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, lack of exercise, 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.

The “Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure” has provided a new guideline for hypertension prevention and management. They have recommended that individuals with a systolic blood pressure of 120 to 139 mm Hg or a diastolic blood pressure of 80 to 89 Hg should be considered as pre-hypertensive. As such, these individuals require heal-promoting lifestyle modifications to prevent cardiovascular diseases. These modifications include maintaining ideal body weight, following a low-salt diet, exercising regularly, reducing stress and limiting alcohol consumption. Higher levels of blood pressure, such as stage 1 hypertension (140-159 systolic or 90-99 diastolic) and stage 2 hypertension (systolic 160 or greater, or a diastolic 100 or greater) require medication.

Today, blood pressure can usually be controlled by taking long acting medication (e.g. on a once daily basis). Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other blood pressure lowering drug classes, Most patients with hypertension will require 2 or more blood pressure lowering medication to achieve a goal of less than 140/90, or less than 130/80 for patients with diabetes or chronic kidney disease.

Medication

There are four major classes of blood pressure lowering 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 data has demonstrated their safety and benefit in reducing stroke and heart disease. Possible side effects include muscle weakness and cramps, excessive loss of potassium, increase 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.