Hypertension Management: Tips for Controlling High Blood Pressure
Description: Discover effective hypertension management strategies—lifestyle tips, diet, exercise, and treatment options to control high blood pressure.
Hypertension Management
Hypertension management involves a combination of lifestyle changes (Non-Pharmacological) and medications (Pharmacological) as recommended by a healthcare professional.
Related Article: High Blood Pressure Explained: Causes, Warning Signs
Non-Pharmacological Management
Reduced salt intake
To keep the body’s metabolism balanced, the amount of salt we eat should match the amount we lose.
In people without high blood pressure, eating less salt can still lower blood pressure.
Reducing salt can help prevent high blood pressure and may lower the need for blood pressure medicines.
The World Health Organization recommends eating less than 5 grams of salt per day, which is enough for normal daily activities.
However, in most countries, people consume much more—around 9–12 grams of salt per day.
Increased potassium intake
The daily potassium consumption for healthy people with normal renal function is 4.7 g.
Since potassium is easily eliminated by those without chronic kidney diseases, a higher intake is not linked to an increased risk.
Eating more potassium can help lower blood pressure
When potassium intake is increased and salt intake is decreased, blood pressure decreases more.
Therefore, the best course of action is to simultaneously increase potassium intake and decrease salt intake.
Moderate alcohol consumption
A 2–4 mmHg drop in blood pressure can also be achieved by limiting alcohol consumption to ≤2 standard drinks (~3.5 alcohol units) for males and ≤1 standard drink (~1.75 alcohol units) for women per day.
Physical activity
Regular exercise lowers blood pressure.
People with hypertension benefit more from physical activity than people with normal blood pressure.
At least three times a week, 40–60 minute aerobic sessions had the biggest impact on blood pressure.
Weight Loss
In susceptible people, excess body fat results in a raised blood pressure.
Those with hypertension who are also obese need more antihypertensive drugs to regulate their blood pressure and are more likely to be resistant to therapy.
Weight loss is recommended for obese people, and it may be particularly important if they also have hypertension.
Bariatric surgery is extremely effective at lowering body weight, and the risk of arterial hypertension is significantly reduced for up to five years after surgery.
Pharmacological Management
Antihypertensive Pharmacotherapy
When doctors start treatment for high blood pressure (hypertension) with medicines, they usually use first-line drugs either in monotherapy or in combination.
First-line antihypertensive drugs include ACE inhibitors, angiotensin II receptor blockers (also known as sartans), dihydropyridine calcium channel blockers, and thiazide diuretics.
Beta-blockers are also indicated in patients with heart failure and reduced left ventricular ejection fraction or post myocardial infarction, and some guidelines advocate beta-blockers as the first line antihypertensive medicine.
ACE inhibitors (angiotensin II receptor blockers), thiazide diuretics, and dihydropyridine calcium channel blockers all work together to reduce blood pressure and can be used in either alone or in combination.
Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.
ACE inhibitors and angiotensin II receptor blockers are considered first-line antihypertensives, whereas other antihypertensive medications targeting RAAS, such as direct renin inhibitors and mineralocorticoid receptor antagonists, are typically considered reserve medications due to a lack of clinical trial evidence supporting their use as first-line antihypertensive therapy.
The two approaches appear to be similarly effective in lowering CVD risk.
These help the body use glucose more effectively.
This can be especially helpful for younger people or those at risk of type 2 diabetes, such as people who are overweight or have metabolic syndrome.
ACE inhibitors are generally well tolerated; however they may cause
- Decrease kidney function
- Hyperkalemia
- Cough
- Angioedema (swelling caused by fluid accumulation).
ACE inhibitors that can be administered once a day.
Angiotensin II receptor blockers can cause hyperkalemia and declining kidney function, although they are unlikely to cause cough or angioedema.
Dihydropyridine calcium channel blockers
Dihydropyridine calcium channel blockers cause vasodilation by inhibiting vascular smooth muscle L-type calcium channels.
They are effective antihypertensive drugs that have undergone extensive clinical trials.
This medication class has the practical advantage of being compatible with all other first-line antihypertensives.
Side effect– Peripheral edema is a typical adverse effect, caused by peripheral arterial dilatation rather than worsening heart failure or kidney dysfunction, especially in obese people.
Some calcium channel blockers (called non-dihydropyridines, such as verapamil and diltiazem) don’t just relax blood vessels — they also act directly on the heart.
- They slow down the heart rate (negative chronotropic effect).
- They weaken the force of the heart’s contraction (negative inotropic effect).
Thiazide-type and thiazide-like diuretics
Thiazide-type diuretics have a benzothiadiazine ring, but thiazide-like diuretics do not have this structure.
Both subclasses of thiazide diuretics block Na+ and CI- co-transporters in renal tubules, causing natriuresis, and have been a key component of pharmacological hypertension management.
Over the years, diuretic doses have been substantially reduced to attain better risk-benefit profiles.
Thiazide-type and thiazide-like diuretics can impair glucose metabolism, which may increase the risk of developing new diabetes. However, it is not clear whether this side effect actually leads to a higher risk of cardiovascular disease (CVD) in the long run.
Effect of less sodium and more potassium
Drug-related electrolyte changes, such as hypokalemia and hyponatremia (low blood potassium and sodium levels, respectively), are particularly serious side effects –
- Hypokalemia can cause cardiac arrhythmias and muscle weakness, while
- Hyponatremia can cause confusion, seizures, and coma.
The risk of hypokalemia is reduced when thiazide-type and thiazide-like diuretics are coupled with potassium supplements or potassium-sparing medicines, such as ACE inhibitors, angiotensin receptor blockers, or potassium-sparing diuretics.
Beta-adrenoreceptor blockers
Beta-blockers lower blood pressure by reducing how hard and how fast the heart pumps (cardiac output and heart rate)
It decreases renin release from the kidneys, and lowering the activity of the sympathetic (adrenergic) nervous system.
They are very beneficial after a heart attack (myocardial infarction) and in people with heart failure with reduced ejection fraction (weakened pumping ability of the heart).
But, if a patient doesn’t have these heart problems, beta-blockers are usually less effective than other first-line blood pressure medicines at preventing long-term heart and blood vessel complications.
The reason beta-blockers are not as effective as other blood pressure medicines.
They can have negative side effects on metabolism, such as causing weight gain and making blood sugar control worse.
Treatment Resistant Hypertension
Treatment-resistant hypertension is generally diagnosed when the office blood pressure is greater than 140/90 mmHg despite treatment with three or more correctly dosed antihypertensive medicines.
In comparison to alpha- or beta-adrenoreceptor blockage, the mineralocorticoid receptor antagonist spironolactone was the most successful fourth antihypertensive medication.
Mineralocorticoid receptor antagonists (like spironolactone, eplerenone) can be good medicines for people whose high blood pressure is hard to control with standard drugs.
But they can cause hyperkalemia (too much potassium in the blood).
That’s why doctors need to regularly check blood potassium levels in patients taking these drugs.
Device-based Treatments
Device-based treatments have been developed largely for patients with severe resistant hypertension, whose blood pressure cannot be controlled with antihypertensive medications.
Catheter-based renal nerve ablation, electrical carotid sinus stimulation, baroreflex transduction modulation using a specific carotid stent, carotid body denervation, and deep brain stimulation are thought to lower blood pressure via inhibiting the SNS.
These therapies are at different stages of clinical development, with the most robust evidence currently available for renal nerve ablation and electrical carotid sinus stimulation.
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