Treatment with Medication:
 Nobody wants to take medication, especially as for most people this will be lifelong. But the taking medication is designed to prevent a problem in the future. There is quite a choice of medication, and to some extent the choice should be tailored to the person. The following is a rough guide to medical treatment modes:
Elderly patients: First choice - Thiazide diuretics. Second choice - Calcium antagonists.
Black patients: First choice - Calcium antagonists. Second choice - Doxazosin.
Young patients: First choice - ACE inhibitors. Second choice - Calcium antagonists
Beta blockers are a class of drugs (drugs usually ending in the suffix "-ol") that were used traditionally as first line drugs. However recent concerns have been raised that this class may increase the risk of diabetes, so they are no longer first line. What is less well described is whether patients already on beta-blockers should be have the drug changed. Generally I would say yes unless there are specific reasons to stay on them: e.g, co-existing angina, or intolerance to other medication.).
What has generally not been appreciated is that nowadays with stricter limits on blood pressure levels, patients on average require more than one drug to control pressure effectively. So don't be alarmed if your list of medication is stepped up.
Side Effects:
The list of side effects for anyone medication is as long as your arm, but the reality is that the chance of developing side effects is quite low. Remember to read the list of side-effects supplied with the tablets. Don't get too alarmed as the list is overstated. If you are unkeen to take the tablets because of something you read, discuss it first with your doctor as he or she may be able to reassure you. Too often patients have been unkeen to take medication because of undue fears of side-effects.
Resistant Hypertension:
One major problem is that with medical treatment, blood pressure may still not be controlled with just one medication. In fact we think that at least half the patients will require more than one medication. If blood pressure is not adequately controlled adequately, the following should be considered:
- You may need a higher dose of your medication,
- You may need more than one type of tablet,
- There may be an underlying cause of your hypertension,
- Your blood pressure may be fine, but you have a superadded white coat hypertension element.
 The way to resolve this is to perform some home recordings or a 24 hour monitor. This would exclude the latter option so one could focus on the first three options. Your family doctor would probably adjust the medication at first, but if still not controlled would explore a secondary cause.
OK, What about lifestyle?
Here are some main pointers:
- Stop smoking before you do anything else,
- Lose weight,
- Dietary modification (e.g. reduce salt intake),
- Reduce alcohol consumption to 2 units/day,
- Increase your level of cardiovascular exercise,
- Reduce Caffeine intake (coffee, tea, soft drinks).
Taking ownership of an elevation in our blood pressure
You are in the driving seat over this, but I have highlighted a few points that you may wish to follow:
1. Establish whether there are any obvious causes for your blood pressure to be elevated: examine for domestic or work related stress. Are you on any medication that may be causing it?
2. Consider consumable substances such as smoking, caffeine, and alcohol.
3. If your blood pressure is fluctuating it may be appropriate to investigate whether you are truly hypertensive.
4. If you are hypertensive you will need a combination of lifestyle and medication to tackle the problem.
5. Other cardiovascular risk factors and kidney function need to be evaluated as this may influence treatment.
6. If you are young (< 50 years) or your blood pressure treatment is resistant you need to have the cause identified.
7. Your blood pressure should be reviewed regularly, preferably by yourself using a home monitor. Any fluctuation in blood pressure should be discussed with your family doctor.
8. Consider a full hypertensive assessment with central blood pressure assessment and pulse wave velocity for prognosis.
|
Smoking
