Guest Author - Denise Howard, M.D., M.P.H.

Hypertension is defined as blood pressure greater than 140/90. There are two types: Benign Essential Hypertension and Secondary Hypertension. Once hypertension is diagnosed a thorough evaluation is indicated to discover possible causes of secondary hypertension. Identifying an underlying cause may lead to a definitive cure of the hypertension. The underlying cause may also be another major medical problem which could potentially be life threatening. Finally the evaluation could identify some damage already done by the high blood pressure which might require immediate intervention or more aggressive treatment to prevent premature death or disability.

The evaluation should first consist of a thorough history and physical examination. The urine is analyzed for the presence of kidney disease. Blood work is also drawn to evaluate kidney function and other medical problems such as diabetes and elevated cholesterol. An EKG is done to evaluate the condition of the heart. It may reveal evidence of heart failure, abnormal rhythm or an unrecognized heart attack. Other test may include a detailed eye examination looking for damage to the retina. Other scans or special test maybe ordered to look for arterial aneurysms and kidney function.

Treatment for secondary hypertension is dependent on the underlying cause. Benign essential hypertension is treated with medication and lifestyle changes. Medicines are designed to control the blood pressure with minimal side effects. There are many medications available with varying cost, effects, and side effects. The medications fall into different categories. Commonly used medications include diuretics (such as hydrochlorthiazide), Beta blockers (such as atenolol and labetolol), Calcium channel blockers (such as verapamil and diltiazem), and ACE inhibitors (such as Captopril and and Lisinopril). Sometimes combination treatment is required to control the blood pressure and usually they will be from the different categories.

Life style changes are also effective. Significant weight loss in an obese individual can result in normalization of the blood pressure and no further need for the hypertensive medication. Salt restriction is an important aspect of blood pressure control. Regular aerobic exercise is effective in blood pressure control. In addition to exercise, dietary changes can control or prevent hypercholesterolemia and diabetes. All of these changes are beneficial in decreasing the risk of heart disease.

Those who have hypertension, hypercholesterolemia and diabetes are at significant risk of developing heart disease. If you have these conditions then controlling them all is crucial to prevent heart disease and other complications. We all must die of something but the goal is to maintain the quality of life. Controlling hypertension allows you to achieve this goal.