Hypertension Treatment: How to Find Best Approach to High Blood Pressure? (9)
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Hypertension Treatment: How to Find Best Approach to High Blood Pressure? (9)

August 30, 2019


Hypertension is often silent.
Dr. Anton Titov MD People are not aware of their high blood pressure
until stroke or heart attack happens. What is the best way to treat hypertension? What principles of high blood pressure treatment
do you apply in your medical practice? Yes. You are right. People often do not have good control of their
blood pressure. We have so much data linking high blood pressure
especially to stroke. Hypertension also causes kidney problems. Hypertension is linked to definite heart attacks
a little bit less. But high blood pressure causes hypertensive
heart disease, where the heart muscle gets thicker. In patients with hypertension heart muscle
becomes more rigid and less compliant. It is always remarkable that even today in
the United States 25% of people with hypertension do not have good control of their high blood
pressure. Treatment of hypertension is so basic but
many people do not succeed in its treatment. What is the best way to treat hypertension? First step is to know how high is your blood
pressure. We live in era when everyone has equipment
to measure blood pressure. It’s very easy for patients to check their
blood pressure. I always tell my patients: don’t go crazy
checking blood pressure Check your blood pressure about three times per week. Check blood pressure in different circumstances. Sometimes you have been very busy and active. Sometimes you are under stress. Check it once. Is it useful to check blood pressure on both
arms? Difference of blood pressure results between
two arms has been linked to higher risk of death. A large difference in blood pressure results
between two arms can indicate a problem in the aorta or blockage in different blood vessels. So absolutely, check blood pressure in both
arms at the same time at least the first time you take blood pressure measurement. We also want people to check their blood pressure
in the morning when they wake up. People also should check blood pressure when
they are under stress. Check your blood pressure also when you are
relaxed. Blood pressure is similar to LDL cholesterol. The lower level of blood pressure – the better
for your health. Same is true with LDL cholesterol levels. So lower blood pressure results mean lower
risk of stroke. It is important not to make blood pressure
so low that people have symptoms. If the blood pressure is too low, people may
feel dizzy or they may have blurred vision. Or they feel they are about to pass out. We don’t need to make blood pressure very
low by using medications. People should be really mindful of how they
eat. They should keep their weight in good order. People also should be really fit. By doing these three things they can help
themselves a huge amount. I always tell my patients a sad story. It is a story about a man who always had very
high blood pressure. His hypertension was very difficult to treat. And I always said to him: “I am worried about
your diet.” And he always replied: “My diet is great.” Then unfortunately one day this man had a
stroke. After stroke he could not eat on his own. His hand was paralyzed. Since that time we never had a problem with
his blood pressure. Never. Not once. It is possible that stroke changed something
in his brain. But there is a better explanation of his normal
blood pressure after stroke. What he ate after stroke was controlled by
others and the food became more healthy. So often there is a strong dietary component
to hypertension. We have strong medications at our disposal
to treat hypertension. In some people with resistant hypertension
we need to use three and four medications. But almost always we can get patient’s blood
pressure under control. What are examples of medicines we use today
to treat hypertension Carvedilol is a nonselective beta blocker and also an alpha blocker. Carvedilol can be very helpful to treat high
blood pressure. Medicines that antagonize aldosterone are
useful to treat hypertension. For example, Spironolactone or Eplerenone
also can be very very helpful to treat hypertension in difficult cases Technology of renal denervation
received a lot of attention recently. Can you put a catheter into the renal artery
and can you apply radiofrequency ablation? Ablation of sympathetic nerves around renal
artery can decrease the sympathetic nervous system drive from the renal arteries. Many studies on renal denervation have been
done. Very careful studies in animals showed renal
sympathetic denervation would have a good effect. There were also small trials in humans that
look like renal denervation was very effective. These trials were not “blinded” But “blinded”
clinical trial did not show a good effect of renal denervation procedure on lowering
high blood pressure. Maybe one day we will know more about that
technology.

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  1. Carvedilol can be very helpful to treat high blood pressure. Medicines that antagonize aldosterone are useful to treat hypertension. For example, Spironolactone or Eplerenone also can be very very helpful to treat hypertension in difficult cases Technology of renal denervation received a lot of attention recently. Can you put a catheter into the renal artery and can you apply radiofrequency ablation? Ablation of sympathetic nerves around renal artery can decrease the sympathetic nervous system drive from the renal arteries. Many studies on renal denervation have been done. Very careful studies in animals showed renal sympathetic denervation would have a good effect. There were also small trials in humans that look like renal denervation was very effective. These trials were not "blinded" But "blinded" clinical trial did not show a good effect of renal denervation procedure on lowering high blood pressure. Maybe one day we will know more about that technology.

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