Having High Blood Pressure? When to Initiate Drug Therapy?

If you are diagnosed with hypertension, you may be wondering whether to start drug therapy of not. Many of your friends and relatives will bombard you with their valuable (?) suggestions, which will make you more confused. Your doctor might initially advise non-pharmacological measures for management of hypertension. The usefulness of the non-pharmacological measures for management of hypertension is limited and modest. And it is not easier for many patients to continue with dietary changes and lifestyle management that are advised as non-pharmacological measures for management of hypertension. Furthermore, if your initial blood pressure was quite high, most likely the non-pharmacological measures alone will not be enough for reducing blood pressure to target level. Under these circumstances, pharmacological (drug) therapy must be initiated.ID-100286439

What next?

When an individual is diagnosed with hypertension, the person should be regarded as high risk individual for atherosclerotic cardiovascular diseases, which are major contributor of death all over the world, resulting from renal, cerebrovascular, cardiac and peripheral vascular diseases, due to hypertension.

Currently hypertension is defined as systolic and diastolic blood pressure of 140/90 mm Hg or more and systolic of 120-139 mm Hg and diastolic BP of 80-89 mm Hg as pre- hypertension. Ideally all the patients with hypertension, the treatment target of blood pressure should be systolic below 120 mm Hg and diastolic >80 mm Hg. Because the higher is the BP, the greater is the risk of complications related to hypertension. However it may not be practicable and possible to bring down blood pressure to ideal level.

The BP target for various groups of patients with hypertension

  • If there is no complications involved with hypertension, the target should be <140 systolic and <90 diastolic BP
  • In case of hypertension with diabetes the target should be <130 systolic and <80 diastolic BP
  • If there is risk of congestive heart failure the target should be <120 systolic and <80 diastolic BP or ideally <110 and <75
  • If there is risk of renal disease, the target should be <130 systolic and <80 diastolic BP
  • If there is risk of coronary heart disease the target should be <120 systolic and <80 diastolic BP

If the above targets cannot be reached, the lowest possible BP should be tried.

What about individuals with pre- hypertension?

Individuals with pre- hypertension should be encouraged to adopt non-pharmacological measures to reduce blood pressure and reduce risks associated with hypertension and pre- hypertension. Because latest clinical trials and studies on hypertension are clearly indicating that the risk of mortality and morbidity increases when the systolic BP is 120 mm Hg or more. Hence, individuals with pre- hypertension need to be careful and take precautionary measures. These patients also need to track their BP at regular interval, to be able to know when hypertension occurs. Many experts suggest, treating individuals with pre- hypertension, with anti- hypertension medications, if non-pharmacological measures, that is lifestyle modification and healthy dietary changes fail to correct blood pressure.

Image courtesy of [David Castillo Dominici] at FreeDigitalPhotos.net

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