Treatment of arterial hypertension

Arterial hypertension, treatment

Prior to prescribing both pharmaceutical and non-pharmaceutical treatment of arterial hypertension, not only blood pressure level and obesity level must be assessed, but also all patient's risk factors and associated sicknesses must be determined, i.e. the risk must be stratified. Selection of medicines and application of non-pharmaceutical treatment means and intensity depend on the risk group assigned to a patient suffering from arterial hypertension.
arterial hypertension

The main tasks at treatment of arterial hypertension:
1. Protection of organs - targets:

  • myocardium, in order to prevent hypertrophy of the left ventricle of heart, coronary heart disease, cardiac insufficiency,
  • kidneys, in order to prevent renal insufficiency,
  • brain, in order to prevent stroke.

2. Improvement of life quality.
3. Reduction of death and sickness rate.

Non-pharmaceutical principles of treatment of arterial hypertension

Objectives of arterial hypertension treatment:

  • reduce blood pressure of a specific patient,
  • reduce the need for anti-hypertension medicines,
  • treat other existing risk factors,
  • primary prevention of hypertension and its associated heart and blood vessels diseases in population.

Efficiency of non-pharmaceutical treatment of arterial hypertension largely depends on the patient's motivation. In this case a physician must help the patient to comprehend that and clarify all possible measures.

First of all, this is modification of a lifestyle:

  • Smoking cessation.
  • Control of body weight.
  • Restriction of alcohol consumption.
  • Restriction of salt consumption.
  • Adequate amount of potassium, magnesium and calcium in food.
  • Reduced consumption of saturated fats and cholesterol.
  • Regular physical exercises.

In case of obesity all measures of non-pharmaceutical treatment of arterial hypertension are very important helping to control body weight. Some studies indicate that even a small weight decrease by 5 - 10% can significantly reduce the risk of heart diseases, lipids and glucose amount in blood, obtain better control of arterial blood pressure. Data of specific studies shows that body weight decrease by one kilogram causes decrease of arterial blood pressure by 1.6 - 1.3 mm Hg. In these days obesity is interpreted as a chronic state requiring long-term treatment.

Therefore, a recommendation is made to develop an individual treatment plan for each specific patient, the plan precisely indicating the measures of non-pharmaceutical treatment of arterial hypertension, its implementation scope and speed. Only successive body weight reduction which is well chosen considering the patient's clinical state can produce good long-term results of arterial hypertension treatment. Short-term obesity treatment is recommended only in order to mitigate the risk before surgical interventions.

Observation data of several long-term studies show that a part of patients fail to maintain the reached body weight in spite of keeping to further recommendations. The reason for that is a considerable release of proteins from fat cells which stimulate the satiety center in brain. These patients need pharmaceutical treatment of obesity. If body weight index is over 27 - 30 or several risk factors are available or secondary preventive measures of some sicknesses are being applied, the recommended amount of salt is up to 6 g. per day, including the salt incoming with already made food products.

Pharmaceutical principles of treatment of arterial hypertension and obesity

Milestones of hypertension treatment indicate six groups of anti-hypertension medicines but a question is always raised about which medicine to choose.
If there is an expectation to reach optimal blood pressure by a sustaining diet and one medicine, the following general principles must be recalled before prescribing the medicine:

  • Start treatment with small medicine doses in order to avoid the smallest adverse reaction;
  • If an adverse reaction occurs at medicine prescription but high blood pressure is still in place, then the medicine dose must be increased until the tolerated value or until side effects occur;
  • Prescribe a medicine operating 24 hours a day, which is convenient for dosing and allows avoiding the "yo-yo" phenomena.

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