Non-drug treatment (non-pharmacological) and Treatment with drugs (pharmacological)

In the past, people are less enthusiastic about the investigation of non pharmacological treatment in essential hypertension, because it is less effective and very difficult to implement. However, given that mild hypertension includes most of the cases and the presence of side effects due to treatment performed in the long term, prompting experts to investigate the advantages of non-pharmacological treatment.

Non-pharmacological treatment sometimes can control blood pressure so that the pharmacological treatment becomes unnecessary, or at least postponed. While the circumstances in which the anti-hypertensive medication is required, non-pharmacological treatments can be used as a complement to obtain better treatment effect. 

Non Pharmacological treatment include :

• Overcoming Obesity / lose excess weight.
• Reduce salt intake to the body. Salt reduction advice should consider eating habits. Salt causes fluid accumulated in the body, leading to increased volume and blood pressure. According to the WHO Expert Committee on Cardiovascular Disease Prevention of salt intake should be no more than 6 grams a day.
• Create a relaxed state. Various ways of relaxation such as meditation, yoga or hypnosis can control the nervous system that finally can lower blood pressure.
• Doing sports like aerobics or brisk walking for 30-45 minutes as much as 3-4 times a week.
• Stop smoking and reduce alcohol consumption. 
• Measure blood pressure regularly. 
• Consult with your doctor regularly.

Treatment with drugs (pharmacological)

Treatment of hypertension based on several principles which are:

• Treatment of secondary hypertension is more priority to the treatment of the causes of hypertension. 
• Treatment of essential hypertension is aimed at lowering blood pressure to extend the life expectancy and reduce the incidence of complications. 
• Efforts to lower blood pressure achieved with anti-hypertensive drugs. 
• Treatment of hypertension is a long-term treatment, even the possibility of a lifetime

 

Treatment Options for High Blood Pressure

Generally, patients with blood pressure readings 140/90mmHg or more can be said to be candidates for medical intervention, in addition to lifestyle changes. Patients with isolated systolic hypertension with blood pressure of 160/89mmHg or more than 65 years of age is also a candidate for medical therapy . Patients with pre-hypertension is generally advisable to make some lifestyle changes before medical treatment begins.

There are so many medications to control high blood pressure. If you need your doctor will recommend its use according to your conditions, starting with low doses of the drug and the results which will be monitored. If necessary the dose will be increased gradually so that your blood pressure can be controlled. 

Noteworthy is that once you start using drugs, there will likely continue to use it during your life. High blood pressure medication does not eliminate the disease but only control it. The drugs did not survive to live in our bodies, longer period of drug use is the better it works.  You should always carry medication with you and how its consumer. 

Hypertension Treatment in general divided into 2 types :

• Use of non-medication (non-pharmacological)

• Treatment with drugs (pharmacological)

Methods for Diagnosing High Blood Pressure

Diagnosis of high blood pressure begins when the doctor collects the patient's medical history. The doctor will ask about heart-related disorders in families of patients (eg high blood pressure, coronary heart disease). The doctor also will ask about the patient's lifestyle such as diet, exercise and stress.

In some cases doctors will ask patients to measure their own blood pressure at home and keep a diary of their blood pressure is. This strategy will assist in determining patterns of patients with normal blood pressure and get rid of hypertension caused by anxiety while in the doctor's office. It appears that adults at age 65 years or more, his blood pressure will decrease 2 hours after eating. This is probably due to inaccuracies if the blood pressure readings done at the time. Blood pressure readings are also affected when patients drink coffee or smoke 30 minutes prior to measurement. Patients should also go to the bathroom before the measurement because a full bladder can change the blood pressure readings. Blood pressure was measured by placing the cuff (which is connected with a mercury manometer on the upper arm and using a stethoscope to listen brakhial artery located on the inside of the arm above the elbow. The cuff is pumped fully, so the blood flow will stop short. Then the cuff is slowly deflated so the blood flow will return to normal. At the time air in the cuff is released, the examiner will observe the height of the mercury that falls softly on the mercury manometer and wait until you hear a heartbeat. The exact figure at the time of the first pulse indicates the systolic pressure. When the cuff is shrinking, the height of the mercury will decrease and when the sound of the heartbeat sounded the last time, the numbers on the mercury manometer is the diastolic pressure. Tools and other blood pressure can also be used. Some people use a digital blood pressure. 

The monitor of blood pressure that can be trusted can be obtained for those who are interested to monitor their own blood pressure or other members of their families. When using a monitor, it is very important to consultation with the doctor about the quality of these tools. Generally this digital monitor is the easiest and most reliable but requires periodic checks by using a sphygmomanometer. The researchers also conducted tests of blood pressure monitors 24 hours, with initial studies focused on patients with high of blood pressure who have a high risk for heart attack. 

According to the American Heart Association, an automatic of blood pressure cuffs that are often found in public places such as in drug stores or pharmacies should not be regarded as an accurate tool. Equipment is often not well maintained and can give inaccurate results in many individuals. Ambulatory of blood pressure monitor revealed that in normal individuals, high of blood pressure experienced during the morning and will drop at night (dipping phenomenon). If not found this phenomenon, it is called abnormal and is associated with increased risk of complications in the brain and the heart in patients with or without previous hypertension. 

After the physical examination, some tests can be done, including :

• Urinalaisis and some blood tests (such as electrolytes and wastes) to get rid of impaired renal function. Examination for blood sugar levels and a complete lipid profile including cholesterol levels and also suggested trigliseride done. Other blood tests such as thyroid function and measurement of the number of white blood cells, including calcium and phosphate levels
•   Electrocardiogram (EKG) to measure the heart's electrical activity. By analyzing the EKG, the doctor can see presence of cardiac disorders associated with hypertension (eg left ventricular hypertrophy) that may occur due to the long-standing, high blood pressure are not controlled. Doppler examination also detect abnormalities of heart relaxation (diastolic dysfunction) as a complication of hypertension.

• ·Echocardiogram uses ultrasound waves to visualize the structure and function of the heart. This test is also used to check for other disorders such as left ventricular hypertrophy.
•  Examination of the chest x-ray images to get rid an enlarged heart.

When the diagnosis has been made and other serious problems are like impaired renal function has been eliminated, treatment can be implemented. Although a very high blood pressure require additional tests to get rid of unusual causes. For example, Doppler renal sonogram or scan can be performed to assess the hypertension associated with kidney disease or due to renal artery narrowing. 24-hour urine test may also be needed to get rid endocrine disorders such as Cushing's disease or pheochromocytoma. 

Some people may be also diagnosed with a condition to the contrary, the low blood pressure (hypotension).  Although some people with high blood pressure do not need medication, they can control risk factors such as body weight, and most people require long-term therapy with these drugs.

Malignant hypertension and The Purpose of Laboratory Examinations in Patients with Hypertension

Malignant hypertension can be regarded as a very severe hypertension. Cases of malignant hypertension is very rare, estimated that only 1 in 200 people suffering from malignant hypertension. If the patient does not immediately get medical help, patients who had malignant hypertension may die within 3-6 months. 

Blood pressure can increase due to increased of fluids in the circulation. This occurs if there are abnormalities of kidney function and is unable to discard some salt and water from the body, the body's blood volume increases so that a jug of blood pressure increase. 

Likewise a low blood pressure is also caused by reduced activity of the heart pumping, arterial widening experience, a lot of fluid out of circulation. The best way to avoid high blood pressure is to change the direction of an active healthy lifestyle such as exercise. Adjust diet or a diet such as low salt, low cholesterol and saturated fat, increasing consumption of fruits and vegetables, do not consume alcohol and smoking.

But if you have been diagnosed with hypertension, the most important beginning step is to lower your blood pressure by following a healthy lifestyle as above and take the medicine according to doctor's instructions. In addition it is also is recommended to perform laboratory examinations with a panel of the initial evaluation of hypertension or a panel of healthy living with hypertension.

The purpose of laboratory examinations in patients with hypertension :

• To search for the possible causes of secondary hypertension

• To assess whether there is disease and organ damage To estimate the prognosis

• To determine the presence of other factors that increase the risk of coronary heart disease

  Laboratory tests for hypertension, there are 2 kinds :

• Panel initial evaluation of hypertension : The examination is performed immediately after diagnosis of hypertension and prior to starting treatment. 

• Panel of healthy living with hypertension: to monitor therapeutic efficacy.

Signs and Symptoms of High Blood Pressure (Hypertension)

The cause of high blood pressure (hypertension) mostly unknown, but researchers have shown that high blood pressure associated with insulin resistance or increased insulin levels (hyper insulin's). Both, high blood pressure and insulin resistance is a characteristic of the metabolic syndrome, abnormalities group consisting   of obesity, increased triglycerides and low HDL (good cholesterol). 

 Researchers have also identified a dozen genes that contribute to high blood pressure. Although hypertension seems to be a hereditary disease, but the relationship is not simple. Hypertension is the result of the interaction of diverse genes, so there is no genetic test that can identify people at risk for hypertension occurs consistently. 

Whatever the cause, high blood pressure have a major impact on society. High blood pressure is a major risk factor for heart attack, stroke and heart failure. AHA report, 69% of patients with heart attacks, 77% of patients with stroke and 74% of patients with heart failure suffer from hypertension.

Incidence of hypertension, can lead to serious consequences, but the incidence of hypertension can be diagnosed easily and controlled with a healthy lifestyle modifications and medication. So it's important to do blood pressure checks periodically and when it was diagnosed with hypertension. Patients should seek help and follow the management given by a doctor. If hypertension is left without treatment the blood pressure will continue to rise gradually and lead to excessive cardiac workload. Excessive workload of the heart, eventually resulting in serious damage to blood vessels and organs such as heart, kidney, eye and brain. 

 Hypertension patients have an increased risk for occurrence of :

• Cardiovascular disease (heart failure, sudden death, cardiomyopathy) and arrhythmia's stroke

• Coronary Heart Disease

• Aortic aneurysm (weakness of the aortic wall resulting in dilatation of up to 1.5 times greater and the risk for rupture) often lead to sudden death kidney failure

• Retinopathy (eye disease that can lead to blindness).

Risk to occur one or more of the above conditions, increases with increasing blood pressure. Distribution of blood pressure is made to help the understanding of doctors and patients about the dangers associated with hypertension. Following categories apply to adults who do not drink at the time of high blood pressure medication.

Categorys	Systolic Blood Pressure	Diastolic Blood Pressure
Normal*	≤ 120 mm Hg	≤ 80 mm Hg
Pre-hypertension**	120-139 mm Hg	80-89 mm Hg
Stage  1 (Small Hypertension)	140-159 mm Hg	90-99 mm Hg
Stage 2 (Medium Hypertension)	160-179 mm Hg	100-109 mm Hg
Stage 3 (Serious Hypertension)	180-209 mm Hg	110-119 mm Hg
Stage 4 (Malignant hypertension)	210 mm Hg or more	120mm Hg or more

* Optimal limit for the risk of cardiovascular disease. But blood pressure is too low (below 90/60) also can lead to heart problems and need medical help.

** Pre-hypertension is a condition in which is not required medication, but included the high-risk groups to be hypertension, coronary heart disease and stroke. Individuals with pre-hypertension do not need the medication but it is recommended to perform healthy lifestyle modifications are important to prevent an increase in blood pressure. Healthy lifestyle modifications include weight loss, diet, exercise, reducing salt intake, quitting smoking and limiting alcohol.

Factors that increase the risk of hypertension are :

• Descent

• Age

• Weight loss

• Salt consumption

• Type of race

• Diet and lifestyle

• Sports activities

High blood pressure can cause signs and symptoms of which include :

• Fatigue

• Confused

• Nausea or indigestion

• Disorders or vision problems

• Excessive sweating

• Skin that looks pale and nosebleeds

• Feeling of Anxiety

• A strong heartbeat, rapid and irregular

• The sound of ringing ears

• Impotence

• Dizziness

• Headache