Treatment
Treatment strategies are often difficult because hypertension is an asymptomatic disease.
Patients are not always happy about being told they have a medical problem that could lead to a life-ending event.
Many go through a period of denial and are resistant to education and the best efforts of physicians, but it is important for patients to know early on why they need to be treated and what the appropriate treatment goals should be.
It is critical that patients understand why certain blood pressure goals are chosen and what is necessary to achieve them.
Lifestyle modification should always be utilized to achieve better blood pressure control even when pharmacotherapy is also required.
Patients should be told that most medications only reduce blood pressure by about 10 mm Hg, which is why they may need more than one medication to control their blood pressure.
At the same time, the clinician can also evaluate which pharmacotherapies are appropriate for the individual patient.
Blood pressure medications that are well tolerated and effective make an important difference in risk for cardiovascular events, and frequent use of medicine combinations in single tablets may help facilitate patient compliance.
Renin-angiotensin system blocking drugs as part of a multidrug regimen uniformly reduce risk in patients with heart or kidney disease.
Blood pressure must always be met: in preventing or treating cardiovascular events no drugs are so good that the need for controlled blood pressure is eliminated.
Substantial controversy surrounds pharmacotherapy for blood pressure control. There is even debate about appropriate blood pressure in individual patients and how blood pressure should be lowered.
From an epidemiologic standpoint blood pressures below 120/80 mm Hg are least likely o be associated with cardiovascular events.
Yet it is unknown whether it is appropriate to lower everyone’s blood pressure to this level.
Treatment
