Effective Strategies For Lowering Blood Pressure In Hospitals

Hypertension, or high blood pressure, is a common health problem that can lead to serious complications, including heart disease, heart attack, and stroke. While inpatient hypertension control is considered important by physicians, there is limited guidance on treating acute elevations of blood pressure in hospitalised patients. This may be due to the unreliable nature of inpatient blood pressure measurements, which can be influenced by factors such as uncontrolled pain, noise, anxiety, and sleep disruption. Physicians often initiate or adjust medications to achieve blood pressure control in hospitalised patients, but recent studies suggest that pharmacological treatment of acute, asymptomatic, in-hospital elevations may offer no benefit. However, in the case of a hypertensive crisis, where blood pressure surges to dangerous levels, emergency treatment in the form of medication is necessary to bring it down to a safe level.

Medication

In the case of a hypertensive crisis, which is when blood pressure surges to 180/120 mm Hg or higher, treatment happens in the emergency room. Providers will administer medicine to bring blood pressure down to a safe level, and the patient may be discharged the same day with medications to take at home if there are no signs of organ damage. However, if the patient is experiencing a hypertensive emergency, they will need to be admitted to the intensive care unit (ICU) for several days. During this time, providers will administer medicine directly into the patient's veins through an IV while continuously monitoring their blood pressure.

The speed at which healthcare providers bring down a patient's blood pressure depends on their other medical conditions. In some cases, lowering blood pressure too quickly can deprive organs and tissues of sufficient blood supply. Therefore, providers may opt to lower blood pressure gradually over 24 to 48 hours. However, they will act more quickly if the patient has certain conditions, such as aortic dissection, severe preeclampsia, or eclampsia.

It is worth noting that a study in a UK hospital questioned the reliability of inpatient blood pressure measurements. The study found that factors such as incorrect cuff size, staff and patient conversation during measurement, uncontrolled pain, noise, anxiety, and disrupted sleep patterns could contribute to high blood pressure readings in a hospital setting. As a result, the study casts doubt on the use of these measurements as a sole justification for starting or increasing antihypertensive treatment for inpatients who are asymptomatic.

Lifestyle changes

While there is limited information on how hospitals bring down blood pressure, physicians do treat hypertension in ambulatory care settings, and there are some instances where hypertension is treated in the hospital. For example, in the case of a hypertensive crisis, treatment happens in the emergency room. Providers will administer medicine to bring blood pressure down to a safe level. If there are no signs of organ damage, the patient may be discharged the same day with medication. However, if there is organ damage, the patient will be admitted to the intensive care unit (ICU) for several days, where they will be closely monitored.

In terms of general lifestyle changes, here are some ways to bring down blood pressure:

Diet

Adopting a healthy diet is crucial for managing blood pressure. This includes consuming a balanced variety of nutritious foods and limiting the intake of unhealthy fats, processed foods, and excessive salt, all of which can contribute to high blood pressure. Maintaining a healthy weight is also important, as excess weight can strain the heart and blood vessels, leading to increased blood pressure.

Exercise

Regular physical activity is essential for maintaining cardiovascular health and managing blood pressure. Aim for at least 30 minutes of moderate-intensity exercise, such as brisk walking, swimming, or cycling, on most days of the week. If you have not been physically active, it is important to start slowly and gradually increase the duration and intensity of your workouts over time. Consult with your healthcare provider to determine the appropriate type and amount of exercise for your specific needs and conditions.

Stress Management

Chronic stress can significantly contribute to high blood pressure. Finding healthy ways to manage stress is crucial for maintaining overall health and well-being. This may include practices such as meditation, deep breathing exercises, yoga, or engaging in relaxing hobbies. Additionally, learning to say "no" to extra tasks and setting realistic expectations for yourself can help reduce stress levels.

Limit Alcohol and Quit Smoking

Excessive alcohol consumption can raise blood pressure, so it is important to drink in moderation or not at all. Smoking is another major risk factor for high blood pressure and heart disease. Quitting smoking can have immediate and long-term benefits for your blood pressure and overall health.

Medication Adherence

If you are taking medication to manage your blood pressure, it is crucial to take it as directed by your healthcare provider. Be sure to attend regular health check-ups and discuss any challenges or side effects you may be experiencing. Additionally, keep your provider informed about any other medications, vitamins, or supplements you are taking, as some substances can interact with blood pressure medications.

It is important to note that lifestyle changes can be challenging to implement and maintain. Consider seeking support from friends and family or joining a support group to help you stay on track with your health goals.

Exercise

Isometric exercises, such as bridges, planks, squats, and wall sits, have been found to be particularly effective in lowering blood pressure. These exercises involve holding a static position without movement, engaging particular muscles, and are considered low-intensity. However, it is important to note that isometric exercises can cause a significant temporary increase in blood pressure, so those with uncontrolled high blood pressure or cardiovascular conditions should proceed with caution and consult their doctor before starting this form of exercise.

To get the most benefit from exercise for blood pressure management, it is important to be consistent and frequent. Regular exercise prompts the body to form new capillaries, creating extra "release valves" for the heart and reducing pressure on the existing blood vessels. Breaking up workouts into several shorter sessions throughout the day may be more effective in preventing blood pressure spikes than a single long workout. For example, one study found that three 10-minute walks per day were more beneficial than one 30-minute walk.

In addition to the type and frequency of exercise, proper warm-up and cool-down routines are crucial. Warming up helps the heart transition gradually from rest to activity, reducing the risk of injury and soreness. A proper cool-down is equally important, as stopping exercise too quickly can cause a sharp drop in blood pressure, leading to muscle cramping. Adding some relaxing yoga poses to the cool-down routine can increase flexibility and promote relaxation. Regular, deep breathing during exercise can also help lower blood pressure and reduce stress.

Finally, it is important to note that exercise should be complemented by other lifestyle changes, such as a healthy diet and weight management, to effectively lower blood pressure. Finding the motivation to exercise can be challenging, but even starting with a few minutes a day can have enormous benefits. Consulting with a healthcare professional can help determine the best exercise routine and lifestyle changes for managing blood pressure.

Diet

The DASH diet has been found to effectively reduce blood pressure, with results seen within two weeks of starting the plan. In the DASH-Sodium study, participants on the DASH diet experienced lower blood pressure, with the greatest decrease observed at the lowest sodium intake of 1,500 mg per day. This highlights the importance of reducing sodium intake to lower blood pressure.

In addition to the DASH diet, there are specific foods that can help lower blood pressure. Increasing potassium intake through foods like bananas and kiwifruit may help maintain blood pressure. Carrots, rich in plant-based compounds, have been associated with a reduced risk of high blood pressure. Eggs have also been linked to lower blood pressure and a decreased likelihood of developing heart disease.

Consuming fatty fish, such as salmon, is beneficial due to their high content of omega-3 fats, which can help reduce inflammation and lower blood pressure. Nuts and seeds are also a good addition to a balanced diet focused on lowering blood pressure as they provide important nutrients like fiber and arginine, which is essential for blood vessel relaxation.

It is important to note that dietary changes should be made gradually and in consultation with a healthcare provider. Small changes over a longer period are more sustainable and effective in maintaining a healthy blood pressure-lowering diet.

Measurement

High blood pressure, or hypertension, is a common but dangerous condition that often has no symptoms. As such, the only way to know if you have high blood pressure is to get it checked by a healthcare professional. This can be done at a hospital, clinic, pharmacy, or even at home with the right equipment.

A blood pressure test involves inflating a band, or cuff, around the upper arm and measuring the pressure in the blood vessels. This reading will give two numbers, for example, 120/80 mm Hg, which indicate the pressure when the heart is contracting and relaxing, respectively. Normal blood pressure is considered to be below 120/80 mm Hg, while a hypertensive crisis is defined as a reading of 180/120 mm Hg or higher, which requires immediate medical attention.

It is important to monitor blood pressure regularly, especially if you have been diagnosed with high blood pressure or are at risk due to family history, lifestyle factors, or other medical conditions. This can be done at home with a blood pressure monitor or during routine health check-ups with a healthcare provider. By tracking your blood pressure readings over time, you can identify patterns and see if any lifestyle changes or medications are helping to lower your blood pressure.

If you are experiencing symptoms such as chest pain, shortness of breath, blurry vision, or heart palpitations, it could be a sign of a hypertensive crisis, and you should seek immediate medical attention.

Frequently asked questions