Hypertension is managed using lifestyle modification and antihypertensive drugs. Hypertension is usually treated to achieve blood pressure below 140/90 mmHg to 160/100 mmHg. According to a 2003 review, a reduction in blood pressure of 5 mmHg may reduce the risk of stroke by 34%, ischemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and death from cardiovascular disease.
Video Management of hypertension
Target tekanan darah
For most people, the recommendation is to reduce blood pressure to be less than or equal to somewhere between 140/90 mmHg to 160/100 mmHg. Attempts to reach lower levels have not been shown to improve outcomes while there is evidence that it increases the side effects. In those with diabetes or kidney disease, some recommend rates below 120/80 mmHg; However, the evidence does not support this lower level.
The benefits of drugs are linked to a person's heart disease risk. Evidence for drugs in those with mild hypertension (between 140/90 mmHg and 160/100 mmHg) and no other obvious health issues with some reviews found no benefit and other reviews found beneficial. A review of Cochrane 2012 found a cure for mild hypertension does not reduce the risk of death, stroke, or cardiovascular disease, but causes side effects in 1 out of every 12 people. A second review looking at high-risk people (mostly diabetics whose blood pressure is difficult to control) found that the drug prevented a stroke for 1 in every 223 and deaths for 1 out of every 110 people who took it. If there is benefit to treating people with mild hypertension, they seem to occur primarily among those at high risk, although all groups experience side effects at the same rate (1 in 12). Drugs are not recommended for people with prehypertension or normal high blood pressure.
If the goal of blood pressure is not met, a change in treatment should be done as an inertia therapy is a clear obstacle to controlling blood pressure.
Maps Management of hypertension
Lifestyle modifications
First-line treatment for hypertension is identical to suggested prevention lifestyle changes and includes dietary changes, physical exercise, and weight loss. All of this has been shown to reduce blood pressure significantly in people with hypertension. Their potential effectiveness is similar to and sometimes exceeds a single drug. If hypertension is high enough to justify the immediate use of drugs, lifestyle changes are still recommended in relation to drugs.
Changes in diet, such as low-sodium diet and vegetarian diets are beneficial. Long-term sodium diets (more than 4 weeks) are effective in lowering blood pressure, both in people with hypertension and in people with normal blood pressure. Also, the DASH diet, a diet rich in nuts, seeds, fish, poultry, fruit and vegetables lowers blood pressure. The main feature of the plan is to limit sodium intake, although this diet is also rich in potassium, magnesium, calcium, and protein. A vegetarian diet is associated with lower blood pressure and switching to such a diet might be useful for reducing high blood pressure. A review in 2012 found that high-potassium diets lowered blood pressure in those with high blood pressure and could improve outcomes in those with normal kidney function, while a 2006 review found inconsistent evidence; In addition, the review did not find a significant decrease in overall blood pressure for people with high blood pressure who were given oral potassium supplementation. Meta-analyzes performed by the Cochrane Hypertension group found no evidence of sufficient drop in blood pressure from a combination of calcium, magnesium or potassium supplements; this information conflicts with previous systematic reviews which indicate that adjusting food intake for each of these can be beneficial for adults with high blood pressure. While weight loss diets lose weight and blood pressure, it is unclear whether they reduce the negative results.
Some programs aimed at reducing psychological pressure such as biofeedback or transcendental meditation may be a reasonable add-on for other treatments to reduce hypertension. But some techniques, namely yoga, relaxation and other forms of meditation do not appear to reduce blood pressure, and there are major methodological limitations with many studies of stress reduction techniques. There is no clear evidence that a simple drop in blood pressure with stress reduction techniques results in the prevention of cardiovascular disease.
Some sports regimes - including isometric resistance exercises, aerobic exercise, resistance training, and device-guided breathing - may be useful in reducing blood pressure.
Drugs
Some classes of drugs, collectively referred to as antihypertensive drugs, are available to treat hypertension. Use should take into account a person's cardiovascular risk (including the risk of myocardial infarction and stroke) as well as blood pressure readings, to get a more accurate picture of the person's risk.
The first-line drugs are best debated. Cochrane's Collaboration, World Health Organization and US guidelines support low-dose thiazide-based diuretics as first-line treatment. The UK Guidelines emphasize calcium channel blockers (CCB) in preference for people over 55 years of age or if coming from African or Caribbean families, with angiotensin converting enzyme inhibitors (ACE-I) using first-line for younger people. In Japan starting with one of six classes of drugs including: CCB, ACEI/ARB, thiazide diuretics, beta-blockers, and alpha-blockers are considered fair, while in Canada and Europe all this but alpha-blockers are recommended as an option. When compared with placebo, beta-blockers have a greater benefit in stroke reduction, but there is no difference in coronary heart disease or all-cause mortality. However, three-quarters of active beta-blocker treatments in randomized controlled trials included in the review were with atenolol and none with newer vasodilatory beta-blockers.
Combination of drug
The majority of people need more than one drug to control their hypertension. In those with systolic blood pressure greater than 160 mmHg or diastolic blood pressure over 100 mmHg American Heart Association recommends initiating thiazides and ACEI, ARB or CCB. The combination of ACEI and CCB can be used as well. In general, drugs should be implemented in a stepwise treatment approach when people do not reach the targeted blood pressure level.
Unacceptable combinations are non-dihydropyridine calcium inhibitors (such as verapamil or diltiazem) and beta-blockers, blockade of multiple renin-angiotensin systems (eg angiotensin converting enzyme inhibitors angiotensin receptor blockers), renin-angiotensin system blockers and beta-blockers, beta - blockers and central acting drugs. The combination of an ACE-inhibitor or ngiotensin II-antagonist receptor , a diuretic and NSAID (including selectively COX- 2 and non-prescribed drugs such as ibuprofen should be avoided where possible because of the high risk of acute kidney failure documented.This combination is known as a "triple whammy" in the Australian healthcare industry.These tablets contain a fixed combination of two classes of drugs available and while convenient for people with HIV- people, may be better provided for those who have been established in each component.In addition, the use of treatments with vasoactive agents for people with pulmonary hypertension with left heart disease or lung disease hypoxemia can lead to unnecessary hazards and costs.
Elderly
Treating moderate to severe hypertension decreases mortality and cardiovascular morbidity and mortality in people aged 60 and older. Recommended BP goals are recommended as & lt; 150/90 mm Hg with thiazide, CCB, ACEI, or ARB diuretics into first-line drugs in the United States, and in revised UK guidelines, calcium-channel blockers are recommended as first-line with clinical reading targets; 150/90, or & lt; 145/85 on outpatient or home blood pressure monitoring.
There were no randomized clinical trials aimed at hypertensive blood pressure for 79 years. A recent review concluded that antihypertensive treatment reduced mortality and cardiovascular disease, but did not significantly reduce total mortality. Two professional organizations have published guidelines for management of hypertension in people over the age of 79 years.
Resistant hypertension
Resistant hypertension is defined as hypertension that stays above the target blood pressure despite using, at the same time, three antihypertensive drugs belonging to different drug classes. Guidelines for treating resistant hypertension have been published in the UK and US. It has been suggested that the proportion of resistant hypertension may be the result of chronic high activity of the chronic autonomic nervous system; this concept is known as "neurogenic hypertension". Low adherence to treatment is an important cause of resistant hypertension.
Research
Non-drug treatments
One way of research investigating more effective treatments for severe resistant hypertension focuses on the use of selective radio frequency ablation. It uses a catheter-based device to cause thermal injury to the sympathetic nerves surrounding the renal artery, with the aim of reducing the renal sympathetic overactivity (called "renal denervation") and thereby reducing blood pressure. It has been used in clinical trials for resistant hypertension. However, controlled, blind, random, and controlled clinical trials failed to confirm beneficial effects. Rare renal artery dissection, femoral artery pseudoaneurysm, excessive blood pressure and heart rate depression have been reported. A 2014 consensus statement from The Joint UK Societies recommends radio frequency ablation not being used for the treatment of resistant hypertension, but it supports ongoing clinical trials. Patient selection, taking into account the measurement of pre-and post-procedure sympathetic nervous activity and norepinephrine levels, may help differentiate responders from non-responders by this procedure.
Although considered an experimental treatment in the United States and Britain, it is an approved treatment in Europe, Australia and Asia.
Pregnancy
Regarding research on hypertension occurring during pregnancy, it has been recommended that basic research is directed to improve genetic understanding and pathogenesis of oxidative stress in preeclampsia; and that clinical trials are initiated to assess which interventions are effective in preventing oxidative stress during pregnancy. Regarding the management of essential hypertension in women who become pregnant, the recommendation is that clinical trials begin to assess the effectiveness of various drug regimens, and their effects on the mother and fetus.
2017 guidelines
The American Heart Association and the American College of Cardiology issued guidelines on 13 November 2017 based on the findings of the Systolic Blood Pressure Intervention Trial (SPRINT), a large randomized trial published in November 2015 that looked at systolic blood pressure targets of 140 and 120 mmHg. among people with at least 130 mmHg systolic blood pressure, increased cardiovascular risk, and no diabetes. Lower targets were associated with 0.5% annual absolute decrease in cardiovascular episodes and all-cause mortality (relative risk 0.75), but also increased rates of serious adverse events. Also the blood pressure measurement method in SPRINT is different from that used for standard office blood pressure. The method used by SPRINT usually gives a lower blood pressure estimate of 5-10mmHg, and this may need to be taken into account when setting blood pressure targets.
References
Source of the article : Wikipedia
0 Comments