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[Up] [Definition & criteria] [Cardiovascular anatomy] [Hypertension causes] [High risk group] [Manifestations] [Complications] [Investigations] [Management principles] [Management] [Prevention] [Questions & answers] [Checking Blood pressure] [Medicines]

Management of hypertension

 

 

                                                                                           

                Blood pressure monitoring                                  Good History taking                          Thorough Clinical Examination    

 

                                                                                                          

                   Investigations                                     Drug therapy                                 Patient Education

 

                                                                            

                                                Non pharmacological therapy of Hypertension.

 

 

Management includes

  1. Monitoring of Blood pressure up to three times a day in sitting or lying down position. Multiple readings are essential to establish the range of hypertension in newly diagnosed patients and to assess control in patients already on drug therapy.

  2. Assessment of aggravating and risk factors by careful history taking, and thorough clinical examination by doctor.

  3. Detection of coexisting diseases like diabetes, heart diseases etc.

  4. Investigations including:

  • Blood tests.

  • ECG.

  • Echocardiography.

  • Doppler studies.

        These investigations are mandatory for any successful management programme, as they help in.

  • Assessing the cause of Hypertension.

  • Detecting coexisting risk factors, and aggravating factors of Hypertension.

  • To detect complications of long standing or undiagnosed hypertension on various organs and systems.

  • Detection of coexisting diseases.

  • To monitor ongoing treatment. 

    1. Non pharmacological therapy of Hypertension.

    • This is desirable in all patients of Hypertension -mild, moderate or severe ; newly diagnosed or of long standing.

    • This alone, may decrease blood pressure to normal limits in  newly diagnosed patients, who are having mild to moderate Hypertension. 

    • Drug therapy ,without emphasis on 'Non pharmacological therapy', may not prevent complications even if blood pressure is controlled with medication.

    1. Pharmacological therapy of Hypertension.

       This includes anti Hypertensive drug therapy. It is required in:

    • Established cases of Hypertension of long duration.

    • In newly diagnosed patients of Severe Hypertension.

    • In newly diagnosed patients of mild to moderate Hypertension who have evidence of 'End Organ Damage'.

    • In newly diagnosed patients of mild to moderate Hypertension who have failed on 'Non pharmacological therapy' alone after adequate trial for 3-6 months.

    General Management

    • Treatment of underlying disease in secondary hypertension.

    • Systematic exercise.

    • Moderate restriction of dietary sodium. 

    • Decreased alcohol intake.

    • Quitting smoking. 

    • Stress reduction. 

    • Weight loss, if indicated.

    • Regular monitoring of blood pressure.

    • Instruction in the importance of taking medications consistently and the potential long-term complications.

    Essential hypertension

    • Also called Primary hypertension. High blood pressure for which no cause can be found and which is often the only disorder. High blood pressure is a health risk, especially for developing heart disease. Essential hypertension can be controlled by drugs. 

    Controlling Your Blood Pressure

    • At present there is no cure for high blood pressure, but it can be controlled to reduce the chances of developing problems. This takes a team effort, and you are the most important member of the team. 

    • Mild or moderate high blood pressure can often be controlled successfully by a low-salt diet, exercise, and weight loss.

    • Sodium (salt) causes your body to retain fluids, which can put extra strain on the heart and make the blood vessels narrow. For this reason, low-sodium diets are recommended to reduce the amount of retained water, which then helps to lower the blood pressure.

    • Foods that are high in potassium and calcium also help lower blood pressure.

    • A moderate amount of regular exercise has several benefits. It improves your overall physical conditioning, helps with weight loss by burning extra calories, reduces blood cholesterol, and may have a more direct effect on lowering your blood pressure.

    • Maintaining yourself at the right weight for your height and bone structure is important. Extra fat makes your heart work harder. A low-fat, low-calorie diet has the further advantage of reducing your blood cholesterol levels and delaying the beginning of arteriosclerosis.

    • People with high blood pressure can consume moderate amounts of alcohol (about two drinks per day), but a heavy intake of alcohol raises blood pressure. If you are on a weight reduction diet, keep in mind that alcohol is high in calories.

    • Although high blood pressure is not caused by "bad nerves," prolonged stress does increase blood pressure. Learning to relax and taking time out to do things you enjoy should be part of your blood pressure control program.

    Medication

    • Medication is necessary if you have severe high blood pressure or high blood pressure that is not controlled by diet, exercise, and weight reduction.

    • Diuretics (water pills) are often prescribed to eliminate the excess sodium from your body. If diuretic therapy is not effective in bringing your blood pressure down, your doctor will add other medication to the treatment program.

    • Several different types of antihypertensive drugs are available: nerve blockers, beta blockers, blood vessel dilators, hormone inhibitors, and calcium channel blockers. Each type of drug works differently, but basically they control blood pressure by relaxing and opening up narrowed blood vessels. 

    • Since everyone is different, your doctor may have to try more than one drug to find the most effective medication with the fewest side effects.

    • When your doctor prescribes an antihypertensive drug, ask about the type and possible side effects.

    • Be sure to keep appointments with your doctor. Several visits may be necessary to determine exactly the right drug and dosage. 

    • Once your blood pressure is under control, you will need to see your doctor only about three or four times a year.

     

    Remember : 

    • Diuretics and anti hypertensive medications lower your blood pressure only while you are taking them. You cannot stop taking the drug, even after your blood pressure is lowered.

    • PATIENT EDUCATION IS THE MAINSTAY OF ANY MANAGEMENT PROGRAMME WHICH HELPS REGULAR MEDICATION AND AVOIDANCE OF RISKS FACTORS BY PATIENT.

     

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