of lipids (cholesterol and triglycerides) and elevation of uric acid (which may cause gout).

2. Another group of medications, the beta antagonists, reduces blood pressure by slowing the heart rate and force of contraction. People with asthma, certain respiratory disorders, and diabetes should avoid these medications unless supervised by their doctor.

3. A third diverse group of drugs works by dilating blood vessels and thereby lowering the resistance to blood flow. The ACE inhibitors, angiotensin-receptor antagonists and calcium antagonists are commonly used since they have a low incidence of harmful side effects. ACE inhibitors are particularly effective in patients being treated for both hypertension and diabetes. Their most frequent side effects are cough and rash.

4. The last group of drugs reduces blood pressure by interacting with receptors in the brain or nerves. This interaction results in lower levels of adrenaline and similar stimulating hormones.

The lowest dose of medication that is needed to control pressure should be used, since higher doses may only increase the occurrence of side effects.

All blood pressure medications should be taken under the supervision of a doctor.