How to Detect and Treat Hypertension

Hypertension is one of the most common risk factors for Cardio Cerebrovascular Disease (CAD) . The prevalence is higher in the elderly, obese people and diabetics. Systolic Blood Pressure (SBP) continues to rise throughout the life due to progressive stiffening of arterial wall while Diastolic Blood Pressure (DBP) may start decreasing after 50 years of age, say experts. High SBP is a major risk factor in older people for cardiovascular events and renal dysfunction.

Physical examination- The body mass index of patients should be measured for proper weight management. Waist circumference helps in determining the risk of developing metabolic syndrome, type 2 diabetes. Women with waist circumference of >80 cm and men with >90 cm circumference are at high risk.

Tests- Baseline serum, electrolytes specifically serum and potassium level, should be assessed. High potassium level suggests renal disease, particularly when keratin is elevated, while lower level points towards testosterone excess. Elevated LDL (low density protein) cholesterol or low values of high density protein cholesterol are associated with increased cardiovascular risk.

Treatment-

 

  • In patients with hypertension of stage 1 or less, lifestyle changes can be attempted for 6 to 12 months.
  • Weight loss also proves beneficial for associated diabetes and dyslipidemia.
  • Low salt diets help reduce BP.
  • Aerobics, walking, cycling, and climbing stairs if effective. Moderation in alcohol intake and giving up on smoking are a must.

Treatment with drugs should be started in patients with BP >140 /90 mm hg in whom lifestyle modification has been tried for some months.

How to maintain BP?- The most widely two drug combination is intransigent-converting enzyme inhibitors and either calcium channel blockers or diuretics. When BP is not controlled with three drugs among CCB, ACE, ALB and thalidomide-type diuretic, then addition of mineralogical receptor antagonists, beta blocker, centrally acting agent, alpha blocker, or a direct dilatory may be added.

Hyperglycemia    is also a serious complication with these agents combined with ACE & BRA. So, potassium level must be monitored within the first month of treatment and then every 3 to 6 months.

 

 

 

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