High Blood Pressure, Its Diagnosis and Treatment

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Normal blood pressure is critical for people’s well-being because alterations in it are likely to cause a wide range of issues that affect health conditions. Generally, it is perceived as the force made by blood on the walls of blood vessels and belongs to the vital signs that indicate the state of the life-sustaining functions. Depending on the intensity of the pressure, professionals recognize hypotension, normal blood pressure, and hypertension. In order to find out one’s condition, a person should have his/her blood pressure measured. The results will be defined in two numbers that reveal systolic and diastolic blood pressures. The first one shows how much pressure is exerting when the heartbeats, while the second one focuses on the time when the heart rests.

A lot of people today suffer from high blood pressure nowadays. Weber et al. (2014) indicate that “about one-third of adults in most communities in the developed and developing the world have hypertension” (p. 1). It is the most common chronic health condition that affects the global population. This issue is widely recognized that is why not only primary care professionals but also other practitioners deal with it. This paper will synthesize relevant to the topic information obtained from the current literature to develop and justify various approaches and define the best treatment option.

Professionals indicate that it is critical to pay enormous attention to the patient’s blood pressure levels because they are tightly connected with other health-related issues. For example, because of hypertension, individuals can face cardiovascular problems, strokes, and kidney disease. Those who have a blood pressure of around 115/75 mm Hg are the least likely to deal with the mentioned complications. Increased rates of hypertension are currently observed because of two causes. The first one is the increased age of the individuals, which makes them more vulnerable.

As a rule, it happens with those people who are more than 50-60 years old. It is significant to consult a doctor regularly because this problem can face regardless of other factors. Moreover, diastolic pressure starts to decrease very often, which makes people think that they are fine however systolic pressure may increase during the rest of their life. The second reason is obesity that is among the most critical issues in the USA and other countries. Salt intake can also be a trigger of increases in high pressure that is why it is significant for the patients to pay attention to their diet.

To diagnose hypertension, professionals refer to clinical guidelines such as Clinical Practice Guidelines for the Management of Hypertension in the Community (Weber at al., 2014). According to it, they need to conduct a repeated examination, during which a person’s blood pressure is to be ≥140/90 mm Hg for adults between 18-80 years. For those who are older, systolic blood pressure up to 150 mm Hg is normal. When the issue is revealed, physicians indicate the necessity of treatment, which presupposes various interventions aimed at the reduction of blood pressure.

Professionals state that according to the research studies the best results are 115/75 mm Hg. However, they believe that it is not obligatory to reduce the high blood pressure to these numbers. What is more, there is no evidence that can justify a particular level to which hypertension should be treated. One more drawback deals with the fact that the adult population is considered as a whole while those who are 18-55 years old and those who are older may have more benefit when defining hypertension at different levels and receiving various treatments as their health conditions tend to have lots of discrepancies. For example, Weber et al. (2014) notice that some recent studies recommend addressing hypertension with 130/80 mm Hg for “patients with diabetes or chronic kidney disease” (p. 2). However, no changes in the general guideline were made.

Hypertension is classified into several categories. 120/80 – 139/89 mm Hg is a prehypertension stage that does not require any pharmacological treatment and can be addressed with lifestyle changes. Stage 1 is diagnosed with 140/90 – 159/99 mm Hg, and stage 2 with ≥160/100 mm Hg. Healthcare professionals differentiate primary (essential) and secondary hypertension. The first type of condition is defined in 95% of all cases. Its causes are still unknown, but the situation can be affected by genetic and environmental factors (Revanasiddappaa & Bhadauria, 2013).

In this way, attention should be paid to salt intake, obesity, diet, stiffening of the aorta with age, or high activity of the sympathetic nervous. Secondary hypertension is rarely observed, but its cause can be found so that the possibility to treat the condition exists. As a rule, it deals with chronic kidney disease, pheochromocytoma, “sleep apnea, renal artery stenosis, and hyperaldosteronism” (Börgel et al., 2010, p. 500). Gladding, Patrick, Manley, Mash, and Shepherd (2015) state that hypertension may be inherited in about 65% of all cases. Moreover, a research study was conducted by scientists to identify “a number of genes and single nucleotide polymorphisms… such as ATP2B1 and CYP17A1” (p. 299). Still, the results proved that they affect people’s blood pressure only on 1 mm Hg, which is not critical.

It is impossible to make a diagnosis of hypertension without blood pressure measurement. Healthcare professionals can refer to a conventional sphygmomanometer or by an electronic device. In fact, it is believed that the electronic device is preferable because it reduces the influence of technique variations and observer’s biases. If it is not available, arm cuffs should be used instead of the finger and wrist one’s because they are more accurate. Initially, the pressure should be measured in both arms to obtain the most reliable results. If it differs, the highest results are to be considered.

The measurement should be conducted when the clients emptied their bladders and are sitting in the uncrossed position. The arm used for the measurement should be on the same level as the heart. In addition to that, it is better to maintain two readings after 1-3 minutes. The second one can be done when a patient stands to consider postural changes in the elderly. The diagnosis can be confirmed at the next patient visit in 1-4 weeks. The results obtained during it should also confirm hypertension. Only if the results were initially very high, the diagnosis could be made on the first visit and treatment offered. Of course, these procedures can be maintained only by those professionals who have already received the required treatment and are able to work with related techniques.

It is significant for healthcare professionals to pay attention to the client’s behavior because one can have white-coat hypertension. It deals with the fear and stress people face when they are in the clinic. If this condition is suspected, professionals recommend home readings. What is more, home measurement provides an opportunity to consider changes in blood pressure in relation to treatment and different biases so that more useful treatment approaches can be provided.

Diagnosis procedures should include several elements. Patient evaluation focuses on:

Personal history: previous cardiovascular events, including strokes, chronic kidney disease, diabetes, sleep apnea, etc.
Physical examination: measurement of blood pressure, pulse, body mass index calculation, waist circumference, signs of heart failure, neurologic examination, and eyes.
Selective testing: blood or urine sample, electrocardiography.

Students and professionals can obtain this information from the peer-reviewed articles that can be found online or in a printed version. For this paper, a literature search focused on such databases as ProQuest, PubMed, ScienceDirect, and GoogleScholar. The articles were reached using such key words and phrases as hypertension, high blood pressure, adult population, diagnosis, treatment, genetics, guidelines, losartan, and drug treatment.

All in all, healthcare professionals are expected to manage hypertension and deal with the most critical risk factors for cardiovascular disease. They are targeted at the reduction of blood pressure until it is <140/90 mm Hg for general patients. Some scientists also recommend to reach <130/80 mm Hg for those individuals who have related complications, but this claim is not well-grounded and is rarely considered because of the lack of reliable evidence. To reach positive health outcomes, it is significant to make the patients realize that their treatment is a life-long process that should not be terminated. As a rule, it includes both non-pharmacological and pharmacological approaches. Regardless of the severity of hypertension, healthcare professionals recommend their patients to implement lifestyle interventions. What is more, they are to keep to them constantly because only in this way this issue and other cardiovascular risk factors can be treated.

For example, those individuals who have stage 1 hypertension or less can see improvement in 6-12 months of a new lifestyle. They can even omit taking medicines, which is preferable. However, if patients have more critical issues and it is clear from the very beginning that their blood pressure does not correspond to the lifestyle or there are some other complications (health issues or inability to make regular clinic visits), it is better to start taking medicines earlier. All in all, non-pharmacological treatment is usually used as a complement to pharmacological one. Usually, professionals recommend such lifestyle changes as: Weight loss. Overweight and obesity are those risk factors that increase chances of having hypertension. Reducing their weight, patients are likely to cope with this problem. In addition to that, it can be helpful with diabetes and lipid disorders.

Even modest changes can bring positive results. Still, patients can face difficulties if they receive no support from people around them. It is recommended to eat fresh fruits and vegetables, which can be relatively expensive and inconvenient for patients, unfortunately (Ghezelbash & Ghorbani, 2012). Salt reduction. Many people often eat salty food, which increases their chances to have high blood pressure. What is more critical, many of them even do not realize that they have large amounts of salt every day because it is included in bread, canned products, and other products in which people do not put salt directly. In the same way, their food often lacks potassium. Thus, they need to be educated regarding the appropriate dietary.

Exercise. A regular structured aerobic exercise regimen can help patients to cope with hypertension. Unfortunately, it is not always available, so professionals encourage their clients to integrate physical activities into routines, walk more, use stairs, etc. Alcohol consumption. Males should have up to 2 drinks a day, and females should have 1 drink a day to reduce blood pressure and prevent other cardiovascular events. Greater amounts of alcohol will have the negative impact on their health condition. Stopping smoking. Even though cigarette smoking does not affect blood pressure directly, it is the main cardiovascular risk factor. People should try to discontinue it to enhance their condition. Still, there is a possibility to gain weight, and patients should be aware of it.

If changes in lifestyle turn out to be ineffective and a patient’s blood pressure is >140/90 mm Hg, healthcare professional should start drug treatment. Still, the initial state of hypertension and absence of abnormal risk factors can be used as a reason to delay pharmacological treatment for several months. A 2-drug combination is needed to treat patients with stage 2 hypertension. Individuals who are more than 80 years old and have the blood pressure of ≥150/90 mm Hg should also be treated with medicaments. The effectiveness of the selected treatment can be perceived in 1-8 weeks that is why a change in the dosage or usage of additional drugs is usually maintained in 2-3 weeks after the initial prescription. If the patient’s blood pressure is 20/10 mm Hg higher than needed, professionals recommend using 2 drugs simultaneously (Makridakis & DiNicolantonio, 2014).

Drugs are selected on the basis of various factors. Thus, professionals consider age, other clinical characteristics, and related health conditions. Doses depend on the drugs that they can be long-acting and short-acting. Their availability and affordability are to be discussed because the patient should be able to obtain prescribed medicine. Drugs of several classes can be used to treat hypertension:

Angiotensin-Converting Enzyme Inhibitors. They block the renin-angiotensin system, which affects blood pressure. They are well tolerated and can be used by the majority of patients. Still, it rarely leads to angioedema (e.g. captopril).
Angiotensin Receptor Blockers. They affect the renin-angiotensin system and are well tolerated. Being available, they are often preferred over the angiotensin-converting enzyme inhibitors but cannot be used along with them. They also cannot be used during pregnancy (e.g. losartan).
Diuretics: They can be thiazide and thiazide-like. They reduce blood pressure increasing excretion of sodium. Still, they can have metabolic side effects. They can be combined with other medicines (e.g. hydrochlorothiazide).
Calcium Channel Blockers. These drugs block the inward flow of calcium. They can sometimes lead to peripheral edema. To avoid it, professionals tend to combine them with other drugs (e.g. verapamil).
β-Blockers. They reduce cardiac output and are often prescribed to patients who had myocardial infarction or heart failure even though an ordinary patient is likely to notice a less significant improvement (e.g. propranolol).
α-Blockers. They block arterial α -adrenergic receptors and are rarely used as first-step agents. They are often combined with other drugs, especially diuretics. They are good for men with prostatic hypertrophy (e.g. prazosin).
Centrally Acting Agents. They reduce sympathetic outflow and allow to each positive effects in most patient groups. They can lead to drowsiness and dry mouth but are widely used to reduce blood pressure in pregnancy (e.g. clonidine).
Direct Vasodilators. They are used as fourth-line treatment as a rule because can cause fluid retention and tachycardia (e.g. hydralazine).
Mineralocorticoid Receptor Antagonists. They are usually used in a low dose in treatment-resistant patients and often lead to gynecomastia and sexual dysfunction (e.g. spironolactone).

Of course, different treatment options can be recommended to cope with hypertension, but this paper will focus on the usage of angiotensin receptor blockers, losartan, in particular. This drug prevents blood vessels from narrowing, which allows to improve patient’s condition. What is more critical, this medicine can be used to prevent strokes. Unfortunately, it cannot be used during pregnancy, but an ordinary patient is likely to benefit from such treatment (Meredith, Murray, & McInnes, 2010).

Losartan, just like the majority of other drugs is prescribed by a healthcare professional after a thorough examination. The dose depends on individual’s condition but generally it equals 25-100 mg (Siyad, 2011). For the blood pressure to reduce, a patient should take it for 3-6 weeks. If a dose is missed, no extra one is needed. Professionals recommend taking another dose according to the schedule. Losartan is likely to bring more positive outcomes when being combined with amlodipine. Hong, Park, Kim, Yoon, and Yoon (2012) recommend a “fixed-dose amlodipine/losartan 5 mg /100 mg” (p. 194). Park, Youn, Chae, Yang, and Kim (2012) conducted research that proved that better outcomes are obtained with not with monotherapy but with a combination of camsylate and losartan “5 mg/50 mg, 5 mg/100 mg and 10 mg/50 mg” (p. 46). Thus, it can be claimed that losartan is an appropriate drug for treating hypertension, but it is better to combine it with other medicine to achieve more significant results.

High blood pressure is a critical issue that affects people’s health adversely. To diagnose hypertension, professionals should refer to clinical guideline and assess patient’s condition, paying attention to both systolic and diastolic blood pressure results. However, more emphasis is often made on systolic blood pressure because it is the main factor that can be used to identify cardiovascular diseases and hypertension. The risk of hypertension may increase because of other conditions.

As a rule, it is observed along with lipid issues, diabetes, obesity, cardiovascular diseases, and smoking. Considering the fact that lots of people are affected by this condition, professionals develop numerous diagnosis and treatment approaches that can be used to improve the overall health of the population. To define the most appropriate blood pressure treatment (non-pharmacological or pharmacological one), different factors should be considered including age, other diseases, pregnancy, etc. This paper, for example, recommends a combination of losartan with other drugs.

Healthcare professionals and scientists should pay attention to those diagnosis and treatment approaches that were discussed in this paper because they define what will be advantageous for the patients. They should address those gaps that were identified and try to fill them to improve the knowledge in the sphere and provide others with evidence. A research study should be maintained to consider differences in treatment of young adults and those who are older than 80 years. In addition to that, a particular level to which hypertension should be treated is to be identified. For now, this paper can be used as a basis when examining a patient and developing a diagnosis. Finally, it can help professionals select the most appropriate treatment option.

References

Börgel, J., Springer, S., Ghafoor, J., Arndt, D., Duchna, H., Barthel, A.,… Mugge, A. (2010). Unrecognized secondary causes of hypertension in patients with hypertensive urgency/emergency: prevalence and co-prevalence. Clinical Research in Cardiology, 99(8), 499-506.

Ghezelbash, S., & Ghorbani, A. (2012). Lifestyle modification and hypertension prevention. ARYA Atherosclerosis, 8, S202-S207.

Gladding, P.,Patrick, A., Manley, P., Mash, L., & Shepherd, P. (2015). Personalized hypertension management in practice. Personalized Medicine, 12(3), 297-311.

Hong, B., Park, G., Kim, S., Yoon, H., & Yoon, J. (2012). Comparison of the efficacy and safety of fixed-dose amlodipine/losartan and losartan in hypertensive patients inadequately controlled with losartan. American Journal of Cardiovascular Drugs, 12(3), 189-95.

Makridakis, S., & DiNicolantonio, J. (2014). Hypertension: empirical evidence and implications in 2014. Open Heart, 1(1), 1-8.

Meredith, P., Murray, S., & McInnes, T. (2010). Comparison of the efficacy of candesartan and losartan: a meta-analysis of trials in the treatment of hypertension. Journal of Human Hypertension, 24(8), 525-31.

Park, G., Youn, H., Chae, C., Yang, J., & Kim, H. (2012). Evaluation of the dose-response relationship of amlodipine and losartan combination in patients with essential hypertension. American Journal of Cardiovascular Drugs, 12(1), 35-47.

Revanasiddappaa, M., & Bhadauria, D. (2013). The role of genetics in hypertension. Clinical Queries: Nephrology, 2(3), 120-125.

Siyad, A. (2011). Hypertension. HYGEIA: Journal for Drugs and Medicines, 3(1), 1-16.

Weber, M., Schiffrin., E., White., W., Mann, S., Lindholm, L., Kenerson., J.,…Harrap, S. (2014). Clinical practice guidelines for the management of hypertension in the community a statement by the American society of hypertension and the international society of hypertension. The Journal of Clinical Hypertension, 1, 1-13.

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High Blood Pressure, Its Diagnosis and Treatment

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