Medication for hypertension management
Hypertension is a major risk factor for cardiovascular disease, heart failure, vascular dementia and chronic kidney disease, and the management of hypertension combines both lifestyle and pharmacological interventions. Guidelines are available nationally and internationally to support these approaches to managing blood pressure and reducing cardiovascular risk. This article discusses the diagnosis and management of hypertension, along with the role of medication to lower blood pressure. Particular consideration is given to the place for different drug treatments based on their mode of action, specific indications and potential side effects. By the end of this article, readers should be able to review how different types of hypertension are diagnosed; compare national and international guidelines; consider the different types of medication most commonly used in hypertension; and evaluate the mode of action and how this influences indication for use and possible side effects.
According to the National Institute for Health and Care Excellence (NICE, 2019a), the definition of hypertension is ‘persistently raised arterial blood pressure’. However, use of the term ‘raised’ is open to interpretation, as the range of normal blood pressure (BP) readings in the general population is widely distributed, and comorbidities such as chronic kidney disease can affect recommended targets (NICE, 2021).
In its guideline on hypertension diagnosis and management, NICE states that exceeding an upper limit of 140 mmHg systolic BP and/or 90 mmHg diastolic BP is when a diagnosis of hypertension should be suspected. Home blood pressure monitoring is recommended as the preferred method of confirming the diagnosis. Wherever the BP is measured, and whoever is doing it, correct technique should be used and repeated measurements taken to confirm the accuracy of the readings (Nitzan et al, 2017).
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