The goal of treatment for hypertension is to reduce blood pressure to a level that lowers your risk of heart attack, stroke, and other serious health problems. Lifestyle modifications are usually recommended as the primary treatment method for blood pressure at a high normal level. If your blood pressure crosses the line into hypertension, your doctor will probably add medication to the treatment plan. However, you may be able to get results with less medication if you continue to follow the lifestyle changes intended to lower your blood pressure. Medication is generally prescribed right away for patients whose blood pressure is high normal but who also have heart failure, kidney failure, or diabetes.
Primary hypertension does not ordinarily require emergency treatment. Malignant hypertension, however, does require immediate attention. If you have a history of hypertension and experience symptoms such as drowsiness, confusion, headache, nausea, or loss of vision, call your doctor or call 911, or go to the nearest emergency department. You will probably be hospitalized until the hypertension is brought under control. Intravenous medications such as nitroglycerin may be administered to lower your blood pressure. After the acute hypertension is under control, you may be given oral antihypertensive medication to help manage your condition.
You may require hospital admission if you develop problems such as kidney failure, cerebral hemorrhage, severe preeclampsia (a blood pressure-related condition that develops in late pregnancy), heart attack, or other heart problems. If you develop one of these problems, you will probably be treated in the intensive care unit. The interventions and length of stay depend on the nature of your hypertension-related problem. You may be referred to a nephrologist (specialist in kidney disease), cardiologist, endocrinologist, radiologist-angioplaster, or vascular surgeon for specialized care.
Many of the recommendations for reducing your blood pressure require you to change your lifestyle. You should lose excess weight, exercise more, stop smoking, reduce your alcohol consumption, and cut back on salt. You also may want to look for ways to reduce stress in your life, such as making more time for activities you enjoy, or engaging in some form of relaxation therapy.
Your doctor is the best source of information on the drug treatment choices available to you.
Surgery is not a treatment method for hypertension, although it might be required for serious medical problems that stem from hypertension. Surgery is sometimes performed to repair damaged arteries leading to the kidneys. Your doctor also may recommend balloon angioplasty to open the damaged arteries, improve blood flow, and lower your blood pressure.
Stress management, biofeedback, meditation, and relaxation techniques may help you reduce your blood pressure. You may want to try programs such as yoga, progressive muscle relaxation, transcendental meditation, Qi Gong (a Chinese breathing exercise), or hypnosis. Aspects of Chinese traditional medicine, including herbal treatments and acupuncture, also may be used to treat hypertension.
Since either hypertension or diabetes alone are major risk factors for stroke and heart disease, having both conditions significantly increases your risk of serious health problems. Hypertension is also a risk factor for kidney failure, a common problem for people with diabetes. If you suffer from diabetes you can help preserve your kidney function by controlling your blood pressure.
Hypertension during pregnancy along with protein in the urine (preeclampsia) can cause serious complications for the mother and baby. This condition (preeclampsia) can decrease the supply of blood and oxygen available to the mother and developing baby. This may result in a lower birth weight and other problems for the baby. The mother would be at risk for kidney problems, seizures, strokes, breathing problems, and even death, in rare instances. The cause of preeclampsia is not known.
Preeclampsia usually occurs during the second half of the pregnancy, and affects about 5% of pregnant women. Your risk of developing preeclampsia is higher if you are pregnant for the first time, under age 17 (some experts say under 20), or over age 35 to 40, pregnant with twins or triplets, are overweight, smoke, have another health problem such as diabetes or kidney disease, have a history of high blood pressure, preeclamsia in a previous pregnancy, or follow a poor diet during your pregnancy.
Even if your blood pressure is high during pregnancy, you will not necessarily be diagnosed with preeclampsia. High blood pressure may be a precursor of preeclampsia, so your doctor will watch you closely for signs that your condition is worsening. A diagnosis of preeclampsia is given if you have high blood pressure and protein in your urine.
Preeclampsia is diagnosed through blood pressure checks, which are routine at prenatal visits. A rapid increase in your blood pressure is a sign that you may be developing hypertension. Your doctor also will order a test to determine whether you have protein in your urine.
The only effective treatment for preeclampsia is to give birth. This may not be possible if your baby is too small to live outside the womb. The fetal age and severity of the disease are some of the factors that will be used to make the decision. Your doctor will also decide whether to perform a cesarean section, induce labor, or wait for labor to occur naturally. High blood pressure usually goes away after the baby is born.
Children can have high blood pressure, either primary or secondary. While experts once thought that most cases of hypertension in children were caused by other diseases, there is growing recognition that children, even young babies, can have primary or essential high blood pressure. It isn't clearly understood why, although children who are overweight have higher blood pressure than those who are not. Having a parent with high blood pressure also increases the likelihood that a child will develop hypertension. A special diet, weight control, and exercise are the primary recommendations. Medication may be prescribed if lifestyle modifications do not lower the child's blood pressure.
Hypertension can be controlled, although the success of treatment depends on the severity of the condition and compliance with your doctor's recommendations. Whether you are relying on lifestyle modifications, medication, or both, treatment is a lifelong commitment. You will need to see your doctor regularly to monitor your progress and make any necessary adjustments to your therapy. We each have individual risk factors for heart disease, some of which we can do something about, such as hypertension, and some that we can't do much about, such as genetic vulnerability. It is helpful to view controlling your blood pressure as a feasible opportunity to make a difference in reducing your chance of bad health outcomes.
Malignant hypertension can be controlled if it is treated promptly. If it is not treated promptly, however, you face the risk of severe, life-threatening complications such as damage to the brain, eyes, blood vessels, heart, and kidneys.
Because high blood pressure can be treated but not cured, you need to have regular blood pressure checks and consultations with your doctor If your blood pressure reading is optimal (less than 120/80) or normal (less than 130/85), you should be rechecked every two years. If your blood pressure is in the high normal range (systolic pressure of 130 to 139 or diastolic pressure of 85 to 89), have it rechecked once a year. If you have been diagnosed with hypertension, follow your doctor's recommendations for rechecks. If you have Stage 1 (mild) hypertension, have the reading confirmed within two months. If you have Stage 2 (moderate) hypertension, return to your health care provider for evaluation within two months. If you have Stage 3 (severe) hypertension, you should be evaluated immediately or within one week, depending on the clinical situation.
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