Managing High Blood Pressure: Hospital Treatment Options

High blood pressure, or hypertension, is a common condition that affects millions of Americans. It can lead to serious health issues, including heart attacks, strokes, and kidney disease. While there are usually no symptoms, it is important to get your blood pressure checked regularly, especially if you are at a higher risk due to age, ethnicity, or other factors. If you are experiencing a hypertensive crisis, it is crucial to seek immediate medical attention. Hospitals treat high blood pressure by first assessing the patient's condition and then providing oral or intravenous medications to lower blood pressure and prevent damage to organs and blood vessels. Doctors may also recommend lifestyle changes, such as a healthier diet and increased physical activity, to help manage the condition. In some cases, a combination of medications and self-help measures may be necessary.

Lifestyle changes: e.g. losing weight, eating healthily, reducing alcohol

Lifestyle changes are often recommended by healthcare providers to help patients lower and control their high blood pressure. These changes can include losing weight, eating healthily, and reducing alcohol consumption.

Losing weight

Losing weight is often recommended for patients with high blood pressure as obesity increases the risk of high blood pressure and related complications such as coronary artery disease, congestive heart failure, stroke, and kidney disease. Losing weight can help reduce the strain on the body's critical plumbing system, allowing blood to flow more efficiently and reducing the pressure on blood vessels.

Eating healthily

Adopting a heart-healthy diet is crucial for managing high blood pressure. The DASH (Dietary Approaches to Stop Hypertension) eating plan, which involves limiting salt and sodium intake, has been shown to be effective in lowering blood pressure. Eating a healthy, balanced diet that includes a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats can help maintain a healthy blood pressure range. Additionally, reducing salt and alcohol intake can further assist in lowering blood pressure levels.

Reducing alcohol consumption

Alcohol consumption can contribute to high blood pressure, so reducing or eliminating alcohol intake is often recommended. Alcohol can cause weight gain, disrupt sleep, and increase stress levels, all of which can negatively impact blood pressure. Quitting or cutting down on alcohol can have a positive impact on overall health and help in managing blood pressure.

It is important to note that lifestyle changes may not be sufficient for everyone with high blood pressure. In some cases, medication may be necessary to effectively manage the condition. Regular monitoring and consultation with a healthcare provider are essential to determine the most appropriate treatment plan for each individual.

Medication: e.g. ACE inhibitors, ARBs, CCBs

Medication is often required when lifestyle changes alone fail to treat high blood pressure. The type of medicine used depends on the patient's overall health and the severity of their condition. Doctors often find that a combination of two or more blood pressure medications is more effective than a single drug. It may take some time to identify the best medication or combination of medications for a patient.

Several types of drugs can be used to treat high blood pressure, including ACE inhibitors, ARBs, and CCBs. ACE inhibitors, or angiotensin-converting enzyme inhibitors, help relax blood vessels by blocking the formation of angiotensin II, a hormone that causes blood vessels to narrow. ARBs, or angiotensin II receptor blockers, work similarly by blocking the action of angiotensin II on its receptors. This action prevents blood vessels from narrowing, thereby reducing blood pressure. CCBs, or calcium channel blockers, work by blocking the entry of calcium into the cells of the heart and blood vessels, leading to a relaxation of blood vessels and improved blood flow.

The goal of blood pressure treatment is typically to achieve a reading of less than 130/80 mm Hg. However, this target can vary depending on age and health conditions, especially for individuals over 65. For example, a healthy adult under 65 with a high risk of developing cardiovascular disease in the next ten years should aim for the aforementioned target. On the other hand, older individuals or those with specific conditions like chronic kidney disease, diabetes, or coronary artery disease may have different targets.

It is important for patients taking medication for high blood pressure to maintain open communication with their healthcare providers. If a patient is skipping doses due to cost, side effects, or forgetfulness, they should discuss this with their doctor to find solutions or alternative treatments. Additionally, patients taking multiple medications for blood pressure control should be closely monitored, and further investigations should be conducted if their blood pressure remains high despite pharmacological interventions.

Monitoring: regular blood pressure checks at home or over 24 hours

Monitoring blood pressure is an important part of treating hypertension. This can be done through regular blood pressure checks at home or over 24 hours with ambulatory blood pressure monitoring (ABPM).

ABPM is a useful tool for identifying issues that might otherwise stay hidden and ruling out white coat hypertension, where patients have normal blood pressure at home but high blood pressure during office visits. It provides a more accurate measurement of a patient's "real" blood pressure and can be used to calculate the 24-hour average blood pressure, the average daytime blood pressure, the average nighttime blood pressure, and the percentage drop in blood pressure at night. The current monitors available on the market are small, lightweight devices that can be connected to the arm cuff and measure blood pressure every 15 to 30 minutes.

When choosing a blood pressure monitor for home use, it is important to ensure that it is validated for the user and that the cuff fits properly. The monitor should be checked by a healthcare professional to ensure that it is being used correctly and providing accurate results. It is recommended to bring the monitor to appointments so that the doctor or nurse can review the results and provide guidance on usage if needed.

To measure blood pressure at home, it is advised to take readings in the morning and evening, every day for a week. Three readings should be taken in each session, one to two minutes apart, and the average should be calculated. It is important to keep a diary of blood pressure readings, including the time and date, and any factors that may have influenced the reading, such as changes in treatment or symptoms.

By combining ABPM data with in-office findings, healthcare professionals can better understand a patient's blood pressure patterns and make more informed treatment decisions.

Pregnancy: controlling blood pressure during pregnancy

Pregnancy is a crucial time to control high blood pressure (hypertension) to ensure the health of both the mother and the baby. Severe or uncontrolled high blood pressure during pregnancy can cause serious complications, including preeclampsia, eclampsia, stroke, the need for labor induction, and placental abruption. The baby is also at risk of preterm delivery and low birth weight. Therefore, it is important to seek medical advice and create a plan for managing blood pressure before, during, and after pregnancy.

If you have high blood pressure and are planning to become pregnant, consult your doctor or obstetrician-gynaecologist (ob-gyn). They will assess your overall health and review your medications to determine if any adjustments are needed to ensure safety during pregnancy. Your ob-gyn may also perform tests to evaluate the functioning of your heart and kidneys. Additionally, they will educate you about the signs and symptoms of preeclampsia, a serious high blood pressure disorder that can occur during pregnancy or soon after childbirth.

During pregnancy, your healthcare provider should monitor your blood pressure at each prenatal care visit. Blood pressure readings consist of two numbers: systolic blood pressure, which is the pressure when the heart contracts, and diastolic blood pressure, which is the pressure when the heart relaxes between contractions. A blood pressure reading of 140/90 mm Hg or higher in two readings taken at least four hours apart indicates high blood pressure during pregnancy.

To manage high blood pressure during pregnancy, your healthcare team may recommend lifestyle changes, such as healthy eating, regular physical activity, and maintaining a healthy weight. They will also guide you on safe medications to take during this time. It is crucial to attend all your prenatal appointments and follow your healthcare provider's recommendations. Additionally, you can invest in a home blood pressure monitor to keep track of your readings and inform your healthcare team of any significant changes.

After giving birth, continue to monitor your health, especially if you had high blood pressure during pregnancy. You are at an increased risk of stroke and other complications, including preeclampsia. Therefore, be vigilant about any symptoms and seek immediate medical attention if necessary.

Hypertensive crisis: when to seek emergency treatment

A hypertensive crisis is a medical emergency that requires immediate treatment. It occurs when there is a sudden and marked elevation in blood pressure, surging to 180/120 mm Hg or higher. This can be a warning sign that an individual's blood pressure is not at a healthy level and requires immediate medical attention to prevent further complications.

During a hypertensive crisis, an individual may experience symptoms such as headache, dizziness, altered mental status, shortness of breath, chest pain, decreased urine output, vomiting, or changes in vision. These symptoms, in conjunction with a blood pressure reading of 180/120, indicate a hypertensive emergency, and the individual should seek emergency treatment without delay.

Upon arrival at the emergency room, healthcare providers will take the individual's blood pressure in both arms to confirm the diagnosis of a hypertensive crisis. They will also review the patient's medical history, discuss their symptoms, and perform a physical examination. Further tests, such as metabolic panels, urinalysis, cardiac enzymes, and imaging studies, may be necessary to assess for organ damage and determine the specific treatment approach.

The treatment for a hypertensive crisis focuses on rapidly lowering the blood pressure to a safe level. Healthcare providers will administer medications to reduce blood pressure, taking into account the patient's medical conditions and other medications they may be taking. In cases of hypertensive emergency with signs of organ damage, the patient will require admission to the intensive care unit (ICU) for close monitoring and aggressive management of blood pressure.

It is important to note that hypertensive crises can affect individuals with or without a history of high blood pressure. Therefore, anyone experiencing symptoms indicative of a hypertensive crisis should seek emergency treatment, even if they do not have a personal blood pressure monitoring device at home.

Frequently asked questions