Treatment of Hypertension: A Review

Abstract

Hypertension is the most common modifiable risk factor for death and disability including stroke, accelerated coronary and systemic atherosclerosis, heart failure, chronic kidney disease, lowering the BP with antihypertensive drugs, and reducing the target organ damage and prevalence of the occurrence of cardiovascular disease. According to the 2017 American college of cardiology (ACC)/American heart association (AHA) hypertension guidelines hypertension is defined as systolic BP is ≥130 mmHg or diastolic BP is ≥80 mmHg. BP should be lower than 130/80 mmHg in patient with CHD, CHF, after renal transplantation, diabetes mellitus and stroke. Recommended lifestyle modification included restriction of dietary sodium intake, weight loss if patient is overweight, regular exercise, moderate alcohol intake and increase consumption of potassium rich foods. The initial antihypertensive agent should be generally selected from one of the following four classes—thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers, shown to reduce cardiovascular events. There are two interventional approaches—Renal Denervation and Baroreflex activation therapy, which are used in clinical practice for treatment of several treatment resistant hypertensions. Other interventional approaches are carotid body ablation and AVF placement but none of them prevent cardiovascular disease outcome or death in hypertensive patient.