Treatment of Hypertensions

High blood pressure or hypertension is a chronic illness that can lead to severe complications.

It is defined as persistently elevated blood pressure of 140mmHg (Systolic) or greater and/or diastolic BP of 90 mmHg or greater.

However, systolic blood pressure ranging 120 – 139 or diastolic 80 – 89 (120–139 / 80–89) is considered to be pre-hypertensive and treatment of hypertension for this specific type is only lifestyle modification (non-pharmacological treatment) to keep blood pressure under control. These include healthy living and dieting. Examples are to reduce salt intake, do regular physical activity, limit alcohol intake to < 2 drinks per day, increase dietary potassium and lose weight.

Stages of hypertension :

Stage 1 (Mild)	140-159 and/or 90-99
Stage 2 (Moderate)	160-179 and/or 100-109
Stage 3 (Severe)	≥180 and/or ≥110
Isolated Systolic Hypertension	≥140 and <90

According to CPG Malaysia, about 37% of the Malaysian population has high blood pressure. Generally, high blood pressure does not have a specific cause but factors such as the family history of high blood pressure, obesity, stress, and diabetes have been linked to the cause of the disease. People with high blood pressure usually do not have any specific symptoms.

High blood pressure causes organs such as the heart, brain, and kidneys to be exposed to chronic high pressure. Exposure to these high blood pressure results in the narrowing of the blood vessels in the brain and heart resulting in stroke (stroke) and heart attack. Kidney failure can also occur if high blood pressure is not controlled.

There are few drugs available for hypertension, however, the choice of drug should be individualized and the effectiveness of these drugs varies individually. Before starting the drug treatment, the patient should also be risk-stratified.

Drugs that can be used to treat hypertension effectively are :

Angiotensin-Converting enzyme Inhibitor (ACEI)

It acts by lowering cardiovascular risk, reducing mortality and morbidity in hypertensive patients and those at high cardiovascular risk. It also effectively preventing coronary artery disease in patients with hypertension.

Angiotensin Receptor Blocker (ARB)

It helps relaxing blood vessels by blocking the action of a natural chemical that narrows blood vessels. It is also effective in preventing the progression of diabetic nephropathy and may reduce the incidence of cardiac events in patients with heart failure.

Calcium Channel Blocker (CCB)

This drug that may work better for elderly people acts by relaxing the muscles surrounding blood vessels

Diuretics

It acts on your kidneys to eliminate sodium and water, reducing blood volume.

Sometime, doctors may prescribe these drugs in addition to the above-mentioned drugs to reach your blood pressure goal.

Alpha-blockers

These medications lower blood pressure by reducing peripheral resistance.

Alpha- beta-blockers

It slows down the heartbeat for the effectiveness of pumping of blood in the heart

What Happen To Our Organs If Complications Occur?

Complications of hypertension can occur in the short term or even later. It depends on how well the blood pressure is controlled by the patient. If hypertensive patients have other health problems such as diabetes or heart disease, this condition will further worsen the complications.

Damage to blood vessels

High blood pressure causes damage to the blood vessel wall. This activates the damaging process, which eventually leads to thicker and harder blood vessels (Arteriosclerosis).

Aneurysm – continuous and uncontrolled high blood pressure causes the damaged blood vessels to weaken and forms new thin and unstable wall layers. This wall of blood vessels is called aneurysm and it is easily ruptured

Heart problems

Narrow blood vessels due to high blood pressure decrease the blood supply to the heart. Existing narrow blood vessels will cause complete closure in the event of blood clots or accumulated excess fat. Patients will have a sudden heart attack and if delayed; treatment can lead to death.