Managing Blood Pressure: Hospital Treatment Options

High blood pressure is one of the most common reasons for emergency room visits, and it can lead to life-threatening conditions if left untreated. While it is important to seek medical attention for high blood pressure, rushing to the ER is not always necessary. In the hospital, hypertensive emergencies are treated with injectable drugs such as sodium nitroprusside, labetalol, and nicardipine. However, there are also preventative measures and at-home treatments for high blood pressure, including lifestyle modifications, drugs, and medications. This includes muscle relaxants like minoxidil, which dilate the peripheral arteries, and combinations of alpha and beta-blockers such as carvedilol and labetalol.

Relaxation techniques

One such technique is deep breathing, also known as abdominal breathing, diaphragmatic breathing, or paced respiration. This technique promotes a full oxygen exchange, allowing for a beneficial trade of oxygen coming in and carbon dioxide going out. It also helps to decrease heart rate and blood pressure. To practice deep breathing, sit quietly in a comfortable position and close your eyes. Breathe slowly through your nose, and if it helps, silently repeat a mantra or a word such as "one" or "peace". When other thoughts come to mind, simply return your focus to your breath. You can also try diaphragmatic breathing, which involves focusing on filling your diaphragm with air, rather than just your chest.

Yoga is another relaxation technique that can help lower blood pressure. Yoga aims to build strength, harmony, and awareness in the mind and body. It typically includes meditation, breathing exercises, and assuming postures to stretch or flex different muscle groups.

Transcendental meditation has also shown promising results in lowering blood pressure. This technique involves silently repeating a mantra and requires specific training. Mindfulness meditation, which focuses on being present and aware of your surroundings and sensations, can also be effective in reducing stress, a significant contributor to high blood pressure. By nurturing relaxation and helping manage stress, mindfulness can indirectly contribute to lower blood pressure.

Other relaxation techniques that can help lower blood pressure include progressive muscle relaxation, biofeedback, and autogenic training. These activities are typically coupled with mental imagery or breathing exercises to achieve maximum mental and physical relaxation.

Drug combinations

There are several types of blood pressure medications that can be combined. Diuretics, for example, are commonly used to treat high blood pressure by helping the kidneys eliminate excess water, sodium, and salt. This reduces the volume of blood passing through blood vessels, thereby lowering blood pressure. Thiazide-type diuretics, such as metolazone and hydrochlorothiazide, are often prescribed as first-line therapies.

Calcium channel blockers are another type of medication that helps relax blood vessels by reducing calcium entry into the cells lining the vessel walls. These drugs may be particularly effective for older individuals and Black patients. Examples include amlodipine (Norvasc) and diltiazem (Cardizem, Tiazac). It is important to note that consuming grapefruit products while taking calcium channel blockers can be dangerous, as it increases blood levels of certain calcium channel blockers.

Beta-blockers are not usually recommended as a standalone treatment but may be combined with other blood pressure medications. They work by slowing the heart rate and reducing the force of the heartbeat, leading to a decrease in blood pressure. Additionally, ACE inhibitors, or angiotensin-converting enzyme inhibitors, help the body produce less angiotensin, a chemical that causes arteries to narrow. By inhibiting the production of angiotensin, ACE inhibitors help blood vessels relax and open up, lowering blood pressure.

Aldosterone antagonists, such as spironolactone (Aldactone) and eplerenone (Inspra), are used to treat resistant hypertension. They block the effects of aldosterone, a natural chemical that can lead to salt and fluid buildup in the body. Renin inhibitors, such as aliskiren (Tekturna), slow the production of renin, an enzyme that increases blood pressure. However, due to the risk of serious complications, including stroke, aliskiren should not be taken with ACE inhibitors or angiotensin II receptor blockers (ARBs).

Injectable drugs for emergencies

Injectable drugs are often used in hypertensive emergencies to lower blood pressure and prevent organ damage. Hypertensive emergencies are characterised by a sudden spike in blood pressure to 180/120 mmHg or higher, which can lead to life-threatening situations.

Intravenous nitroglycerin is often administered in hypertensive emergencies and has an initial infusion rate of 5 mcg/min and a maximum rate of 20 mcg/min. This drug is particularly useful in patients with acute myocardial infarction or unstable angina pectoris, with a target blood pressure of less than 140/90 mmHg. Additionally, intravenous sodium nitroprusside is another option, with an initial infusion rate of 0.3-0.5 mcg/kg/min and a maximum rate of 10 mcg/kg/min.

In cases of acute pulmonary edema, intravenous clevidipine is a preferred treatment option, with an initial infusion rate of 1-2 mg/h and a maximum rate of 32 mg/h. Beta blockers are contraindicated in such cases. For patients with acute renal failure, intravenous fenoldopam and nicardipine are the drugs of choice. The initial infusion rate of fenoldopam is 0.1-0.3 mcg/kg/min, with a maximum rate of 1.6 mcg/kg/min. As for nicardipine, its initial infusion rate is 5 mg/h.

It is important to note that while these injectable drugs are used in hypertensive emergencies, there is insufficient data to determine the most effective antihypertensive drug for reducing mortality and morbidity. More randomized clinical trials are required to establish the optimal treatment approaches in terms of speed and extent of blood pressure reduction.

Lifestyle modifications

While hospitals can treat hypertensive emergencies with injectable drugs, high blood pressure can often be managed with lifestyle modifications.

• Relaxation techniques: Relaxation techniques can help to reduce high blood pressure. This can include activities such as deep breathing, meditation, or yoga. Reducing stress through these practices can help to lower blood pressure.
• Dietary changes: A healthy, balanced diet is crucial. Reducing salt and increasing potassium intake can help, as salt increases blood pressure by retaining water in the body. A diet rich in fruits, vegetables, whole grains, lean proteins, and low-fat dairy products is recommended.
• Exercise: Regular physical activity can help lower blood pressure. Aim for at least 30 minutes of moderate-intensity exercise, such as walking, swimming, or cycling, most days of the week.
• Weight management: Losing weight can help reduce blood pressure. Even a small amount of weight loss can make a difference. Maintaining a balanced diet and exercising regularly can aid in weight management.
• Reducing alcohol intake: Alcohol can raise blood pressure, so limiting consumption is important. It is recommended that women have no more than one drink per day and men no more than two.
• Quitting smoking: Smoking increases blood pressure by damaging the walls of blood vessels and reducing the amount of oxygen in the blood. Quitting smoking can improve blood pressure and overall health.

It is important to note that while lifestyle modifications can be effective, some people may also require medication to manage their blood pressure. It is always best to consult with a healthcare professional to determine the most appropriate treatment plan for your individual needs.

Renin inhibitors

The only drug of the renin inhibitor class that has been studied and approved for treatment is aliskiren. Aliskiren relaxes blood vessels, improves the free flow of blood, decreases blood volume, and reduces sympathetic activity, thus lowering blood pressure. It is usually used if other drugs are not working well or are not suitable for the patient. For example, if they are experiencing side effects, have other health problems, or are taking certain medications. Aliskiren can also be used alongside other blood pressure medications.

It is important to note that aliskiren is a relatively new medicine, and as such, not much is known about its possible side effects. However, it is likely that patients will not experience any side effects, or they may have minor side effects that do not cause significant problems. The most common side effect is diarrhoea. Other less common side effects include a sudden drop in blood pressure when going from lying or sitting down to standing up (postural hypotension) and swelling of the limbs, face, or throat, which is a rare allergic reaction.

Frequently asked questions