Treatment of arterial High Blood Pressure

Hypertension treatment not only consists of taking medication, but in fact making lifestyle changes is just as important as taking pharmaceuticals, if not more so. As such, patients with high blood pressure are advised to:

In addition to lifestyle changes, which should always be implemented, most patients also need to take antihypertensive medication.

The greatest benefit derived from antihypertensive drugs is the very fact that they reduce blood pressure. However, the degree of hypertension, whether any organs are affected and, ultimately, the risk of developing any cardiovascular complications are the factors that will determine which medications are best suited to reducing each specific patient’s blood pressure.

Frequently, more than two drugs are required to bring the patient’s blood pressure down to normal values. It is better when these two-drug combinations are taken as just a single tablet (fixed combination) rather than two tablets (one for each medication).

There are now some alternative therapies for patients with what is known as resistant hypertension; that is, cases where the blood pressure cannot be reduced to normal levels despite implementing appropriate lifestyle changes and taking a suitable combination of at least three full dose antihypertensives.

Doctors must always ensure that lifestyle changes have been incorporated correctly, the patient is complying with the treatment regimen and there are no other factors contributing to uncontrolled hypertension, such as interaction with other medicines (e.g., anti-inflammatories) or sleep apnoea.

The possibility that treatment is not working because of a specific underlying disease that increases blood pressure must also be taken into consideration. Such cases are known as secondary hypertension and may be due to the consumption of illicit drugs (e.g., cocaine), tumours that produce hypertensive substances, etc.

In a few very specific cases, and which have not yet been studied in any depth, there are two new types of interventional therapy for patients with resistant hypertension:

• Carotid baroreceptor stimulation. This technique consists in the permanent electrical stimulation of the carotid sinus nerves (located in the neck) by means of a device implanted under the skin (like a pacemaker). In addition to the slight risk associated with the operation, the system is very expensive and does not work in all patients.

• Renal denervation. Bilateral destruction of nerves running along the renal artery using a radiofrequency ablation catheter inserted percutaneously (by means of a patch attached to the skin which allows certain substances to pass through to the dermal capillaries). Apparently, this technique works in some patients. It is an expensive system and its effectiveness has not been tested thoroughly.