Hypertension Management Guidelines Handout

What is high blood pressure?

Hypertension, commonly known as high blood pressure, is a chronic medical condition characterized by persistently elevated pressure within the blood vessels. It occurs when the force of blood against the artery walls is consistently higher than normal. An estimated 1.28 billion of the adult population has hypertension (World Health Organization, 2023).

Blood pressure (BP) is measured using systolic blood pressure (when the heart beats) and diastolic blood pressure levels (when the heart rests between beats). In adults, hypertension is generally defined as elevated systolic BP consistently at or above 130 mmHg and/or diastolic BP at or above 80 mmHg, where the normal blood pressure rests at 120/80 mmHg.

Causes of hypertension

Most cases of hypertension are classified as primary or essential hypertension, which develops gradually over time without a single identifiable cause. Key risk factors include:

1. Age: Blood pressure tends to rise as we get older.
2. Family history: Genetic factors play a significant role.
3. Obesity: Excess weight increases strain on the heart and blood vessels.
4. Sedentary lifestyle: Lack of physical activity is linked to higher blood pressure.
5. Alcohol consumption: Regular, heavy drinking can lead to hypertension.
6. Stress: Chronic stress may contribute to elevated blood pressure.

High blood pressure also sometimes results from an underlying condition or medication. Common causes in these cases include the following:

1. Chronic kidney disease
2. Cardiovascular disease
3. Hormonal disorders (e.g., thyroid problems, Cushing’s syndrome)
4. Obstructive sleep apnea
5. Certain medications (e.g., birth control pills, decongestants, some pain relievers)
6. Illegal drugs (e.g., cocaine, amphetamines)

Hypertension treatments and management strategies

Effective management of hypertension often requires a multi-faceted approach, combining lifestyle modifications with medical interventions when necessary. Here are key strategies for treating and managing hypertension discussed in clinical practice guidelines:

Lifestyle modifications

Lifestyle changes are often the first-line approach in managing hypertension. These include adopting a heart-healthy, reducing sodium intake, increasing physical activity, maintaining a healthy weight, limiting alcohol consumption, and managing stress.

Medications

When lifestyle modifications are insufficient, antihypertensive drug therapy is often prescribed. Common classes of antihypertensive medications include diuretics, ACE inhibitors, ARBs, calcium channel blockers, and beta-blockers. The choice of BP-lowering medications depends on various factors, including the patient's age, race, comorbidities, and potential side effects.

Physical devices and interventions

Physical devices and interventions may be considered for patients with resistant hypertension. This usually includes baroreceptor activation therapy, which involves implanting a device to stimulate baroreceptors in the carotid artery. While these interventions show promise, they are typically reserved for cases where conventional treatments have failed and should be performed by specialists in hypertension management.

Regular monitoring and follow-up

Consistent blood pressure monitoring is crucial for effective hypertension management. This includes regular check-ups, home blood pressure monitoring, and occasionally 24-hour ambulatory blood pressure monitoring.

Patient education and self-management

This includes educating patients about the risks associated with hypertension, the importance of medication adherence, and how to interpret their blood pressure readings. Teaching self-management skills, such as how to make sustainable lifestyle changes and when to seek medical attention, can lead to better blood pressure control, achieving the target blood pressure, and reducing complications.

How to use our guidelines for hypertension management

This handout is designed to be a quick reference tool for health care professionals managing patients with hypertension. Here's a step-by-step guide on how to integrate this resource into your practice:

Step 1: Familiarize yourself with the content

Take time to review the handout thoroughly. Understand the key sections, including the definition of hypertension, risk factors, treatment strategies, and monitoring recommendations.

Step 2: Use during patient consultations

Keep the handout readily accessible during patient visits. It can be a visual aid when explaining a clinical practice guideline to patients or a quick reference when deciding on treatment plans.

Step 3: Personalize recommendations

While the handout provides general guidelines, it is used as a starting point to tailor advice to each patient's specific needs to manage their elevated BP, considering their medical history, including possible cardiovascular diseases and other conditions, lifestyle, and preferences.

Step 4: Encourage patient engagement

Share relevant handout sections with patients to promote their understanding and involvement in their care. This can help improve treatment adherence and lifestyle modifications.

Reference

World Health Organization. (2023). Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension