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Diseases » Hypertension » Treatments

Treatments for Hypertension



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Treatments for Hypertension:

High blood pressure is highly treatable. Perhaps the biggest obstacle to successful treatment of high blood pressure is not recognizing that this "silent" condition exists. This is why it is important to get regular medical check-ups so that blood pressure can be measured, monitored for trends, and evaluated within a context of a full family and personal medical history and physical exam. The overall treatment goal for people with high blood pressure is to control and maintain blood pressure at a normal level, which minimizes the risk of developing serious complications and diseases, such as kidney disease, stroke, coronary heart disease, and heart failure. As a very general guide, this means keeping blood pressure below 140/90 mmHg for adults. Current guidelines consider consistent readings over 120/80mmHg as "pre-hypertensive", which should be monitored and addressed to ensure they readings do not rise over time. Your health care provider will work with you to develop an individualized treatment plan that best fits your condition and your life style. The most effective treatment plans offer a multifaceted approach that can include medications and life style changes.

Addressing lifestyle habits that may result in high blood pressure includes eating a heart healthy diet that is high in vegetable, fruits, and whole grains, and low in sodium. This also means limiting alcohol intake to two drinks per day for men and one drink per day for women. Getting enough exercise is also important. This includes at least 30 minutes of moderate-intensity activity on most or all days of the week, as recommended by your health care provider. These lifestyle interventions can also help to achieve and maintain a healthy weight, another important factor in preventing and treating high blood pressure. Because smoking raises blood pressure, quitting smoking is key to achieving a healthy blood pressure. Your health care provider can prescribe treatments to help you quit smoking and refer you to smoking cessation programs. Reducing stress is another key step to take to minimize high blood pressure.

Not all people can effectively manage their blood pressure by lifestyle changes alone. For these cases, there are a wide variety of oral medications, also known as anti-hypertensive drugs, which are safe and effective in treating high blood pressure in conjunction with continuing lifestyle changes. Individual medication may be used alone or in combination with other medications. Diuretics, also known as "water pills", lower blood pressure by stimulating the kidneys to flush extra fluid and salt from the body. ACE inhibitors lower blood pressure by preventing the body from making a hormone called angiotensin II, which narrows and tightens blood vessels. Angiotensin II receptor blockers protect blood vessels from the narrowing effects of angiotensin. Beta blockers help the heart to beat slower and less forcefully. Calcium channel blockers block calcium from entering the cells of the heart and blood vessels, resulting in relaxation of the vessels. Alpha blockers decrease nerve impulses that tighten blood vessels. Vasodilators relax and widen the blood vessels walls. Nervous system inhibitors work in the brain to increase messages to the blood vessels to relax and widen them.

Sticking to a treatment regimen for high blood pressure can be a challenge because people with high blood pressure often feel fine without treatment until major damage has been done. It is very important to stick to your treatment regimen and not change or discontinue your medications without consulting with your health care provider. Ensure that all your health care providers, including the dentist, are aware that you have high blood pressure and that you are taking antihypertensive medications.

Treatments for Hypertension

The list of treatments mentioned in various sources for Hypertension includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

Hypertension: Is the Diagnosis Correct?

The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Hypertension may include:

Hidden causes of Hypertension may be incorrectly diagnosed:

Hypertension: Marketplace Products, Discounts & Offers

Products, offers and promotion categories available for Hypertension:

Curable Types of Hypertension

Possibly curable types of Hypertension may include:

  • Eclampsia of pregnancy
  • Hyperthyroidism induced hypertension
  • Cushing's disease induced hypertension
  • more curable types...»

Hypertension: Research Doctors & Specialists

Research all specialists including ratings, affiliations, and sanctions.

Drugs and Medications used to treat Hypertension:

Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment or change in treatment plans.

Some of the different medications used in the treatment of Hypertension include:

  • Acebutolol
  • Apo-Acebutolol
  • Gen-Acebutolol
  • Med-Acebutolol
  • Monitan
  • Rhotral
  • Sectral
  • Amiloride
  • Apo-Amilzide
  • Midamor
  • Moduret
  • Moduretic
  • Novamilor
  • Nu-Amilzide
  • Riva-Amilzide
  • Amlodipine
  • Lotrel
  • Norvasc
  • Angiotensin Converting Enzyme
  • ACE Inhibitor
  • Benazepril
  • Lotensin
  • Lotensin HCT
  • Captopril
  • Apo-Capto
  • Capoten
  • Capozide
  • Novo-Captopril
  • Nu-Capto
  • Syn-Captopril
  • Enalapril
  • Lexxel
  • Vaseretic
  • Vasotec
  • Fosinopril
  • Lin-Fosinopril
  • Monopril
  • Monopril HCT
  • Lisinopril
  • Prinivil
  • Prinzide
  • Zestoretic
  • Zestril
  • Quinapril
  • Accupril
  • Accuretic
  • Ramipril
  • Altace
  • Ramace
  • Angiotensin II Receptor Antagonists
  • Candesartan
  • Atacand
  • Atacand HCT
  • Eprosartan
  • Teveten
  • Irbesartan
  • Avapro
  • Avalide
  • Losartan
  • Cozaar
  • Hyzaar
  • Telmisartan
  • Micardis
  • Valsartan
  • Diovan
  • Diovan HCT
  • Atenolol
  • Apo-Atenolol
  • Novo-Atenolol
  • Nu-Atenolol
  • PMS-Atenolol
  • Tenoretic
  • Tenormin
  • Betaxolol
  • Betoptic
  • Betoptic-Pilo
  • Betoptic-S
  • Kerlone
  • Novo-Betaxolol
  • Carteolol
  • Cartrol
  • Ocupress
  • Occupress
  • Carvedilol
  • Coreg
  • Dilatrend
  • Eucardic
  • Proreg
  • Clonidine
  • Apo-Clonidine
  • Catapres
  • Catapres-TTS
  • Combipres
  • Dixarit
  • Duraclon
  • Novo-Clonidine
  • Nu-Clonidine
  • Diltiazem
  • Albert Diltiazem CD
  • Apo-Diltiaz
  • Alti-Diltiazem
  • Cardizem
  • Cardizem CD
  • Cardizem SR
  • Cartia XT
  • Dilacor XR
  • Diltia XT
  • Diltiazem ER
  • Med-Diltiazem SR
  • Novo-Diltiazem
  • Nu-Diltiaz
  • Pharma-Diltiaz
  • Syn-Diltiazem
  • Teczem
  • Tiamate
  • Tiazac
  • Doxazosin
  • Apo-Doxazosin
  • Cardura
  • Cardura-1
  • Doxaloc
  • Gen-Doxazosin
  • Med-Doxazosin
  • Felodipine
  • Plendil
  • Altace plus Felodipine
  • Logimax
  • Renedil
  • Furosemide
  • Albert Furosemide
  • Apo-Furosemide
  • Fumide MD
  • Furocot
  • Furomide MD
  • Furose
  • Furosemide-10
  • Furoside
  • Lasaject
  • Lasimide
  • Lasix
  • Lasix Special
  • Lo-Aqua
  • Luramide
  • Myrosemide
  • Novo-Semide
  • Ro-Semide
  • SK-Furosemide
  • Uritol
  • Tenex
  • Hydralazine
  • Alazine
  • Alphapres
  • Apo-Hydralazine
  • Apresazide
  • Apresoline
  • Apresoline-Esidrix
  • Cam-Ap-Es
  • Dralserp
  • DralzineH-H-R
  • Hydroserpine
  • Hyserp
  • Lo-Ten
  • Marpres
  • Novo-Hylazin
  • Nu-Hydral
  • Ser-A-Gen
  • Ser-Ap-Es
  • Serpasil-Apresoline
  • Serprex
  • Supres
  • Tri-Hydroserpine
  • Unipres
  • Uniserp
  • Apo-Indapamide
  • Dom-Indapamide
  • Gen-Indapamide
  • Lozide
  • Lozol
  • PMS-Indapamide
  • Isradipine
  • DynaCirc
  • DynaCirc CR
  • Labetalol
  • Normodyne
  • Normozide
  • Trandate
  • Trandate HCT
  • Metoprolol
  • Apo-Metoprolol
  • Betaloc
  • Co-Betaloc
  • Lopressor
  • Lopressor Delayed-Release
  • Lopressor HCT
  • Lopressor OROS
  • Novo-Metoprol
  • Nu-Metop
  • Toprol
  • Toprol XL
  • Mibefradil
  • Minoxidil
  • Alostil
  • Apo-Gain
  • Kresse
  • Loniten
  • Med-Minoxidil
  • Minocalve 5
  • Minodyl
  • Minoximen
  • Nadolol
  • Alti-Nadol
  • Apo-Nadol
  • Corgard
  • Corzide
  • Syn-Nadol
  • Nicardipine
  • Cardene
  • Cardene SR
  • Nifedipine
  • Adalat
  • Adalat CC
  • Adalat FT
  • Adalat P.A
  • Apo-Nifed
  • Gen-Nifedipine
  • Novo-Nifedin
  • Nu-Nifed
  • Procardia
  • Procardia XL
  • Scheinpharm Nifedipine XL
  • Nisoldipine
  • Sular
  • Penbutolol
  • Levatol
  • Pindolol
  • Apo-Pindol
  • Dom-Pindolol
  • Novo-Pindol
  • Nu-Pindol
  • Syn-Pindolol
  • Viskazide
  • Visken
  • Prazosin
  • Apo-Prazo
  • Minipres
  • Minizide
  • Novo-Prazin
  • Nu-Prazo
  • Propranolol
  • Apo-Propranolol
  • Betachron
  • Detensol
  • Inderal
  • Inderal-LA
  • Inderide
  • Inderide LA
  • Ipran
  • Novo-Pranol
  • PMS Propranolol
  • Spironolactone
  • Alatone
  • Aldactazide
  • Aldactone
  • Apo-Spirozide
  • Novo-Spiroton
  • Novo-Spirozine
  • Sincomen
  • Spironazide
  • Terazosin
  • Apo-Terazosin
  • Hytrin
  • Novo-Terazosin
  • Thiazide Diuretics
  • Bendroflumethiazide
  • Naturetin
  • Chlorothiazide
  • Aldochlor
  • Diachlor
  • Diupres
  • Diurigen
  • Diuril
  • SK-Chlorothiazide
  • Chlorothalidone
  • Apo-Chlorthalidone
  • Demi-Regroton
  • Hygroton
  • Hygroton-Resperpine
  • Hylidone
  • Novothalidone
  • Regroton
  • Thalitone
  • Uridon
  • Hydrochlorothiazide
  • Aldoril D30/D50
  • Aldoril-15/25
  • Apo-Hydro
  • Apo-Methazide
  • Apo-Triazide
  • Diaqua
  • Diuchlor H
  • Dyazide
  • Esidrex
  • Ezide
  • H-H-R
  • HydroDiuril
  • Hydromal
  • Hydro-Par
  • Hydropres
  • Hydroserpine Plus
  • Hydro-T
  • Hydro-Z-50
  • Ismelin-Esidrex
  • Maxzide
  • Maxzide-25
  • M Dopazide
  • Microzide
  • Mictrin
  • Natrimax
  • Neo-Codema
  • Novo-Doparil
  • Novo-Hydrazide
  • Novo-Trimzide
  • Oretic
  • Oreticyl
  • PMS Dopazide
  • Serpasil-Esidrex
  • SK-Hydrochlorothiazide
  • Thiuretic
  • Timolide
  • Uniretic
  • Urozide
  • Ziac
  • Zide
  • Hydroflumethiazide
  • Diucardin
  • Saluron
  • Methyclothiazide
  • Aquatensen
  • Duretic
  • Enduron
  • Metolazone
  • Diulo
  • Microx
  • Mykrox
  • Zaroxolyn
  • Trichlormethiazide
  • Duirese
  • Marazide II
  • Metahydrin
  • Naqua
  • Naquival
  • Timolol
  • Apo-Timolol
  • Apo-Timop
  • Betimol
  • Blocadren
  • Cosopt
  • Dom-Timolol
  • Novo-Timolol
  • Triamterene
  • Dyrenium
  • Novo-Triamzide
  • Nu-Triazide
  • Riva-Zide
  • Verapamil
  • Alti-Verapamil
  • Apo-Verap
  • Calan
  • Calan SR
  • Chronovera
  • Covera-HS
  • Dom-Verapamil SR
  • Gen-Verapamil
  • Isoptin
  • Isoptin SR
  • Med-Verapamil
  • Nu-Verap
  • PMS-Verapamil
  • Tarka
  • Verelan
  • Verelan PM
  • Nov-Acebutolol
  • Nu-Acebutolol
  • Amiloride and Hydrochlorothiazide
  • Norvas
  • Caduet - mainly used to treat patients with hypertension and angina
  • Amlodipine and Atorvastatin - mainly used to treat patients with hypertension and angina
  • Amlodipine and Benazepril
  • Gen-Atenolol
  • Rhoxal-atenolol
  • Tenolin
  • Blokium
  • Bisoprolol
  • Zebeta
  • Monocor
  • Bisoprolol and Hydrochlorothiazide
  • Bumedyl
  • Drenural
  • Miccil
  • Alti-Captopril
  • Gen-Captopril
  • PMS-Captopril
  • Captral
  • Cardipril
  • Cryopril
  • Ecaten
  • Kenolan
  • Lenpryl
  • Romir
  • Chlorthalidone
  • Cilazapril
  • Inhibace
  • Clonidine and Chlorthalidone
  • Clorpres
  • Diazoxide
  • Hyperstat I.V
  • Angiotrofin
  • Novo-Diltiazem-CD
  • Novo-Diltiazem SR
  • Nu-Diltiaz-CD
  • Ratio-Diltiazem CD
  • Rhoxal-Diltiazem CD
  • Rhoxal-Diltiazem SR
  • Gen-Diltiazem
  • Gen-Diltiazem SR
  • Apo-Diltiaz SR
  • Apo-Diltiaz CD
  • Alti-Diltiazem SR
  • Taztia XT
  • Feliberal
  • Glioten
  • Kenopril
  • Norpril
  • Palane
  • Pulsol
  • Renitec
  • Eplerenone
  • Inspra
  • Eprosartan and Hydrochlorothiazide
  • Teveten HCT
  • Esmolol
  • Brevibloc
  • Fenoldopam
  • Corlopam
  • Guanfacine
  • Guanabenz
  • Wytensin
  • Hydra-Zide
  • Hydralazine and Hydrochlorothiazide
  • Mecamylamine
  • Inversine
  • Mthyclothiazide and Deserpidine
  • Enduronyl
  • Enduronyl Forte
  • Moexipril
  • Univasc
  • Moexipril and Hydrochlorothiazide
  • Syscor
  • Olmesartan
  • Benicar
  • Benicar HCT
  • Olmesartan and Hydrochlorothiazide
  • Oxprenolol
  • Slow-Trasicor
  • Trasicor
  • Perindopril Erbumine
  • Coversyl
  • Phentolamine
  • Regitine
  • Rogitine
  • Z-Max
  • Polythiazide
  • Renesse
  • Propranolol and Hydrochlorothiazide
  • Micardis HCT
  • Micardis Plus
  • Telmisartan and Hydrochlorthiazide
  • Trandolapril and Verapamil
  • Metatensin
  • Trichlorex
  • Captohexal
  • Acenorm
  • Enzace
  • Liprace
  • Uremide
  • GenRx Frusemide
  • Frusid
  • Frusehexal
  • Alphapress
  • Lercanidipine
  • Zanidip
  • Phenoxybenzamine
  • Dibenyline
  • Garlic

Unlabeled Drugs and Medications to treat Hypertension:

Unlabelled alternative drug treatments for Hypertension include:

  • Bumetanide
  • Bumex
  • Burinex
  • Carteolol
  • Cartrol
  • Ocupress
  • Occupress
  • Clonidine - mainly used as second line treatment in congestive heart failure patients
  • Apo-Clonidine - mainly used as second line treatment in congestive heart failure patients
  • Catapres - mainly used as second line treatment in congestive heart failure patients
  • Catapres-TTS - mainly used as second line treatment in congestive heart failure patients
  • Combipres - mainly used as second line treatment in congestive heart failure patients
  • Dixarit - mainly used as second line treatment in congestive heart failure patients
  • Duraclon - mainly used as second line treatment in congestive heart failure patients
  • Novo-Clonidine - mainly used as second line treatment in congestive heart failure patients
  • Nu-Clonidine - mainly used as second line treatment in congestive heart failure patients
  • Alti-Captopril - mainly used to treat hypertension secondary to scleroderma renal crisis and Takayasu's disease
  • Gen-Captopril - mainly used to treat hypertension secondary to scleroderma renal crisis and Takayasu's disease
  • PMS-Captopril - mainly used to treat hypertension secondary to scleroderma renal crisis and Takayasu's disease
  • Captral - mainly used to treat hypertension secondary to scleroderma renal crisis and Takayasu's disease
  • Cardipril - mainly used to treat hypertension secondary to scleroderma renal crisis and Takayasu's disease
  • Cryopril - mainly used to treat hypertension secondary to scleroderma renal crisis and Takayasu's disease
  • Ecaten - mainly used to treat hypertension secondary to scleroderma renal crisis and Takayasu's disease
  • Kenolan - mainly used to treat hypertension secondary to scleroderma renal crisis and Takayasu's disease
  • Lenpryl - mainly used to treat hypertension secondary to scleroderma renal crisis and Takayasu's disease
  • Romir - mainly used to treat hypertension secondary to scleroderma renal crisis and Takayasu's disease

Latest treatments for Hypertension:

The following are some of the latest treatments for Hypertension:

Hospital statistics for Hypertension:

These medical statistics relate to hospitals, hospitalization and Hypertension:

  • 0.17% (22,006) of hospital episodes were for hypertensive disease in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 79% of hospital consultations for hypertensive disease required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 52% of hospital episodes for hypertensive disease were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 48% of hospital episodes for hypertensive disease were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • more hospital information...»

Hospitals & Medical Clinics: Hypertension

Research quality ratings and patient incidents/safety measures for hospitals and medical facilities in specialties related to Hypertension:

Hospital & Clinic quality ratings » »

Choosing the Best Treatment Hospital: More general information, not necessarily in relation to Hypertension, on hospital and medical facility performance and surgical care quality:

Medical news summaries about treatments for Hypertension:

The following medical news items are relevant to treatment of Hypertension:

Discussion of treatments for Hypertension:

High Blood Pressure and Kidney Disease: NIDDK (Excerpt)

Many people need medicine to control high blood pressure. A group of medications called ACE (angiotensin-converting enzyme) inhibitors lower blood pressure and have an added protective effect on the kidney in people with diabetes. Additional studies have shown that ACE inhibitors also reduce proteinuria and slow the progression of kidney damage in people who do not have diabetes. You may need to take a combination of two or more blood pressure medicines to reach 125/75. (Source: excerpt from High Blood Pressure and Kidney Disease: NIDDK)

Heart Disease & Women Preventing & Controlling High Blood Pressure: NHLBI (Excerpt)

Limit Your Alcohol Use. If you drink alcohol, have no more than one drink per day. That means no more than 12 ounces of beer, 5 ounces of wine, or 1 1/2 ounces of hard liquor. (Source: excerpt from Heart Disease & Women Preventing & Controlling High Blood Pressure: NHLBI)

Heart Disease & Women Preventing & Controlling High Blood Pressure: NHLBI (Excerpt)

Use Less Salt. Try seasoning foods instead with herbs, spices, and lemon juice. Keep in mind that sodium, an ingredient in salt, is "hidden" in many packaged and processed foods. Check product labels for the amount of sodium in each serving. Many experts advise a total daily salt intake of no more than 6 grams, which equals about 2,400 milligrams of sodium--this includes whatever is added during cooking and at the table. If you would like to try a salt substitute, talk with your doctor first, because they are not safe for everyone. (Source: excerpt from Heart Disease & Women Preventing & Controlling High Blood Pressure: NHLBI)

Heart Disease & Women Preventing & Controlling High Blood Pressure: NHLBI (Excerpt)

Be Physically Active. Even low- to modeate-intensity activity, if done regularly, can help control and prevent high blood pressure. Examples of such exercise are walking for pleasure, gardening, yardwork, moderate-to-heavy housework, dancing, and home exercise. Try to do one or more of these activities every day. (Source: excerpt from Heart Disease & Women Preventing & Controlling High Blood Pressure: NHLBI)

Heart Disease & Women Preventing & Controlling High Blood Pressure: NHLBI (Excerpt)

Lose Weight If You Are Overweight. Taking off excess pounds will help to control and prevent high blood pressure, and will lower your chances of developing cardiovascular disease in several other ways. Weight loss will help to prevent and control diabetes, and it can also lower blood cholesterol levels. Finally, since being overweight raises the chances of developing heart disease, losing weight can lower your risk. (Source: excerpt from Heart Disease & Women Preventing & Controlling High Blood Pressure: NHLBI)

High Blood Pressure - Age Page - Health Information: NIA (Excerpt)

If you have mild HBP, your doctor may suggest that you lose weight and keep it off, eat less salt, cut down on alcohol, and get more exercise. You may bring your blood pressure down simply by following this advice. Even if medicine is needed, these daily habits may help it work better. (Source: excerpt from High Blood Pressure - Age Page - Health Information: NIA)

Book Excerpts: Treatment of Hypertension

Treatments of Hypertension: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Hypertension.

Hypertension: Treatment
(In a Page: Signs and Symptoms)

  • Essential hypertension: Lifestyle changes are the initial interventions unless significant hypertension, end-organ damage, or diabetes is present (smoking cessation; dietary changes, e.g., DASH diet =low in sodium, rich in potassium and calcium; increased exercise)
  • Pharmacologic therapy usually begins with a diuretic or β-blocker (ACE inhibitor in diabetics)
    –Diuretics are usually first-line agents, especially in CHF, diabetes, and risk of coronary artery disease
    –Use ACE inhibitors in patients with CHF, MI, renal disease, and diabetes
    –Use β-blockers in CAD, recent MI, angina, CHF, atrial fibrillation, migraines, hyperthyroidism
    –Additional drugs may include angiotensin receptor blockers (especially in patients with cough when using ACE inhibitors), calcium channel blockers, and β-blockers
    –Preferred drugs in pregnancy include methyldopa, β-blockers, and vasodilators (do not use ACE/ARBs)
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» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Hypertension: Treatment
(In A Page: Pediatric Signs and Symptoms)

  • Treat the underlying disease when possible
  • Stop smoking and illicit drug use
  • Avoid the offending drug when possible
  • Limit competitive sports and highly static exercises in patients with severe hypertension only until their BP is controlled and there is no evidence of end organ damage
  • Salt restriction (4–5 g/day), weight loss, and exercise are part of most regimens
  • Essential hypertension can usually be resolved with weight loss, moderate exercise, and dietary modifications
  • For other etiologies, many medications are used to control blood pressure
    –IV: Nicardipine, sodium nitroprusside, labetalol
    –Oral: Captopril, enalapril, lisinopril, amlodipine, nifedipine extended release, propranolol, clonidine, hydralazine

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Pulse pressure, widened: Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))

If the patient’s level of consciousness (LOC) is decreased, and you suspect that his widened pulse pressure results from increased ICP, check his vital signs. Maintain a patent airway, and prepare to hyperventilate the patient with a handheld resuscitation bag to help reduce partial pressure of carbon dioxide levels and, thus, ICP. Perform a thorough neurologic examination to serve as a baseline for assessing subsequent changes. Use the Glasgow Coma Scale to evaluate the patient’s LOC. (See Glasgow Coma Scale, page 374.) Also, check cranial nerve function — especially in cranial nerves III, IV, and VI — and assess pupillary reactions, reflexes, and muscle tone. Insertion of an ICP monitor may be necessary. If you don’t suspect increased ICP, ask about associated symptoms, such as chest pain, shortness of breath, weakness, fatigue, or syncope. Check for edema, and auscultate for murmurs.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Hypertension: Treatment
(Professional Guide to Diseases (Eighth Edition))

The National Institutes of Health recommend the following approach for treating primary hypertension:

❑ First, help the patient initiate necessary lifestyle modifications, including weight reduction, moderation of alcohol intake, regular physical exercise, reduction of sodium intake, and smoking cessation.

❑ If the patient fails to achieve the desired blood pressure or make significant progress, continue lifestyle modifications and begin drug therapy.

❑ For stage 1 hypertension (systolic [SBP] blood pressure 140 to 159 mm Hg, or diastolic blood pressure [DBP] 90 to 99 mm Hg) in the absence of compelling indications (heart failure, postmyocardial infarction, high coronary disease risk, diabetes, chronic kidney disease, or recurrent stroke prevention), give most patients thiazide-type diuretics. Consider using an angiotensin-converting enzyme (ACE) inhibitor, beta-adrenergic blocker, calcium channel blocker (CCB), angiotensin-receptor blocker (ARB), or a combination.

❑ For stage 2 hypertension (SBP ≥ 160 mm Hg, or DBP ≥ 100 mm Hg) in the absence of compelling indications, give most patients a two-drug combination (usually a thiazide-type diuretic and an ACE inhibitor, ARB, CCB, or beta-adrenergic blocker).

❑ If the patient has one or more compelling indications, base drug treatment on benefits from outcome studies or existing clinical guidelines. Treatment may include the following, depending on indication:

–  Heart failure — diuretic, beta-adrenergic blocker, ACE inhibitor, ARB, or aldosterone antagonist

–  High coronary disease risk — diuretic, beta-adrenergic blocker, ACE inhibitor, or CCB

–  Diabetes — diuretic, beta-adrenergic blocker, ACE inhibitor, or CCB

–  Chronic kidney disease — ACE inhibitor or ARB

–  Postmyocardial failure — ACE inhibitor, beta-adrenergic blocker, or aldosterone antagonist

–  Recurrent stroke prevention — diuretic or ACE inhibitor.

Give other antihypertensive drugs as needed.

❑ If the patient fails to achieve the desired blood pressure, continue lifestyle modifications and optimize drug dosages or add additional drugs until the goal blood pressure is achieved. Also, consider consultation with a hypertension specialist.

Treatment of secondary hypertension focuses on correcting the underlying cause and controlling hypertensive effects.

Typically, hypertensive emergencies require parenteral administration of a vasodilator or an adrenergic inhibitor or oral administration of a selected drug, such as nifedipine, captopril, clonidine, or labetalol, to rapidly reduce blood pressure. The initial goal is to reduce mean arterial blood pressure by no more than 25% (within minutes to hours) then to 160/110 within 2 hours while avoiding excessive falls in blood pressure that can precipitate renal, cerebral, or myocardial ischemia.

Examples of hypertensive emergencies include hypertensive encephalopathy, intracranial hemorrhage, acute left-sided heart failure with pulmonary edema, and dissecting aortic aneurysm. Hypertensive emergencies are also associated with eclampsia or severe gestational hypertension, unstable angina, and acute myocardial infarction.

Hypertension without accompanying symptoms or target-organ disease seldom requires emergency drug therapy.

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Source: Professional Guide to Diseases (Eighth Edition), 2005

Hypertensive crisis: Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))

Nitroprusside, nitroglycerin, diazoxide, hydralazine, methyldopa

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Source: Professional Guide to Diseases (Eighth Edition), 2005

Renovascular hypertension: Treatment
(Professional Guide to Diseases (Eighth Edition))

Surgery, the treatment of choice, is performed to restore adequate circulation and to control severe hypertension or severely impaired renal function by renal artery bypass, endarterectomy, arterioplasty or, as a last resort, nephrectomy. Balloon catheter renal artery dilation is used in selected cases to correct renal artery stenosis without the risks and morbidity of surgery. Symptomatic measures include antihypertensives, diuretics, and a sodium-restricted diet.

Medications that may be used in an attempt to control blood pressure include diuretics, beta-adrenergic blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and alpha-adrenergic blockers. Diazoxide or nitroprusside may be given in the hospital if symptoms are acute. Response to medications is highly individual and the dosage or specific drug used may need frequent adjustment.

Lifestyle changes may be recommended, including weight, exercise, dietary adjustments, smoking cessation, and avoidance of alcohol. These habits add to the effects of hypertension in causing complications.

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Source: Professional Guide to Diseases (Eighth Edition), 2005

Pregnancy-induced hypertension: Treatment
(Professional Guide to Diseases (Eighth Edition))

Therapy for preeclampsia is designed to halt the disorder’s progress — specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown — and to ensure fetal survival. Some physicians advocate the prompt induction of labor, especially if the patient is near term; others follow a more conservative approach. Therapy may include complete bed rest to increase placental perfusion, reduce hypertension, and evaluate response to therapy. Antihypertensive therapy doesn’t alter the potential for developing eclampsia. Diuretics aren’t appropriate during pregnancy.

If the patient’s blood pressure fails to respond to bed rest and sedation and persistently rises above 160/100 mm Hg, or if central nervous system irritability increases, magnesium sulfate may produce general sedation, promote diuresis, and prevent seizures. Cesarean birth or oxytocin induction may be required to terminate the pregnancy.

Emergency treatment of eclamptic seizures consists of immediate administration of magnesium sulfate (I.V. drip), oxygen administration, and electronic fetal monitoring. After the seizures subside and the patient’s condition stabilizes, delivery should proceed with induction of labor or cesarean birth, depending upon the circumstances.

Adequate nutrition, good prenatal care, and control of pre-existing hypertension during pregnancy decrease the incidence and severity of preeclampsia. Early recognition and prompt treatment of preeclampsia can prevent progression to eclampsia.

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Source: Professional Guide to Diseases (Eighth Edition), 2005

Pulmonary hypertension: Treatment
(Professional Guide to Diseases (Eighth Edition))

Treatment usually includes oxygen therapy to decrease hypoxemia and resulting pulmonary vascular resistance. It may also include vasodilator therapy (nifedipine, diltiazem, or prostaglandin E). For patients with right-sided heart failure, treatment also includes fluid restriction, cardiac glycosides to increase cardiac output, and diuretics to decrease intravascular volume and extravascular fluid accumulation. Treatment also aims to correct the underlying cause.

Some patients with pulmonary hypertension may be candidates for heart-lung transplantation to improve their chances of survival.

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Source: Professional Guide to Diseases (Eighth Edition), 2005

Pulse pressure, widened: Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))

Ifthe patient’s level of consciousness (LOC) is decreased, and you suspect that his widened pulse pressure results from increased ICP, check his vital signs and oxygen saturation. Maintain a patent airway. Provide supplemental oxygen and ventilatory support to keep the patient’s partial pressure of arterial oxygen above 90 mm Hg or his oxygen saturation above 95%. Give osmotic diuretics, such as mannitol, by I.V. infusion to decrease ICP. Insert an indwelling urinary catheter; monitor intake and output during mannitol therapy. Start ICP monitoring. Administer analgesics as ordered. Hyperventilation therapy to decrease the patient’s partial pressure of arterial carbon dioxide and to treat ICP remains controversial but may be needed for short intervals when ICP and neurologic deterioration increase. Perform a neurologic examination. Use the Glasgow Coma Scale (see page 480) to evaluate LOC. Check cranial nerve function—especially cranial nerves III, IV, and VI—and assess papillary reactions, reflexes, and muscle tone. Continue ICP monitoring. If you don’t suspect increased ICP, ask about associated symptoms, such as chest pain, shortness of breath, weakness, fatigue, or syncope. Check for edema and auscultate for murmurs.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Blood pressure increase [Hypertension]: Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))

Encourage the patient to lose weight, if necessary, and to restrict sodium intake. Suggest that he participate in an exercise or stress management program as well. Then teach the patient how to monitor his blood pressure so that he can evaluate the effectiveness of drug therapy and lifestyle changes. Have him record blood pressure readings and symptoms, and ask him to share this information on his return visits.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Hypertension: Treatment
(Handbook of Diseases)

Secondary hypertension treatment focuses on correcting the underlying cause and controlling hypertensive effects.

The National Institutes of Health recommend the following approach for treating primary hypertension:

❑ First, help the patient initiate necessary lifestyle modifications, including weight reduction, moderation of alcohol intake, regular physical exercise, reduction of sodium intake, and smoking cessation.

❑ If the patient fails to achieve the desired blood pressure or make significant progress, continue lifestyle modifications and begin drug therapy.

❑ For stage 1 hypertension (systolic [SBP] blood pressure 140 to 159 mm Hg, or diastolic blood pressure [DBP] 90 to 99 mm Hg) in the absence of compelling indications (heart failure, postmyocardial infarction, high coronary disease risk, diabetes, chronic kidney disease, or recurrent stroke prevention), give most patients thiazide-type diuretics. Consider using an angioten-sin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), beta-adrenergic blocker (BB), calcium channel blocker (CCB), or a combination.

❑ For stage 2 hypertension (SBP ≥ 60 mm Hg, or DBP ≥ 100 mm Hg) in the absence of compelling indications, give most patients a two-drug combination (usually a thiazide-type diuretic and an ACEI, ARB, BB, or CCB).

❑ If the patient has one or more compelling indications, base drug treatment on benefits from outcome studies or existing clinical guidelines. Treatment may include the following, depending on indication:

❑ Heart failure — diuretic, BB, ACEI, ARB, or aldosterone antagonist

❑ Post myocardial infarction — BB, ACEI, or aldosterone antagonist

❑ High coronary disease risk — diuretic, BB, ACEI, or CCB

❑ Diabetes — diuretic, BB, ACEI, ARB, or CCB

❑ Chronic kidney disease — ACEI or ARB

❑ Recurrent stroke prevention — diuretic or ACEI.

Give other antihypertensive drugs as needed.

❑ If the patient fails to achieve the desired blood pressure, continue lifestyle modifications and optimize drug dosages or add additional drugs until the goal blood pressure is achieved. Also, consider consultation with a hypertension specialist.

UNDER STUDY: Studies have shown that omega-3 fatty acids used in the treatment of hypertension significantly reduce total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels and lower systolic and diastolic blood pressure.

Clinical tip  The treatment for renal artery stenosis includes the use of ACE inhibitors and renal artery stents.

Hypertensive emergencies

Examples of hypertensive emergencies include hypertensive encephalopathy, intracranial hemorrhage, acute left-sided heart failure with pulmonary edema, and dissecting aortic aneurysm. Hypertensive emergencies are also associated with eclampsia and severe pregnancy-induced hypertension, unstable angina, and acute MI.

Typically, hypertensive emergencies require parenteral administration of a vasodilator or an adrenergic inhibitor or oral administration of a selected drug, such as nifedipine, captopril, clonidine, or labetalol, to rapidly reduce blood pressure.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Hypertension, pregnancy-induced: Treatment
(Handbook of Diseases)

Adequate nutrition, good prenatal care, and control of preexisting hypertension with hydralazine during pregnancy decrease the incidence and severity of preeclampsia. Early recognition and prompt treatment of preeclampsia can prevent progression to eclampsia.

Therapy for preeclampsia is designed to halt the disorder’s progress — specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown — and to ensure fetal survival. Some physicians advocate the prompt induction of labor, especially if the patient is near term; others follow a more conservative approach.

Conservative measures

Therapy may include sedatives, such as phenobarbital, along with complete bed rest to relieve anxiety, reduce hypertension, and evaluate response to therapy. If renal function remains adequate, a high-protein, low-sodium, low-carbohydrate diet with increased fluid intake is recommended.

If blood pressure fails to respond to bed rest and sedation and persistently rises above 160/100 mm Hg or if CNS irritability increases, magnesium sulfate may produce general sedation, promote diuresis, reduce blood pressure, and prevent seizures.

Cesarean delivery

If these measures fail to improve the patient’s condition or if fetal life is endangered (as determined by stress or nonstress tests), cesarean delivery or oxytocin induction may be required to terminate the pregnancy.

Treatment for seizures

Emergency treatment of eclamptic seizures consists of immediate administration of I.V. diazepam, followed by magnesium sulfate (I.V. drip), oxygen administration, and electronic fetal monitoring. After the patient’s condition stabilizes, a cesarean delivery may be performed.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Pulmonary hypertension: Treatment
(Handbook of Diseases)

Appropriate treatment usually includes oxygen therapy to decrease hypoxemia and resulting pulmonary vascular resistance. For patients with right-sided heart failure, treatment also includes fluid restriction, cardiac glycosides to increase cardiac output, and diuretics to decrease intravascular volume and extravascular fluid accumulation. An important goal of treatment is correction of the underlying cause.

CLINICAL TIP: Patients with primary pulmonary hypertension usually respond to epoprostenol (PGI2) as a continuous home infusion.

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Source: Handbook of Diseases, 2003

Pulse pressure, widened: Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

If the patient displays increased ICP, continually reevaluate his neurologic status and compare your findings carefully with those of previous evaluations. Stay alert for restlessness, confusion, unresponsiveness, or a decreased LOC. Keep in mind, however, that increasing ICP is commonly signaled by subtle changes in the patient’scondition, rather than the abrupt development of any one sign or symptom.

Patient teaching

Explain needed dietary modifications such as restricted sodium and saturated fats. Stress the importance of planning rest periods. If the patient has a decreased LOC, discuss specific safety measures. If the condition is related to increased body temperature, discuss fever management, proper cooling measures if exposed to excessive heat for long periods, and proper fluid consumption with the patient.

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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Pulse pressure, widened: Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Ifthe patient’s level of consciousness (LOC) is decreased, and you suspect that his widened pulse pressure results from increased ICP, check his vital signs. Maintain a patent airway, and prepare to hyperventilate the patient with a handheld resuscitation bag to help reduce partial pressure of carbon dioxide levels and, thus, ICP. Perform a thorough neurologic examination to serve as a baseline for assessing subsequent changes. Use the Glasgow Coma Scale to evaluate the patient’s LOC. (See Glasgow Coma Scale, page 396.) Also, check cranial nerve function — especially in cranial nerves III, IV, and VI — and assess pupillary reactions, reflexes, and muscle tone. Insertion of an ICP monitor may be necessary. Check for edema and auscultate for murmurs.

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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Pulse pressure, widened: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ If the patient displays increased ICP, continually evaluate his neurologic status.

▪ Be alert for restlessness, confusion, unresponsiveness, or decreased LOC.

▪ Watch for subtle changes in the patient's condition.

Patient teaching

▪ Explain diagnostic tests, such as blood studies, computed tomography scan, and magnetic resonance imaging.

▪ Explain the underlying disorder and treatment plan.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

Blood pressure, increased [Hypertension]: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ If routine screening detects elevated blood pressure, prepare the patient for routine blood tests, urinalysis, and depending on the suspected cause of the increased blood pressure, radiographic studies, especially of the kidneys.

▪ Administer antihypertensives, as ordered, and evaluate their effect.

Patient teaching

▪ Explain the importance of regular blood pressure monitoring and keeping follow-up appointments.

▪ Explain how to take prescribed antihypertensives correctly and adverse effects that should be reported.

▪ Instruct the patient not to discontinue medications without contacting the practitioner.

▪ Emphasize the importance of weight loss and regular exercise.

▪ Explain the need for sodium restriction.

▪ Discuss stress management.

▪ Discuss ways of reducing other risk factors for coronary artery disease, such as smoking cessation and lowering elevated cholesterol levels.

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Source: Nursing: Interpreting Signs and Symptoms, 2007


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