Hypertension treatment -
Ambulatory monitoring. A longer blood pressure monitoring test may be done to check blood pressure at regular times over six or 24 hours. This is called ambulatory blood pressure monitoring. However, the devices used for the test aren't available in all medical centers.
Check with your insurer to see if ambulatory blood pressure monitoring is a covered service. Lab tests. Blood and urine tests are done to check for conditions that can cause or worsen high blood pressure.
For example, tests are done to check your cholesterol and blood sugar levels. You may also have lab tests to check your kidney, liver and thyroid function. Electrocardiogram ECG or EKG. This quick and painless test measures the heart's electrical activity.
It can tell how fast or how slow the heart is beating. During an electrocardiogram ECG , sensors called electrodes are attached to the chest and sometimes to the arms or legs.
Wires connect the sensors to a machine, which prints or displays results. This noninvasive exam uses sound waves to create detailed images of the beating heart.
It shows how blood moves through the heart and heart valves. Taking your blood pressure at home Your health care provider may ask you to regularly check your blood pressure at home.
Home blood pressure monitors are available at local stores and pharmacies. More Information. Blood pressure chart. Blood pressure test. Your health care provider may recommend that you make lifestyle changes including: Eating a heart-healthy diet with less salt Getting regular physical activity Maintaining a healthy weight or losing weight Limiting alcohol Not smoking Getting 7 to 9 hours of sleep daily Sometimes lifestyle changes aren't enough to treat high blood pressure.
Medications The type of medicine used to treat hypertension depends on your overall health and how high your blood pressure is. Medicines used to treat high blood pressure include: Water pills diuretics. Angiotensin-converting enzyme ACE inhibitors. These drugs help relax blood vessels.
They block the formation of a natural chemical that narrows blood vessels. Examples include lisinopril Prinivil, Zestril , benazepril Lotensin , captopril and others.
Angiotensin II receptor blockers ARBs. These drugs also relax blood vessels. They block the action, not the formation, of a natural chemical that narrows blood vessels.
angiotensin II receptor blockers ARBs include candesartan Atacand , losartan Cozaar and others. Other medicines sometimes used to treat high blood pressure If you're having trouble reaching your blood pressure goal with combinations of the above medicines, your provider may prescribe: Alpha blockers.
These medicines reduce nerve signals to blood vessels. They help lower the effects of natural chemicals that narrow blood vessels. Alpha blockers include doxazosin Cardura , prazosin Minipress and others.
Alpha-beta blockers. Alpha-beta blockers block nerve signals to blood vessels and slow the heartbeat. They reduce the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol Coreg and labetalol Trandate.
Aldosterone antagonists. These drugs may be used to treat resistant hypertension. They block the effect of a natural chemical that can lead to salt and fluid buildup in the body. Examples are spironolactone Aldactone and eplerenone Inspra.
These medicines stop the muscles in the artery walls from tightening. This prevents the arteries from narrowing. Examples include hydralazine and minoxidil. Central-acting agents. These medicines prevent the brain from telling the nervous system to increase the heart rate and narrow the blood vessels.
Examples include clonidine Catapres, Kapvay , guanfacine Intuniv and methyldopa. Treating resistant hypertension You may have resistant hypertension if: You take at least three different blood pressure drugs, including a diuretic.
But your blood pressure remains stubbornly high. You're taking four different medicines to control high blood pressure. Your care provider should check for a possible second cause of the high blood pressure. Treating resistant hypertension may involve many steps, including: Changing blood pressure medicines to find the best combination and dosage.
Reviewing all your medicines, including those bought without a prescription. Checking blood pressure at home to see if medical appointments cause high blood pressure. This is called white coat hypertension. Eating healthy, managing weight and making other recommended lifestyle changes.
High blood pressure during pregnancy If you have high blood pressure and are pregnant, discuss with your care providers how to control blood pressure during your pregnancy.
Potential future treatments Researchers have been studying the use of heat to destroy specific nerves in the kidney that may play a role in resistant hypertension. Request an appointment. Alpha blockers. Angiotensin II receptor blockers. Show more related information. Choosing blood pressure medicines.
Beta blockers: Do they cause weight gain? Beta blockers: How do they affect exercise? Blood pressure medications: Can they raise my triglycerides?
Calcium supplements: Do they interfere with blood pressure drugs? Diuretics: A cause of low potassium? From Mayo Clinic to your inbox. Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health.
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You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. Clinical trials. Try these heart-healthy strategies: Eat healthy foods.
Eat a healthy diet. Try the Dietary Approaches to Stop Hypertension DASH diet. Choose fruits, vegetables, whole grains, poultry, fish and low-fat dairy foods. Get plenty of potassium from natural sources, which can help lower blood pressure.
Eat less saturated fat and trans fat. Use less salt. Processed meats, canned foods, commercial soups, frozen dinners and certain breads can be hidden sources of salt. Check food labels for the sodium content. Limit foods and beverages that are high in sodium.
A sodium intake of 1, mg a day or less is considered ideal for most adults. But ask your provider what's best for you. Limit alcohol. Even if you're healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women, and up to two drinks a day for men.
One drink equals 12 ounces of beer, 5 ounces of wine or 1. Don't smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries.
If you smoke, ask your care provider for strategies to help you quit. Maintain a healthy weight. If you're overweight or have obesity, losing weight can help control blood pressure and lower the risk of complications. Ask your health care provider what weight is best for you.
In general, blood pressure drops by about 1 mm Hg with every 2. In people with high blood pressure, the drop in blood pressure may be even more significant per kilogram of weight lost.
Practice good sleep habits. Poor sleep may increase the risk of heart disease and other chronic conditions. Adults should aim to get 7 to 9 hours of sleep daily.
Kids often need more. Go to bed and wake at the same time every day, including on weekends. If you have trouble sleeping, talk to your provider about strategies that might help.
Manage stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to reduce stress. Try slow, deep breathing.
Practice taking deep, slow breaths to help relax. Some research shows that slow, paced breathing 5 to 7 deep breaths per minute combined with mindfulness techniques can reduce blood pressure.
There are devices available to promote slow, deep breathing. According to the American Heart Association, device-guided breathing may be a reasonable nondrug option for lowering blood pressure. It may be an good option if you have anxiety with high blood pressure or can't tolerate standard treatments.
High blood pressure and exercise. Medication-free hypertension control. Stress and high blood pressure. Blood pressure medication: Still necessary if I lose weight? Can whole-grain foods lower blood pressure? High blood pressure and cold remedies: Which are safe? Resperate: Can it help reduce blood pressure?
How to measure blood pressure using a manual monitor. How to measure blood pressure using an automatic monitor. What is blood pressure? These supplements include: Fiber, such as blond psyllium and wheat bran Minerals, such as magnesium, calcium and potassium Folic acid Supplements or products that increase nitric oxide or widen blood vessels — called vasodilators — such as cocoa, coenzyme Q10, L-arginine and garlic Omega-3 fatty acids, found in fatty fish, high-dose fish oil supplements and flaxseed Researchers are also studying whether vitamin D can reduce blood pressure, but evidence is conflicting.
L-arginine: Does it lower blood pressure? Some things you can do to help manage the condition are: Take medicines as directed. If side effects or costs pose problems, ask your provider about other options.
Don't stop taking your medicines without first talking to a care provider. Schedule regular health checkups. It takes a team effort to treat high blood pressure successfully.
Work with your provider to bring your blood pressure to a safe level and keep it there. Know your goal blood pressure level. Choose healthy habits. Eat healthy foods, lose excess weight and get regular physical activity. If you smoke, quit.
Say no to extra tasks, release negative thoughts, and remain patient and optimistic. Ask for help. Sticking to lifestyle changes can be difficult, especially if you don't see or feel any symptoms of high blood pressure.
It may help to ask your friends and family to help you meet your goals. Join a support group. You may find that talking about any concerns with others in similar situations can help.
What you can do Write down any symptoms that you're having. High blood pressure rarely has symptoms, but it's a risk factor for heart disease.
Let your care provider know if you have symptoms such as chest pains or shortness of breath. Doing so can help your provider decide how aggressively to treat your high blood pressure.
Write down important medical information, including a family history of high blood pressure, high cholesterol, heart disease, stroke, kidney disease or diabetes, and any major stresses or recent life changes.
Make a list of all medicines, vitamins or supplements that you're taking. Include dosages. Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Be prepared to discuss your diet and exercise habits. If you don't already follow a diet or exercise routine, be ready to talk to your care provider about any challenges you might face in getting started. Write down questions to ask your provider. For high blood pressure, some basic questions to ask your provider include: What kinds of tests will I need?
What is my blood pressure goal? Do I need any medicines? Is there a generic alternative to the medicine you're prescribing for me?
What foods should I eat or avoid? What's an appropriate level of physical activity? How often do I need to schedule appointments to check my blood pressure? Should I monitor my blood pressure at home?
I have other health conditions. How can I best manage them together? Are there brochures or other printed material that I can have? What websites do you recommend? Don't hesitate to ask any other questions that you might have.
What to expect from your doctor Your health care provider is likely to ask you questions. Your provider may ask: Do you have a family history of high cholesterol, high blood pressure or heart disease?
What are your diet and exercise habits like? Do you drink alcohol? How many drinks do you have in a week? Do you smoke? When did you last have your blood pressure checked? What was the result? What you can do in the meantime It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and getting more exercise.
By Mayo Clinic Staff. Sep 15, Show References. High blood pressure. National Heart, Lung, and Blood Institute. Accessed July 18, Flynn JT, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Physical Activity Guidelines for Americans.
Department of Health and Human Services. Accessed June 15, Hypertension in adults: Screening. Preventive Services Task Force. Thomas G, et al. Blood pressure measurement in the diagnosis and treatment of hypertension in adults.
Muntner P, et al. Measurement of blood pressure in humans: A scientific statement from the American Heart Association. Basile J, et al. Overview of hypertension in adults. Accessed July 22, Know your risk factors for high blood pressure.
American Heart Association. Rethinking drinking. Alcohol and your health. National Institute on Alcohol Abuse and Alcoholism. Libby P, et al. Systemic hypertension: Mechanisms, diagnosis, and treatment.
In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Elsevier; Hypertension adult. Mayo Clinic; About metabolic syndrome.
Understanding blood pressure readings. Whelton PK, et al. Monitoring your blood pressure at home. Mann JF. Choice of drug therapy in primary essential hypertension.
Agasthi P, et al. Renal denervation for resistant hypertension in the contemporary era: A systematic review and meta-analysis. Scientific Reports. Chernova I, et al. Resistant hypertension updated guidelines. Current Cardiology Reports.
Forman JP, et al. Diet in the treatment and prevention of hypertension. Goldman L, et al. Cognitive impairment and dementia. In: Goldman-Cecil Medicine. Managing stress to control high blood pressure. Brenner J, et al. Mindfulness with paced breathing reduces blood pressure.
Medical Hypothesis. Grundy SM, et al. Natural medicines in the clinical management of hypertension. Natural Medicines. Accessed Dec. Saper RB, et al. Overview of herbal medicine and dietary supplements. Lopez-Jimenez F expert opinion. Mayo Clinic.
Department of Health and Human Services and U. Department of Agriculture. Börjesson M, et al. Physical activity and exercise lower blood pressure in individuals with hypertension: Narrative review of 27 RCTs. British Journal of Sports Medicine. Lloyd-Jones DM, et al. Life's essential 8: Updating and enhancing the American Heart Association's construct of cardiovascular health: A presidential advisory from the American Heart Association.
American Heart Association adds sleep to cardiovascular health checklist. Accessed July 15, Alpha-beta-blockers have a combined effect. They can decrease the constriction of blood vessels like alpha-1 blockers, and slow down the rate and force of the heartbeat like beta-blockers.
Carvedilol Coreg and labetalol hydrochloride Normodyne are common alpha-beta-blockers. ACE inhibitors help the body produce less of a hormone called angiotensin II, which causes blood vessels to narrow. These medications decrease blood pressure by helping blood vessels expand and let more blood through.
ARBs block the action of angiotensin II directly on the blood vessels. It attaches at the receptor site on the blood vessels and keeps them from narrowing. This causes blood pressure to fall. Movement of calcium into and out of muscle cells is necessary for all muscle contractions.
Calcium channel blockers limit calcium from entering the smooth muscle cells of the heart and blood vessels. This makes the heart beat less forcefully with each beat and helps blood vessels relax. As a result, blood pressure decreases. Your body produces types of hormones called catecholamines when under stress, or chronically in some disease states.
Catecholamines, such as norepinephrine and epinephrine, cause the heart to beat faster and with more force. They also constrict blood vessels. These effects raise blood pressure when the hormones attach to a receptor. The muscles around some blood vessels have what are known as alpha-1 or alpha adrenergic receptors.
When a catecholamine binds to an alpha-1 receptor, the muscle contracts, the blood vessel narrows, and blood pressure rises. Alpha-1 blockers bind to alpha-1 receptors, blocking catecholamines from attaching.
This keeps them from narrowing blood vessels so blood is able to flow through the blood vessels more freely, and blood pressure falls. Alpha-1 blockers are primarily used to treat benign prostatic hyperplasia BPH in men, but are also used to treat high blood pressure.
Alpha-2 receptors are different from alpha-1 receptors. When an alpha-2 receptor is activated, the production of norepinephrine is blocked. This decreases the amount of norepinephrine produced. Less norepinephrine means less constriction of blood vessels and a lower blood pressure.
Methyldopa Aldomet is an example of this type of drug. Vasodilators relax the muscles in the walls of blood vessels, especially small arteries arterioles. This widens the blood vessels and allows blood to flow through them more easily. Blood pressure falls as a result. Hydralazine hydrochloride Apresoline and minoxidil Loniten are examples of these.
Treatment for high blood pressure includes ongoing care, as well as individual treatments tailored for specific situations and younger age groups, including children and teens.
Regular checkups allow your doctor to monitor how well your treatment is going and make any necessary adjustments to your treatment plan.
If your blood pressure starts inching back up, your doctor can respond promptly. Additional treatment options may be needed in certain situations like resistant hypertension or secondary hypertension.
Resistant hypertension refers to blood pressure that remains high after trying at least three different types of blood pressure medication. Someone whose high blood pressure is controlled by taking four different kinds of medication is considered to have resistant hypertension.
Even such hard-to-treat cases can often be managed successfully in time. Your doctor might prescribe a different medication, dose, drug combination, or more aggressive lifestyle changes.
Getting a referral to a heart or kidney specialist may also be useful in treating resistant hypertension. Blood pressure often drops substantially or even goes back to normal once doctors diagnose and treat the root cause.
The first line of treatment for children and teens with high blood pressure is a healthy lifestyle. This includes:. Children may take the same blood pressure medications as adults when necessary.
For children with secondary hypertension, blood pressure often returns to normal once the underlying condition is treated. High blood pressure treatment usually involves a combination of lifestyle changes and medication. Sometimes, lifestyle changes are enough to return your blood pressure to normal levels.
These changes may include diet, exercise, and weight loss. If your high blood pressure continues, be sure to consult a doctor who can prescribe the appropriate medication. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.
Find out when fluctuating blood pressure is normal and when it may signal an underlying condition. Get information on risk factors, diagnosis, treatment, and more. Diet can have a big impact on your blood pressure. We look at key foods that increase your blood pressure, as well as foods to eat and to avoid to….
If left untreated, high blood pressure may lead to heart failure. We show you how to lower your blood pressure using diet, supplements, exercise, and…. Headaches are common and can be mild, but sometimes they can cause severe pain and affect daily life.
Many blood pressure medications, known as antihypertensives, are available by prescription to Treatmenh high treatmrnt pressureHypertensiln known as hypertension. There are a Athletic performance clinics of classes treamtent high blood Hydration for sports involving extreme temperatures medications Hypertension treatment Hypertnesion include a number of different drugs. Diuretics help the body get rid of excess sodium salt and water and help control blood pressure. They are often used in combination with additional prescription therapies. Beta-blockers reduce the heart rate, the heart's workload and the heart's output of blood, which lowers blood pressure. If you have diabetes and you're taking insulin, have your responses to therapy monitored closely.Hypertension treatment -
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National Vital Statistics Reports , 68 9. See 'Choice of initial therapy in patients with comorbidities' below.
In the absence of a compelling indication, we and others recommend that beta blockers not be used as first-line therapy, particularly in patients over age 60 years [ 3, ]. Compared with other antihypertensive drugs in the primary treatment of hypertension, beta blockers appear to be associated with inferior protection against stroke risk and all-cause mortality [ ].
Such disadvantages of beta blockers are primarily seen in patients over age 60 years [ 38, ]. Beta blockers are also associated with impaired glucose tolerance and an increased risk of new-onset diabetes [ 32 ], with the exception of vasodilating beta blockers such as carvedilol and nebivolol [ 43,44 ].
See "Treatment of hypertension in patients with diabetes mellitus". As noted above, when a thiazide diuretic is used, we suggest selecting a thiazide-like diuretic chlorthalidone or indapamide rather than hydrochlorothiazide. Chlorthalidone and indapamide are significantly more potent antihypertensive agents than hydrochlorothiazide, a thiazide-type diuretic, at similar dose levels [ ].
In a meta-analysis of 14 trials that compared the blood pressure reduction with one of three dose levels of hydrochlorothiazide low, intermediate, high with a similar dose of one of the thiazide-like diuretics, systolic pressure reduction was greater with chlorthalidone and indapamide by 3.
A possibly more important difference than potency is the longer duration of action of chlorthalidone and indapamide 24 or more hours versus 6 to 12 hours with hydrochlorothiazide table 3 [ ]. This may not affect office blood pressure if the medication is taken in the morning but may result in a greater fall in nighttime blood pressure.
In one small trial, for example, nighttime blood pressure decreased by The effects of chlorthalidone and hydrochlorothiazide on cardiovascular outcomes were directly compared in a trial of 13, older male veterans mean age 72 years who had uncontrolled hypertension mean systolic pressure mmHg despite taking hydrochlorothiazide 25 mg daily with 87 percent or without 13 percent other antihypertensive agents [ 51 ].
Patients were randomly assigned to continue hydrochlorothiazide or switch to Blood pressure was also similar between the groups and remained uncontrolled throughout the trial. Several limitations of this trial diminish the usefulness of the findings. The primary problem is that when a patient has uncontrolled blood pressure despite taking 25 mg of hydrochlorothiazide , our approach would be to switch the patient to 25 mg of chlorthalidone not The 25 mg dose of chlorthalidone was also the dose used in cardiovascular outcome trials such as ALLHAT [ 52 ].
In addition, more than 15 percent of patients assigned to chlorthalidone switched back to hydrochlorothiazide during the course of the trial, whereas 4 percent switched from hydrochlorothiazide to chlorthalidone, an outcome that could have biased the results of the trial toward the null.
The reasons for this large difference in crossover were not discussed but could be explained at least in part by the need for patients to split their chlorthalidone tablets, which are not available in a Other studies, including several network meta-analyses, concluded that cardiovascular outcomes were superior with chlorthalidone as compared with hydrochlorothiazide [ ].
By contrast, some retrospective observational studies suggest that chlorthalidone and hydrochlorothiazide lead to similar rates of cardiovascular events but that chlorthalidone increases the risk of adverse metabolic effects eg, hypokalemia [ 59,60 ].
However, the metabolic derangements associated with chlorthalidone can be attenuated, at least in part, by pairing it with an ACE inhibitor or ARB. Patients selected for initial combination therapy — When two drugs are used, they should be from different antihypertensive drug classes [ 3 ].
In most patients, the drugs should be selected from among the three preferred classes ie, ACE inhibitors [or ARBs], calcium channel blockers, and thiazide diuretics [ideally a thiazide-like rather than a thiazide-type diuretic].
Conversely, some patients may have an indication for a drug from a different class, as described below table 2. Among those without an indication for one of the nonpreferred agents, we suggest treating with the combination of an ACE inhibitor or ARB and a calcium channel blocker, preferably a dihydropyridine calcium blocker.
In addition, we suggest prescribing these two agents as a single-pill combination, if feasible table 1 and algorithm 1. Some experts initiate therapy with a single-pill combination, whereas other experts initiate free equivalents and then, after titrating the dose of each drug, convert to a single-pill combination.
Single-pill combinations lead to greater blood pressure reduction, increased attainment of blood pressure goal, and better medication adherence as compared with free equivalents ie, in which the two drugs are prescribed as separate pills [ 17,18 ]. In addition, observational data suggest that single-pill combination therapy reduces the risk of cardiovascular disease and mortality compared with free equivalents [ 61 ].
The combination of an ACE inhibitor or ARB with a thiazide diuretic is a reasonable alternative, particularly in patients who have conditions that can benefit from a thiazide diuretic eg, edema, osteoporosis, calcium nephrolithiasis with hypercalciuria.
However, thiazide-like diuretics ie, chlorthalidone , indapamide are preferred over thiazide-type diuretics eg, hydrochlorothiazide , and there are only two single-pill combinations available that combine an ACE inhibitor or ARB with a thiazide-like diuretic ie, perindopril-indapamide and azilsartan-chlorthalidone.
Although treating with a calcium channel blocker and a thiazide diuretic is also a reasonable option, there are no such single-pill combinations available. See "Major side effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers", section on 'Combination of ACE inhibitors and ARBs' and "Treatment of hypertension in patients with diabetes mellitus", section on 'Avoid combination renin-angiotensin system inhibition' and "Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults", section on 'Combination of ACE inhibitors and ARBs'.
Similarly, a direct renin inhibitor should not be combined with an ACE inhibitor or ARB. Choice of initial therapy in patients with comorbidities. Patients with heart failure — Patients with heart failure may have reduced ejection fraction ie, HFrEF , mildly reduced ejection fraction ie, HFmrEF , or preserved ejection fraction ie, HFpEF.
Such patients are often prescribed multiple specific drugs to improve survival and reduce morbidity, independent of the blood pressure, including inhibitors of the renin-angiotensin system eg, ACE inhibitors, ARBs, or ARB-neprilysin inhibitors , beta blockers, diuretics, sodium-glucose cotransporter 2 SGLT-2 inhibitors, and mineralocorticoid receptor antagonists.
Thus, the drugs used to treat hypertension in patients with heart failure are those used to reduce morbidity and mortality from heart failure. The approach to pharmacologic therapy in patients with heart failure is presented in detail separately:.
Patients with recent myocardial infarction — Beta blockers, while generally not recommended as initial monotherapy or as part of combination therapy in patients with hypertension, are indicated in patients who have had a myocardial infarction MI in the previous three years.
However, some experts treat with a beta blocker for just six months to one year following an MI, whereas other experts continue these agents indefinitely.
Patients who have had an MI are also typically prescribed an ACE inhibitor or ARB, regardless of whether they have albuminuria, since they reduce morbidity and mortality after an MI [ 3,63 ].
The treatment of hypertension after MI is discussed in more detail elsewhere. See "Acute myocardial infarction: Role of beta blocker therapy" and "Angiotensin converting enzyme inhibitors and receptor blockers in acute myocardial infarction: Recommendations for use".
Indefinite treatment with an ACE inhibitor or ARB is also recommended. However, most of the data showing benefit from the use of beta blockers post-MI accrued during the pre-reperfusion era. Data from contemporary post-MI cohort studies are inconsistent and suggest that there is no discernable survival benefit when beta blockers are prescribed in patients with preserved ejection fraction [ 64,65 ].
Thus, the appropriate duration of beta blocker use after MI is unclear, and beta blocker discontinuation can reduce polypharmacy and side effects, and may improve adherence to other beneficial medications [ 66 ].
Patients with CKD — Our approach to selecting antihypertensive therapy in patients with chronic kidney disease CKD is as follows:. These agents reduce the risk of progression to end-stage kidney disease ESKD in such patients. The evidence is discussed elsewhere. See "Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults" and "Treatment of diabetic kidney disease".
However, unlike in patients with severely increased albuminuria, a preferential benefit from ACE inhibitors and ARBs on patient-important endpoints eg, ESKD in patients with moderately increased albuminuria is unproven.
Some contributors use one of these agents in nearly all patients with CKD, regardless of the degree of albuminuria. Other contributors, citing the lack of evidence for preferential benefit, do not favor ACE inhibitors or ARBs over other acceptable first-line drugs eg, dihydropyridine calcium channel blockers, diuretics.
However, this disagreement is moot in most cases since hypertension is more difficult to treat in patients with CKD [ 67 ], and therefore such patients require multiple drugs to control the blood pressure and an ACE inhibitor or ARB is typically incorporated into the regimen.
When using diuretics in patients with CKD, we typically treat with a thiazide-like diuretic ie, chlorthalidone or indapamide. See "Thiazides versus loop diuretics in the treatment of hypertension", section on 'Patients with chronic kidney disease'.
Loop diuretics are an alternative to thiazide-like diuretics in patients with severely decreased eGFR and, in addition, may be required in combination with a thiazide-like diuretic ie, dual nephron blockade among those with refractory edema.
If furosemide is prescribed, it should be dosed at least twice daily due to its short duration action four to six hours. See "Causes and treatment of refractory edema in adults", section on 'Combination oral diuretic therapy'. In the absence of heart failure, potassium-sparing diuretics eg, spironolactone should generally be avoided in patients with moderate to severe CKD.
Renal autoregulation is often abnormal and occurs more slowly in patients with CKD figure 1 [ 70 ], and successful blood pressure lowering can, at least over the short term, precipitate a reduction in glomerular filtration rate GFR and a corresponding rise in serum creatinine.
The impairment in GFR following the institution or intensification of antihypertensive therapy is usually moderate and at least partially reversible within several weeks. In addition, attainment of goal blood pressure leads to reductions in cardiovascular events, even among patients who experience a reduction in GFR as a result of antihypertensive therapy.
See "Effect of antihypertensive treatment on kidney function in primary essential hypertension", section on 'Acute effects' and "Goal blood pressure in adults with hypertension", section on 'Patients with chronic kidney disease'. Patients with diabetes — Nearly 80 percent of individuals with diabetes have hypertension.
The approach to antihypertensive drug selection in those with diabetes has changed substantively over time. Formerly, it was believed that ACE inhibitors and ARBs provided a special clinical benefit over other agents such as calcium channel blockers and diuretics.
However, this is not the case in the majority of patients. Rather, the benefit of ACE inhibitors and ARBs over other drugs is limited to patients with diabetes and albuminuria.
See "Treatment of hypertension in patients with diabetes mellitus", section on 'Choice of antihypertensive drug therapy'. Among patients without albuminuria, the approach to antihypertensive therapy is the same as in patients without diabetes.
Since hypertension is often more difficult to control among individuals with diabetes therefore requiring combination therapy , ACE inhibitors and ARBs are nevertheless commonly prescribed to patients without albuminuria.
See 'Choice of initial therapy in most patients' above. See 'Patients with heart failure' above and 'Patients with recent myocardial infarction' above. The rationale and supporting data for our approach to antihypertensive drug therapy in patients with diabetes are presented in another topic.
Patients with orthostatic hypotension — Although infrequently done in clinical practice, all patients with newly diagnosed hypertension should be evaluated, typically at the time of diagnosis, for a substantial orthostatic decline in blood pressure [ 3,4 ].
The definition, evaluation, and diagnosis of orthostatic hypotension are discussed elsewhere. See "Mechanisms, causes, and evaluation of orthostatic hypotension". We evaluate all patients newly diagnosed with hypertension for orthostatic changes in blood pressure, irrespective of symptoms.
This is because most patients with orthostatic hypotension do not report symptoms of dizziness or lightheadedness when their blood pressure falls after two to five minutes of upright posture; conversely, most patients with postural symptoms of dizziness or lightheadedness do not have orthostatic hypotension.
Our approach to pharmacologic therapy in patients whose systolic blood pressure falls by more than 10 to 20 mmHg after changing from a seated to upright posture is as follows:. However, we avoid, if possible, the use of diuretics since these agents may exacerbate orthostatic hypotension [ 71 ], although the data are inconsistent [ 72 ].
If a diuretic is necessary, a low dose should be used. Alpha blockers, central adrenergic inhibitors, and nitrates should be avoided since they worsen orthostatic hypotension. Orthostatic measurements should be obtained at subsequent follow-up visits until the condition resolves.
Patients with atrial fibrillation — In patients with atrial fibrillation, we use either a beta blocker or nondihydropyridine calcium channel blocker.
Among those treated with a rate control strategy, these agents are effective in slowing the heart rate. See "Control of ventricular rate in patients with atrial fibrillation who do not have heart failure: Pharmacologic therapy". We also treat with one of these agents in patients who are managed with a rhythm control strategy and who are in sinus rhythm.
Such patients may have breakthrough atrial fibrillation ie, failure of rhythm control ; a beta blocker or nondihydropyridine calcium channel blocker in this setting can prevent a rapid ventricular response. A dihydropyridine calcium channel blocker can be used in conjunction with a beta blocker, but the combination of a beta blocker and a nondihydropyridine calcium channel blocker is not typically used unless needed for blood pressure control in a patient with allergies or intolerances to other antihypertensive drugs.
Earlier, small trials reported that ACE inhibitors or ARBs prevented recurrence of atrial fibrillation among those who had been converted to sinus rhythm [ ]. However, three subsequent, large trials performed in patients with a history of atrial fibrillation found that these drugs do not prevent recurrence compared with alternative therapy [ ].
Thus, while UpToDate does not recommend ACE inhibitors or ARBs specifically to prevent atrial fibrillation recurrence, these agents are often necessary for blood pressure control or because they are indicated for other comorbidities.
This is discussed in detail elsewhere. See "ACE inhibitors, angiotensin receptor blockers, and atrial fibrillation". Other aspects of antihypertensive therapy in patients with atrial fibrillation include the following:.
Thus, at each follow-up visit for hypertension, blood pressure should be measured in triplicate; also, ambulatory blood pressure monitoring can be useful in this patient population. Patients who could become pregnant — In patients who could become pregnant and who require antihypertensive drug therapy, we typically initiate a dihydropyridine calcium channel blocker eg, nifedipine extended release or amlodipine ; if additional agents are needed, we use thiazide-like diuretics eg, chlorthalidone and certain beta blockers eg, labetalol , carvedilol , metoprolol algorithm 2.
ACE inhibitors and ARBs are avoided in this setting because of potential teratogenicity should the patient become pregnant ; mineralocorticoid receptor antagonists and direct renin inhibitors should also be avoided.
There is a theoretical concern that diuretics could adversely affect the physiologic increase in plasma volume during pregnancy and therefore lead to harm if the patient becomes pregnant. However, there is no evidence that these agents are teratogenic or adversely affect pregnancy.
Nevertheless, if a patient taking a thiazide-like or thiazide-type diuretic becomes pregnant, many clinicians would discontinue the medication or reduce the dose. The management of hypertension during pregnancy is discussed in detail elsewhere.
See "Treatment of hypertension in pregnant and postpartum patients". Role of patient race in selection of initial monotherapy — Although some experts choose different drug classes for monotherapy in Black patients as compared with other patients, it is reasonable for clinicians to choose a consistent therapeutic approach regardless of race.
There is substantial variability in the blood pressure response to drugs such as ACE inhibitors within self-identified Black or African American patients that is larger than the variability in blood pressure response between Black and White individuals [ 83 ].
Thus, although blood pressure responses to ACE inhibitor monotherapy are, on average, lesser among Black patients as compared with White patients, there is considerable overlap in the response [ 83 ].
When used as combination therapy ie, combined with either a calcium channel blocker or a diuretic , ACE inhibitors and ARBs are the most effective two drug combinations. Accordingly, our recommendations for combination therapy do not differ according to race.
See 'Patients selected for initial combination therapy' above and 'Adding a second drug preferred combination therapy ' below.
The preference for a calcium channel blocker or a thiazide-like diuretic as monotherapy in self-described Black patients emanates from evidence in randomized trials showing that these drugs have superior blood pressure-lowering efficacy and superior protection against cardiovascular events compared with ACE inhibitors or ARBs [ ].
However, hypertension control rates among Black patients, as well as racial disparities in control, have not improved, despite an increase in the use of calcium channel blockers in this population and a corresponding decrease in the use of ACE inhibitors and ARBs [ 95 ].
Thus, the focus on single-drug blood pressure responses in Black individuals should be deemphasized in favor of treating this high-risk cohort intensively enough by utilizing initial combination therapy and avoiding therapeutic inertia. In one large health system, for example, implementation of a race-agnostic therapeutic algorithm that focused on combination therapy and avoidance of therapeutic inertia resulted in hypertension control rates exceeding 80 percent for White, Black, and Hispanic patients [ 96 ].
In addition, the disparity in hypertension control comparing Black patients with White patients decreased from 6. Confirm that blood pressure is uncontrolled — There are essentially four, potentially overlapping, explanations for uncontrolled blood pressure in patients who have initiated antihypertensive therapy either with monotherapy or initial combination therapy :.
Before escalating antihypertensive drug therapy, it is generally prudent to confirm that the patient is adherent and that the blood pressure is truly above goal either with out-of-office blood pressure measurements or a series of properly performed office-based measurements [ 3 ].
See 'Assess medication adherence' below and 'Assure proper blood pressure measurement' below. If blood pressure is only slightly above goal, it may be appropriate to reassess after two to three months rather than immediately intensifying drug therapy.
However, if the mild elevation persists, therapeutic inertia should be avoided, and therapy should be intensified. Assess medication adherence — If goal blood pressure is not attained with initial therapy, adherence should be assessed. Nonadherence to medication is a common contributor to why an individual's blood pressure remains uncontrolled despite prescription of antihypertensive drug therapy.
In one meta-analysis, for example, 45 percent of all patients with hypertension were partially or completely nonadherent to antihypertensive therapy; the prevalence of partial or complete nonadherence was 84 percent among those with uncontrolled blood pressure [ 97 ].
Another meta-analysis concluded that approximately 30 percent of patients with apparent treatment resistance were nonadherent, but there was a high degree of heterogeneity, with nonadherence rates of 3 percent to 86 percent, depending upon the individual study [ 98 ]. In general, those studies that relied upon self-report found lower rates of nonadherence, whereas analyses that used more objective measures reported higher rates.
Reports from other surveys indicate that at least 20 percent of patients never initiate newly prescribed antihypertensive drug therapy [ 99 ], and as many as 50 percent who actually do initiate antihypertensive medications stop taking them within one year [ ].
There are various methods for assessing adherence, each of which has significant limitations [ ]: direct patient queries, structured questionnaires, pill counts, electronic surveillance of prescription refill data, direct observation of pill taking, electronic monitoring systems, measurement of drug effects eg, activity of angiotensin-converting enzyme [ACE] in serum , and direct measurement of drug levels in either blood or urine.
These methods are discussed elsewhere. See "Patient adherence and the treatment of hypertension", section on 'Assessment of adherence'.
Our strategies to prevent nonadherence may also be helpful in addressing it once identified [ ]:. These and other strategies are presented in detail elsewhere. See "Patient adherence and the treatment of hypertension", section on 'Methods to improve adherence'.
Assure proper blood pressure measurement — Accurate measurement of blood pressure is imperative for making sound therapeutic decisions regarding antihypertensive drug therapy.
However, in most clinical settings, blood pressure is not measured accurately. Before intensifying antihypertensive therapy in patients with uncontrolled blood pressure based upon casual office readings despite adherence to prescribed treatment, one or more of the following methods should be used to confirm poor control see "Blood pressure measurement in the diagnosis and management of hypertension in adults" :.
See "Blood pressure measurement in the diagnosis and management of hypertension in adults", section on 'Routine office-based blood pressure'. The device is activated by a care provider, who can continue their work and even leave the room.
AOBPM requires specialized equipment but saves time and minimally interrupts clinic flow. Like with standardized office blood pressure just mentioned, talking during the measurements should be avoided.
See "Blood pressure measurement in the diagnosis and management of hypertension in adults", section on 'Automated office blood pressure measurement'. Typically, multiple readings are obtained daily over several consecutive days, and then these readings are averaged to guide clinical decision making.
A common scenario is to instruct patients to take two to four readings daily for five to seven days before attending the clinic. See "Out-of-office blood pressure measurement: Ambulatory and self-measured blood pressure monitoring", section on 'Performance and interpretation of self-measured blood pressure SMBP '.
See "Out-of-office blood pressure measurement: Ambulatory and self-measured blood pressure monitoring", section on 'Performance and interpretation of ambulatory blood pressure monitoring ABPM '. In most outpatient clinical settings, blood pressure is regularly measured incorrectly ie, casually measured blood pressure, without proper technique.
The primary reason for the ubiquitous use of incorrect measurement technique is that of convenience. Specifically, casual blood pressure measurement is simple, quick, and avoids workflow disruptions and interruptions. However, casual blood pressure measurement on average produces an overestimate of the patient's blood pressure, leading to overestimates of hypertension severity and overmedication.
Uncontrolled on monotherapy. Sequential monotherapy versus adding a second drug — Among patients who do not attain goal blood pressure despite adherence to at least moderate-dose monotherapy, the options include:.
In patients started on a single drug, our approach is to add a second drug rather than attempting sequential monotherapy. Antihypertensive efficacy is greater with adding a second drug. In addition, attainment goal blood pressure is likely to occur more rapidly with the stepped-care approach than with sequential monotherapy.
This is important because most practicing clinicians intensify antihypertensive drugs at only a fraction of the visits at which they encounter an elevated blood pressure reading [ 21, ].
The best data come from a trial of individuals with hypertension who were randomly assigned to initial combination therapy with losartan and hydrochlorothiazide or to sequential monotherapy followed, if needed, by combination therapy [ 11 ]. In the sequential monotherapy group, the dose of the first drug was doubled at four weeks; at eight weeks, the first drug was replaced by the other drug, and the dose of that drug was doubled at twelve weeks.
Starting at 16 weeks, combination therapy was used. Blood pressure reduction was greater with initial combination therapy than with sequential monotherapy, although the blood pressures in the two groups became similar once the sequential monotherapy group was switched to combination therapy [ 11 ].
After the sequential monotherapy group was switched to combination therapy, the control rate increased to match the initial combination therapy group. By contrast, there is interindividual heterogeneity in the blood pressure response to specific antihypertensive medications [ ], and therefore switching from one drug that has a suboptimal effect to a different drug may lead to improved control [ ].
In addition, there is one trial that reported numerically similar proportions of hypertension control comparing a stepped-care approach with sequential monotherapy [ 10 ].
However, the agents and dosing strategies that were used in this trial were different in the stepped-care and sequential monotherapy groups, limiting the interpretation of this study. Despite recommendations to add an additional antihypertensive drug when the patient has not attained goal blood pressure, clinicians frequently fail to do this in practice therapeutic inertia.
In the United States, for example, the number of antihypertensive drugs prescribed to adults with hypertension has not changed over the past decade, even though the prevalence of poor hypertension control is high and increasing [ ].
Of those individuals with uncontrolled hypertension, 40 percent are treated with only one antihypertensive medication. Adding a second drug preferred combination therapy — In most patients who require two antihypertensive agents, the drugs should generally be selected from among the three preferred classes ie, ACE inhibitors [or angiotensin receptor blockers ARBs ], dihydropyridine calcium channel blockers, and thiazide diuretics [ideally a thiazide-like rather than a thiazide-type diuretic].
Conversely, some patients may have an indication for a drug from a different class, as described previously table 2. See 'Choice of initial therapy in patients with comorbidities' above.
However, among those without an indication for one of the nonpreferred agents, we suggest treating with the combination of an ACE inhibitor or ARB and a calcium channel blocker, preferably a dihydropyridine calcium blocker.
In addition, we suggest prescribing these two agents as a single-pill combination, if feasible algorithm 1. Patients were randomly assigned to treatment with benazepril 40 mg daily plus amlodipine 5 to 10 mg daily or benazepril plus hydrochlorothiazide At three years, the composite cardiovascular endpoint ie, the combination of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, hospitalization for angina, resuscitation after sudden cardiac death, or coronary revascularization occurred less frequently in the benazepril plus amlodipine group 9.
Benazepril-amlodipine therapy led to a similar reduction in the composite of cardiovascular death or nonfatal myocardial infarction or stroke 5 versus 6.
All-cause mortality was slightly less common in the benazepril plus amlodipine group 4. Although office-based systolic pressure was slightly higher in the group receiving hydrochlorothiazide by 1 mmHg [ 30 ], the hour average ambulatory systolic pressure was 1.
Thus, differences in attained blood pressure likely do not account for the totality of the observed benefit from combining benazepril with amlodipine.
In addition to the cardiovascular benefits, kidney events defined as doubling of serum creatinine or end-stage kidney disease [ESKD] were less frequent in patients who were assigned to benazepril plus amlodipine 2 versus 3. However, as noted above, thiazide-like diuretics chlorthalidone and indapamide are more potent and are therefore preferred over thiazide-type diuretics.
Whether combining an ACE inhibitor or ARB with a dihydropyridine calcium channel blocker is superior to combining it with a thiazide-like diuretic is unknown.
Nevertheless, because single-pill combinations that contain a thiazide-like diuretic are few and often difficult to obtain, we favor the combination of an ACE inhibitor or ARB plus a dihydropyridine calcium channel blocker when two agents are required. Adding a third drug if needed — As noted earlier, the three primary options for antihypertensive drug therapy in most patients include an ACE inhibitor or ARB , dihydropyridine calcium channel blocker, and thiazide diuretic preferably a thiazide-like diuretic [ 3 ].
Thus, in patients whose blood pressure is uncontrolled despite adherence to two drugs, we add a drug from the third class of agents. As an example, in a patient who has not attained goal blood pressure despite taking an ACE inhibitor and calcium channel blocker, we add a thiazide-like diuretic.
Some patients may have an indication for a drug from a different class, as described previously table 2. Apparent treatment-resistant hypertension — Patients who are prescribed three antihypertensive drugs at intermediate or high or maximally tolerated doses, inclusive of a diuretic, and who have uncontrolled blood pressure are defined as having apparent treatment-resistant hypertension; those prescribed four or more medications whether or not their blood pressure is controlled are also defined as having apparent treatment-resistant hypertension.
The word "apparent" is used because many such patients have pseudoresistant hypertension eg, due to nonadherence to prescribed therapy or white coat effect.
This issue is presented in detail elsewhere. See "Definition, risk factors, and evaluation of resistant hypertension", section on 'Apparent, true, and pseudoresistant hypertension'.
Apparent resistant hypertension is relatively common. As an example, in an analysis of National Health and Nutrition Examination Survey NHANES data through , 22 percent of drug-treated individuals with hypertension were prescribed three or more antihypertensive drugs.
Given that nonadherence and white coat effect are prevalent, the proportion of patients with true resistant hypertension is likely considerably less. See "Definition, risk factors, and evaluation of resistant hypertension", section on 'Prevalence'.
Refractory hypertension is defined as having uncontrolled blood pressure despite prescription of five or more antihypertensive drugs. In one study, approximately 6 percent of those with apparent resistant hypertension had refractory hypertension [ ]. Compared with patients who have apparent resistant hypertension, those with refractory hypertension have higher rates of kidney failure and cardiovascular disease [ ].
In addition, rates of nonadherence to therapy are higher among those with apparent refractory hypertension 60 percent in one study [ ].
See "Definition, risk factors, and evaluation of resistant hypertension", section on 'Refractory hypertension'. The evaluation and treatment of patients with resistant and refractory hypertension is presented separately algorithm 3 and figure 2. See "Definition, risk factors, and evaluation of resistant hypertension" and "Treatment of resistant hypertension".
Waiting four weeks to reevaluate after starting or intensifying therapy is typically appropriate to permit long-acting antihypertensive drugs enough time to manifest their full blood pressure-lowering effect.
Reevaluating at two weeks or even sooner is appropriate for patients with severely elevated blood pressure. If blood pressure is uncontrolled, we typically escalate doses of individual antihypertensive drugs to at least half the maximum recommended dose ie, to a moderate or high dose before adding additional therapy.
After goal blood pressure is attained, we usually follow patients every three to six months either in person or by telehealth. To determine if a patient has attained goal blood pressure, it is important that blood pressure be measured appropriately.
As discussed elsewhere, there are four methods to properly measure blood pressure see "Blood pressure measurement in the diagnosis and management of hypertension in adults", section on 'Our approach to measuring blood pressure' :.
The technology of devices available for self-measured blood pressure has advanced considerably. Now, many home monitors contain memory that automatically stores readings, and some even have the capability of making automated readings while asleep.
If home monitoring is performed, the patient should be trained in proper self-measurement technique, and the accuracy of their device should be periodically evaluated eg, annually.
Self-measured blood pressure is discussed in detail elsewhere. See "Out-of-office blood pressure measurement: Ambulatory and self-measured blood pressure monitoring". We monitor electrolytes and serum creatinine one to three weeks after initiation or titration of angiotensin-converting enzyme ACE inhibitors, angiotensin receptor blockers ARBs , mineralocorticoid receptor antagonists, and diuretics table 5.
In patients on stable doses of medications, electrolytes and creatinine are typically monitored annually. OVERVIEW OF ADVERSE EFFECTS — Adverse effects of commonly used antihypertensive drugs are discussed in detail elsewhere table 5 :.
BEDTIME VERSUS MORNING DOSING — The contributors to this topic take different approaches to the timing of antihypertensive therapy:. This approach is supported by the European Society of Hypertension ESH [ ]. Patients with glaucoma, particularly open-angle glaucoma, should not be prescribed antihypertensive medicines at night [ ].
The best data come from the Treatment In the Morning or Evening TIME trial [ ]. In this study, more than 21, adults with hypertension were randomly assigned to take their antihypertensive medications in the morning or the evening. At approximately five years, rates of cardiovascular events were similar between the groups.
There were no important differences in safety or adverse events comparing morning with evening dosing. Although not specifically designed to compare morning with evening dosing, the Colchicine for Prevention of Vascular Inflammation in Noncardioembolic Stroke CONVINCE trial compared sustained release verapamil given at bedtime with an active comparator either hydrochlorothiazide or atenolol , which were dosed in the morning ; there was no difference in the rates of cardiovascular events among the groups [ ].
These data conflict with two other trials the MAPEC and Hygia studies , which concluded that evening dosing leads to fewer cardiovascular events and lower mortality compared with morning dosing [ ,, ].
However, both the MAPEC and Hygia trials were published by the same research group and both trials reported very large benefits from shifting one or more antihypertensive drugs from the morning to bedtime eg, 50 percent or greater relative reductions in stroke, myocardial infarction, and cardiovascular death.
Effects of this magnitude are rarely if ever observed in rigorous cardiovascular trials; in addition, the biologic rationale a modest reduction in nighttime blood pressure without a major difference in hour blood pressure does not support such large effects [ ].
SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. See "Society guideline links: Hypertension in adults". These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10 th to 12 th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are relevant to this topic.
We encourage you to print or e-mail these topics to your patients. You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword s of interest.
Our approach is as follows see 'Choosing between monotherapy and combination drug therapy' above :. Combination therapy lowers blood pressure more than monotherapy and increases the likelihood that target blood pressure will be achieved in a reasonable time period.
In addition, using two drugs may lead to attainment of goal blood pressure with lower doses of each medication, and this reduces the risk of dose-related side effects. Such patients include those adhering to a very low salt intake, those who are underweight or frail, those with a known orthostatic decline in blood pressure, and those with a history of multiple drug allergies or intolerances.
However, by far the most important strategy for ultimately achieving blood pressure control is to avoid therapeutic inertia.
In most patients, the drugs should be selected from among the three preferred classes ie, angiotensin-converting enzyme [ACE] inhibitors [or angiotensin receptor blockers ARBs ], calcium channel blockers, and thiazide diuretics [ideally a thiazide-like rather than a thiazide-type diuretic].
Among patients without an indication for a specific drug class, we suggest treating with the combination of an ACE inhibitor or ARB and a calcium channel blocker, preferably a dihydropyridine calcium blocker, rather than other combinations Grade 2B.
In addition, we suggest prescribing these two agents as a single-pill combination, if feasible table 1 and algorithm 1 Grade 2B. If there are no compelling reasons to select a specific drug class, we suggest treating with an ACE inhibitor or ARB or a dihydropyridine calcium channel blocker, rather than a thiazide diuretic algorithm 1 Grade 2C.
A thiazide diuretic is a reasonable alternative as monotherapy and may be preferred in patients with edema, osteoporosis, or calcium nephrolithiasis with hypercalciuria.
If a thiazide diuretic is used, we suggest treating with a thiazide-like diuretic ie, chlorthalidone , indapamide rather than hydrochlorothiazide Grade 2C.
See 'Patients selected for initial monotherapy' above. Before escalating antihypertensive drug therapy, it is generally prudent to confirm that the patient is adherent and that the blood pressure is truly above goal either with out-of-office blood pressure measurements or a series of properly performed office-based measurements.
See 'Assess medication adherence' above and 'Assure proper blood pressure measurement' above. See 'Uncontrolled on monotherapy' above.
As noted above, among those without an indication for one of the nonpreferred agents, we suggest treating with the combination of an ACE inhibitor or ARB and a calcium channel blocker, preferably a dihydropyridine calcium blocker Grade 2B.
In addition, we suggest prescribing these two agents as a single-pill combination, if feasible algorithm 1 Grade 2B. Resistant hypertension is presented in detail elsewhere algorithm 3 and figure 2. See 'Dose titration and monitoring' above. We monitor electrolytes and serum creatinine one to three weeks after initiation or titration of ACE inhibitors, ARBs, mineralocorticoid receptor antagonists, and diuretics table 5.
Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Choice of drug therapy in primary essential hypertension. Formulary drug information for this topic.
No drug references linked in this topic. Find in topic Formulary Print Share. View in. Language Chinese English. Authors: Johannes FE Mann, MD John M Flack, MD, MPH, FAHA, FASH, MACP Section Editors: George L Bakris, MD William B White, MD Deputy Editors: Karen Law, MD, FACP John P Forman, MD, MSc Contributor Disclosures.
All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Jan This topic last updated: Jan 30, Choice of initial therapy in patients with comorbidities Patients with heart failure — Patients with heart failure may have reduced ejection fraction ie, HFrEF , mildly reduced ejection fraction ie, HFmrEF , or preserved ejection fraction ie, HFpEF.
Circulation ; Yoon SS, Gu Q, Nwankwo T, et al. Trends in blood pressure among adults with hypertension: United States, to Hypertension ; Whelton PK, Carey RM, Aronow WS, et al. Hypertension ; e Mancia G, Kreutz R, Brunström M, et al.
J Hypertens ; Flack JM, Calhoun D. Am J Hypertens ; Wald DS, Morris JK, Wald NJ. Randomized Polypill crossover trial in people aged 50 and over. PLoS One ; 7:e Chow CK, Atkins ER, Hillis GS, et al.
Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension QUARTET : a phase 3, randomised, double-blind, active-controlled trial.
Lancet ; Yusuf S, Joseph P, Dans A, et al. Polypill with or without Aspirin in Persons without Cardiovascular Disease. N Engl J Med ; Egan BM, Bandyopadhyay D, Shaftman SR, et al. Initial monotherapy and combination therapy and hypertension control the first year.
Mourad JJ, Waeber B, Zannad F, et al. MacDonald TM, Williams B, Webb DJ, et al. Combination Therapy Is Superior to Sequential Monotherapy for the Initial Treatment of Hypertension: A Double-Blind Randomized Controlled Trial.
J Am Heart Assoc ; 6. Garjón J, Saiz LC, Azparren A, et al. First-line combination therapy versus first-line monotherapy for primary hypertension. Cochrane Database Syst Rev ; 2:CD Gradman AH, Basile JN, Carter BL, et al. Combination therapy in hypertension. J Am Soc Hypertens ; Epstein M, Bakris G.
Newer approaches to antihypertensive therapy. Use of fixed-dose combination therapy. Arch Intern Med ; J Clin Hypertens Greenwich ; Leggio M, Fusco A, Loreti C, et al.
Importance Alternative energy systems, defined as persistent systolic blood pressure Hydration for sports involving extreme temperatures at least mm Hypertensipn or diastolic BP DBP at least 80 mm Hg, Hypertension treatment approximately million adults Hhpertension the US and Muscle recovery tips than Hypergension billion treamtent worldwide. Hypertension Hypertendion associated Plant-based depression treatment increased treatent Hydration for sports involving extreme temperatures cardiovascular disease CVD Hypertdnsion coronary heart disease, treament failure, and tratment and death. Observations First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern that includes low sodium and high potassium intake, physical activity, and moderation or elimination of alcohol consumption. The BP-lowering effects of individual lifestyle components are partially additive and enhance the efficacy of pharmacologic therapy. The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk. Randomized clinical trials have established the efficacy of BP lowering to reduce the risk of CVD morbidity and mortality. Conclusions and Relevance Hypertension affects approximately million adults in the US and more than 1 billion adults worldwide and is a leading cause of CVD morbidity and mortality. You treatmet be more Plant-based depression treatment to have high blood pressure due teeatment your genetics, age, and whether you have certain health conditions. Treatment may include medication. Hydration for sports involving extreme temperatures blood Hyperteension Hydration for sports involving extreme temperatures takes into account how Lowering cholesterol with mindful eating blood is Hypertensjon through your blood vessels and the amount of resistance the blood meets while the heart is pumping. High blood pressure, or hypertension, occurs when the force of blood pushing through your vessels is consistently too high. Narrow blood vessels, also known as arteries, create more resistance for blood flow. The narrower your arteries are, the more resistance there is, and the higher your blood pressure will be. Over the long term, the increased pressure can cause health issues, including heart disease.Mayo Clinic Avocado Bruschetta Ideas appointments in Arizona, Hydration for sports involving extreme temperatures and Minnesota and at Hypertenskon Clinic Health System Hyeprtension.
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It's important Hypertenwion keep exercising Hypeftension keep blood pressure from rising again. As a general goal, aim for at Hypertensioj 30 minutes of moderate physical activity every treatmenr. Exercise Hypertesion also help keep elevated blood pressure from Hypertensiion into high blood pressure hypertension.
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Strength training Hypertensin can help reduce blood Hyperrension. Aim to include strength training exercises at least two days a week.
Talk to treatmebt health care provider about developing an exercise program. Eating a diet Hypertensjon in whole grains, fruits, vegetables and low-fat dairy products and low in saturated trreatment and Hyperrtension can lower high blood pressure by up to 11 mm Treatmen.
Examples of eating plans that can help control trreatment pressure are the Dietary Approaches Hypertensiion Stop Hypertension DASH hreatment and the Mediterranean diet. Hypertensikn in the treayment can lessen the effects of treatmenr sodium on blood pressure.
Hypertensiln best sources Hypertenxion potassium are foods, such Hydration for sports involving extreme temperatures fruits tretament vegetables, rather than supplements.
Aim for 3, to 5, mg a day, which might lower blood pressure 4 to 5 mm Hg. Ask your care provider how much potassium you should have.
Even a small reduction of sodium in the diet can improve heart health and reduce high blood pressure by about 5 to 6 mm Hg.
The effect of sodium intake on blood pressure varies among groups of people. In general, limit sodium to 2, milligrams mg a day or less. However, a lower sodium intake — 1, mg a day or less — is ideal for most adults. Limiting alcohol to less than one drink a day for women or two drinks a day for men can help lower blood pressure by about 4 mm Hg.
One drink equals 12 ounces of beer, 5 ounces of wine or 1. But drinking too much alcohol can raise blood pressure by several points.
It can also reduce the effectiveness of blood pressure medications. Smoking increases blood pressure. Stopping smoking helps lower blood pressure. It can also reduce the risk of heart disease and improve overall health, possibly leading to a longer life.
Poor sleep quality — getting fewer than six hours of sleep every night for several weeks — can contribute to hypertension. A number of issues can disrupt sleep, including sleep apnea, restless leg syndrome and general sleeplessness insomnia. Let your health care provider know if you often have trouble sleeping.
Finding and treating the cause can help improve sleep. However, if you don't have sleep apnea or restless leg syndrome, follow these simple tips for getting more restful sleep. Long-term chronic emotional stress may contribute to high blood pressure. More research is needed on the effects of stress reduction techniques to find out whether they can reduce blood pressure.
However, it can't hurt to determine what causes stress, such as work, family, finances or illness, and find ways to reduce stress. Try the following:. Home monitoring can help you keep tabs on your blood pressure. It can make certain your medications and lifestyle changes are working.
Home blood pressure monitors are available widely and without a prescription. Talk to a health care provider about home monitoring before you get started. Regular visits with a provider are also key to controlling blood pressure.
If your blood pressure is well controlled, ask your provider how often you need to check it. You might be able to check it only once a day or less often. Supportive family and friends are important to good health. They may encourage you to take care of yourself, drive you to the care provider's office or start an exercise program with you to keep your blood pressure low.
If you find you need support beyond your family and friends, consider joining a support group. This may put you in touch with people who can give you an emotional or morale boost and who can offer practical tips to cope with your condition.
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Show references Feehally J, et al. Nonpharmacologic prevention and treatment of hypertension. In: Comprehensive Clinical Nephrology. Elsevier; Accessed April 20, Hypertension adult. Mayo Clinic; Hall ME, et al.
Weight-loss strategies for prevention and treatment of hypertension: A scientific statement from the American Heart Association. Shimbo D, et al. Self-measured blood pressure monitoring at home: A joint policy statement from the American Heart Association and the American Medical Association.
Department of Health and Human Services and U. Department of Agriculture. Accessed April 23, Libby P, et al. Systemic hypertension: Mechanisms, diagnosis, and treatment.
: Hypertension treatment| High Blood Pressure (Hypertension): Symptoms and More | When you have high blood pressure, also known as hypertension, your reading is consistently in a higher range. High blood pressure treatment typically involves a combination of medication and lifestyle changes to help you manage the condition and prevent or delay related health problems. The goal is to get your blood pressure below the high range. When the systolic blood pressure — the top number — is between and , and the diastolic blood pressure — the bottom number — is less than 80, this is considered elevated blood pressure. But without attention, it will often progress to high blood pressure — which definitely does raise your risk. Hypertension or high blood pressure is present once the systolic pressure is or higher, or the diastolic pressure is 80 or higher. A healthy lifestyle is the first line of defense against high blood pressure. Habits that help control blood pressure include:. Some people find that lifestyle changes alone are enough to control their high blood pressure. But many also take medication to treat their condition. There are many different types of blood pressure medications with different modes of action. For some people, a combination of two or more drugs may be needed to keep their blood pressure under control. Hypertension medications can be divided into the categories listed below, based on how they work. Diuretics , sometimes called water pills, help the kidneys get rid of excess water and salt sodium. This reduces the volume of blood that needs to pass through the blood vessels. As a result, blood pressure goes down. Diuretics in the thiazide group generally have fewer side effects than the others, particularly when taken at the low doses commonly used in treating early high blood pressure. Beta-blockers help the heart to beat with less speed and force. The heart pumps less blood through the blood vessels with each beat, so blood pressure decreases. There are many drugs within this classification, including:. Alpha-beta-blockers have a combined effect. They can decrease the constriction of blood vessels like alpha-1 blockers, and slow down the rate and force of the heartbeat like beta-blockers. Carvedilol Coreg and labetalol hydrochloride Normodyne are common alpha-beta-blockers. ACE inhibitors help the body produce less of a hormone called angiotensin II, which causes blood vessels to narrow. These medications decrease blood pressure by helping blood vessels expand and let more blood through. ARBs block the action of angiotensin II directly on the blood vessels. It attaches at the receptor site on the blood vessels and keeps them from narrowing. This causes blood pressure to fall. Movement of calcium into and out of muscle cells is necessary for all muscle contractions. Calcium channel blockers limit calcium from entering the smooth muscle cells of the heart and blood vessels. This makes the heart beat less forcefully with each beat and helps blood vessels relax. As a result, blood pressure decreases. Your body produces types of hormones called catecholamines when under stress, or chronically in some disease states. Catecholamines, such as norepinephrine and epinephrine, cause the heart to beat faster and with more force. They also constrict blood vessels. These effects raise blood pressure when the hormones attach to a receptor. The muscles around some blood vessels have what are known as alpha-1 or alpha adrenergic receptors. This is because beta blockers are considered less effective than other blood pressure medicines. Common examples are atenolol and bisoprolol. Possible side effects include dizziness, headaches, tiredness, and cold hands and feet. While there are definite benefits from taking medicines to reduce blood pressure if you're under the age of 80, it's less clear it's useful if you're over It's now thought that if you reach 80 while you're taking medicine for high blood pressure, it's fine to continue treatment provided it's still helping you and is not causing side effects. If you're diagnosed with high blood pressure and you're aged over 80, your doctor will also consider your other health risk factors when deciding whether to give you treatment for the high blood pressure. Page last reviewed: 11 July Next review due: 11 July Home Health A to Z High blood pressure hypertension Back to High blood pressure hypertension. Treatment - High blood pressure hypertension Contents Overview Causes Diagnosis Treatment Prevention. When treatment is recommended Everyone with high blood pressure is advised to make healthy lifestyle changes. Try to: cut your salt intake to less than 6g 0. Get more advice about lifestyle changes to prevent and reduce high blood pressure Medicines for high blood pressure Several types of medicine can be used to help control high blood pressure. Many people need to take a combination of different medicines. if you're under 55 years of age, or you're any age and have type 2 diabetes — you'll usually be offered an ACE inhibitor or an angiotensin-2 receptor blocker ARB if you're aged 55 or older, or you're any age and of African or Caribbean origin, and you do not have type 2 diabetes — you'll usually be offered a calcium channel blocker You may need to take blood pressure medicine for the rest of your life. ACE inhibitors Angiotensin-converting enzyme ACE inhibitors reduce blood pressure by relaxing your blood vessels. Angiotensin-2 receptor blockers ARBs ARBs work in a similar way to ACE inhibitors. Calcium channel blockers Calcium channel blockers reduce blood pressure by widening your blood vessels. Possible side effects include headaches, swollen ankles and constipation. Diuretics Sometimes known as water pills, diuretics work by flushing excess water and salt from the body through your pee. Beta blockers Beta blockers can reduce blood pressure by making your heart beat more slowly and with less force. National Vital Statistics Reports , 68 9. Hyattsville, MD: National Center for Health Statistics; Last Reviewed: August 29, Source: National Center for Chronic Disease Prevention and Health Promotion , Division for Heart Disease and Stroke Prevention. Facebook Twitter LinkedIn Syndicate. home High Blood Pressure Home. Links with this icon indicate that you are leaving the CDC website. The Centers for Disease Control and Prevention CDC cannot attest to the accuracy of a non-federal website. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. 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| High blood pressure (hypertension) | Drinking grapefruit juice while taking some calcium channel blockers can increase your risk of side effects. Fixed and Low-Dose Combinations of Blood Pressure-Lowering Agents: For the Many or the Few? Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK TIME study : a prospective, randomised, open-label, blinded-endpoint clinical trial. Eur Heart J Cardiovasc Pharmacother ; See "Out-of-office blood pressure measurement: Ambulatory and self-measured blood pressure monitoring". Regular blood pressure readings can help you and your doctor notice any changes. |
| Changes You Can Make to Manage High Blood Pressure | American Heart Association | Persistent high blood pressure can increase your risk of a number of serious and potentially life-threatening health conditions, such as:. If you have high blood pressure, reducing it even a small amount can help lower your risk of these health conditions. The only way of knowing whether you have high blood pressure is to have a blood pressure test. All adults over 40 years old are advised to have their blood pressure checked at least every 5 years. Some people from African, Afro-Caribbean or South Asian heritage may have high blood pressure at a younger age and are encouraged to get their blood pressure checked earlier. You can also check your blood pressure yourself with a home blood pressure monitor. Find out more about getting a blood pressure test. If you're aged 40 and over, and are eligible, you may be able to get a free blood pressure check at a local pharmacy. Find a pharmacy that offers free blood pressure checks. It's not always clear what causes high blood pressure, but there are things that can increase your risk. Making healthy lifestyle changes can sometimes help reduce your chances of getting high blood pressure and help lower your blood pressure if it's already high. High blood pressure is also sometimes caused by an underlying health condition or taking a certain medicine. This patient decision aid from the National Institute for Health and Care Excellence NICE PDF, kb can also help you to understand your treatment options. Some people with high blood pressure may also need to take 1 or more medicines to stop their blood pressure getting too high. If you're diagnosed with high blood pressure, your doctor may recommend taking 1 or more medicines to keep it under control. The medicine recommended for you will depend on things like how high your blood pressure is, your age and your ethnicity. Changes You Can Make to Manage High Blood Pressure. Baja Tu Presión. Find HBP Tools and Resources. Blood Pressure Toolkit. Help us better understand heart health by choosing to share your Apple Watch data. The Study is a meaningful opportunity to contribute to health research. In this free all-in-one learning tool , you can learn the risks of high blood pressure and how self-monitoring can help get it under control. Explore on your own time and download free information along the way. Home Health Topics High Blood Pressure Changes You Can Make to Manage High Blood Pressure. Know your numbers. By adopting a heart-healthy lifestyle, you can: Reduce high blood pressure. Prevent or delay the development of high blood pressure. Enhance the effectiveness of blood pressure medications. Lower your risk of heart attack , stroke , heart failure , kidney damage , vision loss and sexual dysfunction. HBP Resources Questions to Ask Your Doctor Interactive Questions to Ask Your Doctor PDF Animation Library Track Your Blood Pressure PDF How to Measure Your Blood Pressure PDF Find High Blood Pressure Tools and Resources. Last Reviewed: Jun 1, Get the Research App. |
| High Blood Pressure - Treatment | NHLBI, NIH | Español Other Languages. High Blood Pressure. Minus Related Pages. Learn About High Blood Pressure. Know Your Risk for High Blood Pressure. Prevent and Manage High Blood Pressure. Featured Resources. The Surgeon General's Call to Action to Control Hypertension. Hypertension Control Change Package Second Edition. Sodium Put Your Sodium Smarts to the Test. Reference Kochanek KD, Murphy SL, Xu J, Arias E. Deaths: Final Data for [PDF — 1. The Facts About HBP. Understanding Blood Pressure Readings. Why HBP is a "Silent Killer". Health Threats from HBP. Changes You Can Make to Manage High Blood Pressure. Baja Tu Presión. Find HBP Tools and Resources. Blood Pressure Toolkit. Help us better understand heart health by choosing to share your Apple Watch data. The Study is a meaningful opportunity to contribute to health research. In this free all-in-one learning tool , you can learn the risks of high blood pressure and how self-monitoring can help get it under control. This makes the heart beat less forcefully with each beat and helps blood vessels relax. As a result, blood pressure decreases. Your body produces types of hormones called catecholamines when under stress, or chronically in some disease states. Catecholamines, such as norepinephrine and epinephrine, cause the heart to beat faster and with more force. They also constrict blood vessels. These effects raise blood pressure when the hormones attach to a receptor. The muscles around some blood vessels have what are known as alpha-1 or alpha adrenergic receptors. When a catecholamine binds to an alpha-1 receptor, the muscle contracts, the blood vessel narrows, and blood pressure rises. Alpha-1 blockers bind to alpha-1 receptors, blocking catecholamines from attaching. This keeps them from narrowing blood vessels so blood is able to flow through the blood vessels more freely, and blood pressure falls. Alpha-1 blockers are primarily used to treat benign prostatic hyperplasia BPH in men, but are also used to treat high blood pressure. Alpha-2 receptors are different from alpha-1 receptors. When an alpha-2 receptor is activated, the production of norepinephrine is blocked. This decreases the amount of norepinephrine produced. Less norepinephrine means less constriction of blood vessels and a lower blood pressure. Methyldopa Aldomet is an example of this type of drug. Vasodilators relax the muscles in the walls of blood vessels, especially small arteries arterioles. This widens the blood vessels and allows blood to flow through them more easily. Blood pressure falls as a result. Hydralazine hydrochloride Apresoline and minoxidil Loniten are examples of these. Treatment for high blood pressure includes ongoing care, as well as individual treatments tailored for specific situations and younger age groups, including children and teens. Regular checkups allow your doctor to monitor how well your treatment is going and make any necessary adjustments to your treatment plan. If your blood pressure starts inching back up, your doctor can respond promptly. Additional treatment options may be needed in certain situations like resistant hypertension or secondary hypertension. Resistant hypertension refers to blood pressure that remains high after trying at least three different types of blood pressure medication. Someone whose high blood pressure is controlled by taking four different kinds of medication is considered to have resistant hypertension. Even such hard-to-treat cases can often be managed successfully in time. Your doctor might prescribe a different medication, dose, drug combination, or more aggressive lifestyle changes. Getting a referral to a heart or kidney specialist may also be useful in treating resistant hypertension. Blood pressure often drops substantially or even goes back to normal once doctors diagnose and treat the root cause. The first line of treatment for children and teens with high blood pressure is a healthy lifestyle. This includes:. Children may take the same blood pressure medications as adults when necessary. For children with secondary hypertension, blood pressure often returns to normal once the underlying condition is treated. High blood pressure treatment usually involves a combination of lifestyle changes and medication. Sometimes, lifestyle changes are enough to return your blood pressure to normal levels. These changes may include diet, exercise, and weight loss. |
| Prescription blood pressure drugs come in many classes. | Changes You Can Make to Manage High Blood Pressure. Baja Tu Presión. Find HBP Tools and Resources. Blood Pressure Toolkit. Help us better understand heart health by choosing to share your Apple Watch data. The Study is a meaningful opportunity to contribute to health research. In this free all-in-one learning tool , you can learn the risks of high blood pressure and how self-monitoring can help get it under control. Explore on your own time and download free information along the way. Home Health Topics High Blood Pressure Changes You Can Make to Manage High Blood Pressure. Know your numbers. By adopting a heart-healthy lifestyle, you can: Reduce high blood pressure. High blood pressure rarely has symptoms, but it's a risk factor for heart disease. Let your care provider know if you have symptoms such as chest pains or shortness of breath. Doing so can help your provider decide how aggressively to treat your high blood pressure. Write down important medical information, including a family history of high blood pressure, high cholesterol, heart disease, stroke, kidney disease or diabetes, and any major stresses or recent life changes. Make a list of all medicines, vitamins or supplements that you're taking. Include dosages. Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot. Be prepared to discuss your diet and exercise habits. If you don't already follow a diet or exercise routine, be ready to talk to your care provider about any challenges you might face in getting started. Write down questions to ask your provider. For high blood pressure, some basic questions to ask your provider include: What kinds of tests will I need? What is my blood pressure goal? Do I need any medicines? Is there a generic alternative to the medicine you're prescribing for me? What foods should I eat or avoid? What's an appropriate level of physical activity? How often do I need to schedule appointments to check my blood pressure? Should I monitor my blood pressure at home? I have other health conditions. How can I best manage them together? Are there brochures or other printed material that I can have? What websites do you recommend? Don't hesitate to ask any other questions that you might have. What to expect from your doctor Your health care provider is likely to ask you questions. Your provider may ask: Do you have a family history of high cholesterol, high blood pressure or heart disease? What are your diet and exercise habits like? Do you drink alcohol? How many drinks do you have in a week? Do you smoke? When did you last have your blood pressure checked? What was the result? What you can do in the meantime It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and getting more exercise. By Mayo Clinic Staff. Sep 15, Show References. High blood pressure. National Heart, Lung, and Blood Institute. Accessed July 18, Flynn JT, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Physical Activity Guidelines for Americans. Department of Health and Human Services. Accessed June 15, Hypertension in adults: Screening. Preventive Services Task Force. Thomas G, et al. Blood pressure measurement in the diagnosis and treatment of hypertension in adults. Muntner P, et al. Measurement of blood pressure in humans: A scientific statement from the American Heart Association. Basile J, et al. Overview of hypertension in adults. Accessed July 22, Know your risk factors for high blood pressure. American Heart Association. Rethinking drinking. Alcohol and your health. National Institute on Alcohol Abuse and Alcoholism. Libby P, et al. Systemic hypertension: Mechanisms, diagnosis, and treatment. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Elsevier; Hypertension adult. Mayo Clinic; About metabolic syndrome. Understanding blood pressure readings. Whelton PK, et al. Monitoring your blood pressure at home. Mann JF. Choice of drug therapy in primary essential hypertension. Agasthi P, et al. Renal denervation for resistant hypertension in the contemporary era: A systematic review and meta-analysis. Scientific Reports. Chernova I, et al. Resistant hypertension updated guidelines. Current Cardiology Reports. Forman JP, et al. Diet in the treatment and prevention of hypertension. Goldman L, et al. Cognitive impairment and dementia. In: Goldman-Cecil Medicine. Managing stress to control high blood pressure. Brenner J, et al. Mindfulness with paced breathing reduces blood pressure. Medical Hypothesis. Grundy SM, et al. Natural medicines in the clinical management of hypertension. Natural Medicines. Accessed Dec. Saper RB, et al. Overview of herbal medicine and dietary supplements. Lopez-Jimenez F expert opinion. Mayo Clinic. Department of Health and Human Services and U. Department of Agriculture. Börjesson M, et al. Physical activity and exercise lower blood pressure in individuals with hypertension: Narrative review of 27 RCTs. British Journal of Sports Medicine. Lloyd-Jones DM, et al. Life's essential 8: Updating and enhancing the American Heart Association's construct of cardiovascular health: A presidential advisory from the American Heart Association. American Heart Association adds sleep to cardiovascular health checklist. Accessed July 15, News from Mayo Clinic. Mayo Clinic Q and A: Caffeine's effects on blood sugar and blood pressure. Mayo Clinic Minute: Is salt sneaking into your diet? Mayo Clinic Q and A: What time is best for blood pressure medication? Mayo Clinic Minute: Are you using a salt substitute? Alcohol: Does it affect blood pressure? Show more related content. Anxiety: A cause of high blood pressure? Blood pressure cuff: Does size matter? Blood pressure readings: Why higher at home? Blood pressure: Can it be higher in one arm? Blood pressure: Does it have a daily pattern? Blood pressure: Is it affected by cold weather? Caffeine and hypertension. Can having vitamin D deficiency cause high blood pressure? Free blood pressure machines: Are they accurate? High blood pressure and sex. High blood pressure dangers. Home blood pressure monitoring. Hypertensive crisis: What are the symptoms? Isolated systolic hypertension: A health concern? Medications and supplements that can raise your blood pressure. Menopause and high blood pressure: What's the connection? Pulse pressure: An indicator of heart health? Sleep deprivation: A cause of high blood pressure? What is hypertension? A Mayo Clinic expert explains. White coat hypertension. 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Get the Mayo Clinic app. By making these 10 lifestyle changes, you can lower your blood pressure and reduce your risk of heart disease. If you have high blood pressure, you may wonder if medication is necessary to bring the numbers down. But lifestyle plays a vital role in treating high blood pressure. Controlling blood pressure with a healthy lifestyle might prevent, delay or reduce the need for medication. Blood pressure often increases as weight increases. Being overweight also can cause disrupted breathing while you sleep sleep apnea , which further raises blood pressure. Weight loss is one of the most effective lifestyle changes for controlling blood pressure. If you're overweight or have obesity, losing even a small amount of weight can help reduce blood pressure. In general, blood pressure might go down by about 1 millimeter of mercury mm Hg with each kilogram about 2. Also, the size of the waistline is important. Carrying too much weight around the waist can increase the risk of high blood pressure. These numbers vary among ethnic groups. Ask your health care provider about a healthy waist measurement for you. Regular physical activity can lower high blood pressure by about 5 to 8 mm Hg. It's important to keep exercising to keep blood pressure from rising again. As a general goal, aim for at least 30 minutes of moderate physical activity every day. Exercise can also help keep elevated blood pressure from turning into high blood pressure hypertension. For those who have hypertension, regular physical activity can bring blood pressure down to safer levels. Some examples of aerobic exercise that can help lower blood pressure include walking, jogging, cycling, swimming or dancing. Another possibility is high-intensity interval training. This type of training involves alternating short bursts of intense activity with periods of lighter activity. Strength training also can help reduce blood pressure. Aim to include strength training exercises at least two days a week. Talk to a health care provider about developing an exercise program. Eating a diet rich in whole grains, fruits, vegetables and low-fat dairy products and low in saturated fat and cholesterol can lower high blood pressure by up to 11 mm Hg. Examples of eating plans that can help control blood pressure are the Dietary Approaches to Stop Hypertension DASH diet and the Mediterranean diet. Potassium in the diet can lessen the effects of salt sodium on blood pressure. The best sources of potassium are foods, such as fruits and vegetables, rather than supplements. Aim for 3, to 5, mg a day, which might lower blood pressure 4 to 5 mm Hg. Ask your care provider how much potassium you should have. Even a small reduction of sodium in the diet can improve heart health and reduce high blood pressure by about 5 to 6 mm Hg. The effect of sodium intake on blood pressure varies among groups of people. In general, limit sodium to 2, milligrams mg a day or less. However, a lower sodium intake — 1, mg a day or less — is ideal for most adults. Limiting alcohol to less than one drink a day for women or two drinks a day for men can help lower blood pressure by about 4 mm Hg. One drink equals 12 ounces of beer, 5 ounces of wine or 1. But drinking too much alcohol can raise blood pressure by several points. It can also reduce the effectiveness of blood pressure medications. Smoking increases blood pressure. Stopping smoking helps lower blood pressure. It can also reduce the risk of heart disease and improve overall health, possibly leading to a longer life. Poor sleep quality — getting fewer than six hours of sleep every night for several weeks — can contribute to hypertension. A number of issues can disrupt sleep, including sleep apnea, restless leg syndrome and general sleeplessness insomnia. Let your health care provider know if you often have trouble sleeping. Finding and treating the cause can help improve sleep. However, if you don't have sleep apnea or restless leg syndrome, follow these simple tips for getting more restful sleep. Long-term chronic emotional stress may contribute to high blood pressure. More research is needed on the effects of stress reduction techniques to find out whether they can reduce blood pressure. However, it can't hurt to determine what causes stress, such as work, family, finances or illness, and find ways to reduce stress. Try the following:. Home monitoring can help you keep tabs on your blood pressure. It can make certain your medications and lifestyle changes are working. Home blood pressure monitors are available widely and without a prescription. Talk to a health care provider about home monitoring before you get started. Regular visits with a provider are also key to controlling blood pressure. If your blood pressure is well controlled, ask your provider how often you need to check it. You might be able to check it only once a day or less often. Supportive family and friends are important to good health. They may encourage you to take care of yourself, drive you to the care provider's office or start an exercise program with you to keep your blood pressure low. If you find you need support beyond your family and friends, consider joining a support group. This may put you in touch with people who can give you an emotional or morale boost and who can offer practical tips to cope with your condition. There is a problem with information submitted for this request. Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview. |
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