Hypertension

Non-Pharmacological Therapy

Pharmacological Therapy

Initiation of drug therapy:-

• • In low risk patients, institute lifestyle modifications and observe BP for 2-3 months before deciding whether to start drug therapy. In medium risk patients advise lifestyle modification and initiate drug therapy after 2-4 weeks, if BP remains above 140/90.

  • In high and very high risk groups start drug treatment for hypertension and other risk factors in addition to life style modification.

  • Achieve gradual reduction of BP. Use low dose of antihypertensive drugs to initiate therapy.

  • Combining low doses of two or more drugs having synergistic effects is likely to produce lesser side effects.

  • Use of long acting drugs that provide 24 hours efficacy with OD administration endures smooth and sustained control of BP.

  • Although antihypertensive therapy is generally life long, an effort should be made to decrease dosage and number of antihypertnsive drugs should be considered after effective control of BP(Step Down Therapy).

Antihypertensive Drug Combinations

• • When a patient is in stage 2 or above, therapy can be with either 2 drugs or as a fixed fixed combinations.

  • ACEIs with CCBs is better than combination with ACEI with diuretic.

  • Younger individuals have high renin hypertension, hence ACE inhibitors/ARBs or newer beta-blockers are preferred, while older individuals have low renin hypertension hence diuretics or CCBs(C) are preferred. In combination, one out of two groups A( ACE inhibitor/ARB or (B)beta-blocker is combined with calcium channel blockers or thiazide(D) diuretic. In refractory patients when 3 agents are to be used, A+C+D is a good choice.