The main aim when treating hypertension is to extend the period during which the patient remains free from complications. The idea is to reduce the probability of suffering a stroke, heart attack, heart failure or kidney failure. Therefore, treatment is designed to reduce and maintain blood pressure values to less than 140/90 mmHg (“below a maximum of 14 and a minimum of 9”).
Hypertension treatment not only consists of taking medication, but in fact making lifestyle changes is just as important as taking pharmaceuticals, if not more so. As such, patients with high blood pressure are advised to:
Unequivocally give up smoking.
Reduce their dietary salt intake to 5 g/day.
Restrict alcohol consumption to 20 g/day for men and half in women. This is equivalent to a glass of wine or 500 mL of beer with a meal.
High fibre (fruits, vegetables, pulses, whole grain foods).
Decrease the consumption of foods with a high salt content (cured meats, pickles, ready-made meals). A slight reduction in salt intake decreases blood pressure values, promotes weight loss and reduces the need for antihypertensive medications.
Increase the consumption of omega-3 and omega-6 polyunsaturated fatty acids (oily fish, sweet corn) and reduce that of saturated animal fats.
High calcium (yoghurt, milk, eggs, beans, semolina), magnesium (beans, walnuts, sweet corn, bread, lentils) and potassium (lentils, walnuts, bananas, potatoes, carrots, tomatoes). These foods are recommended because they may help reduce blood pressure.
In addition to lifestyle changes, which should always be implemented, most patients also need to take antihypertensive medication.
The greatest benefit derived from antihypertensive drugs is the very fact that they reduce blood pressure. However, the degree of hypertension, whether any organs are affected and, ultimately, the risk of developing any cardiovascular complications are the factors that will determine which medications are best suited to reducing each specific patient’s blood pressure.
Frequently, more than two drugs are required to bring the patient’s blood pressure down to normal values. It is better when these two-drug combinations are taken as just a single tablet (fixed combination) rather than two tablets (one for each medication).
These drugs must be taken every day and not just when the patient thinks they might have “high pressure”.
Treatment is generally straightforward, convenient and rarely causes problems. Treatment adherence and lifestyle changes help increase life expectancy and quality of life.
Side effects do not usually appear after taking antihypertensive drugs. However, a few people may experience some problems, which are generally mild, associated with antihypertensive medicines. In such cases, patients must inform their doctor who will decide whether to reduce the dose or withdraw the drug and replace it with another one.
The most common side effects are: cough, diarrhoea or constipation, skin reactions, erection problems, headaches, tiredness, dizziness, swollen ankles and feet.
Doctors must pay special attention to any potential side effects because patients tend to stop taking medicines that make them feel unwell. It is important that both patients and their families are informed about the possible appearance of side effects associated with a given medicine at the start of treatment.
There are now some alternative therapies for patients with what is known as resistant hypertension; that is, cases where the blood pressure cannot be reduced to normal levels despite implementing appropriate lifestyle changes and taking a suitable combination of at least three full dose antihypertensives.
Doctors must always ensure that lifestyle changes have been incorporated correctly, the patient is complying with the treatment regimen and there are no other factors contributing to uncontrolled hypertension, such as interaction with other medicines (e.g., anti-inflammatories) or sleep apnoea.
The possibility that treatment is not working because of a specific underlying disease that increases blood pressure must also be taken into consideration. Such cases are known as secondary hypertension and may be due to the consumption of illicit drugs (e.g., cocaine), tumours that produce hypertensive substances, etc.
In a few very specific cases, and which have not yet been studied in any depth, there are two new types of interventional therapy for patients with resistant hypertension:
Carotid baroreceptor stimulation. This technique consists in the permanent electrical stimulation of the carotid sinus nerves (located in the neck) by means of a device implanted under the skin (like a pacemaker). In addition to the slight risk associated with the operation, the system is very expensive and does not work in all patients.
Renal denervation. Bilateral destruction of nerves running along the renal artery using a radiofrequency ablation catheter inserted percutaneously (by means of a patch attached to the skin which allows certain substances to pass through to the dermal capillaries). Apparently, this technique works in some patients. It is an expensive system and its effectiveness has not been tested thoroughly.