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Hypertension is often called the "silent killer" because of its nearly unnoticeable symptoms and its deadly impact. Hypertension is defined as having consistent blood pressure readings above 140/90, either in one or both of the numbers. The first number, 140, represents the pressure that the blood exerts on the walls of the arteries while the heart is contracting; it is called the systolic blood pressure. The second number, 90, refers to the pressure that the blood exerts on the walls of the arteries when the heart is resting and filling with blood. This number is called the diastolic blood pressure. A blood pressure reading is always written as systolic blood pressure over diastolic blood pressure, or systolic/diastolic (140/90). Optimal blood pressure is defined as a reading lower than 120/80 for both numbers.

Causes and Risk Factors for Hypertension

It is critical that people have annual check-ups that include blood pressure readings. Knowing your blood pressure will help you identify your risk factors more accurately, and may also provide some motivation to improve some risk factors. Common risk factors that contribute to the development of hypertension include: smoking, high cholesterol, diabetes, age (above 60), male gender, family history, organ damage (i.e. heart disease, stroke, kidney disease).

A Widespread Problem

Only about 25% of all people receiving treatment for hypertension are able to control their blood pressure to a level below 140/90. In addition, it is estimated that about 33% of the fifty million Americans with hypertension don't even know they have it. Clearly, hypertension is a very common disorder that often goes unnoticed.

The Impact of Hypertension

High blood pressure, or hypertension, is a major risk factor for heart disease and stroke which are the first and third leading killers in the United States, respectively. Numerous studies have proven that high blood pressure can increase the risk of developing coronary artery disease, congestive heart failure, and stroke. High blood pressure has also been linked to an increased incidence of kidney failure in people with or without diabetes.

Lifestyle Changes for the Prevention/Treatment of Hypertension

As one might expect, lifestyle changes that prevent/treat hypertension involve eliminating as many risk factors as possible. It is recommended that anyone with hypertension modify their lifestyle. The following is a list of lifestyle changes that are effective in the treatment/prevention of hypertension:

1. Quit Smoking
2. Lower High Blood Cholesterol
3. Adequately Control Blood Sugar In Those With Diabetes
4. Lose Excess Weight (weight loss can enhance effectiveness of blood pressure lowering medications)
5. Limit Alcohol Use (no more than 2 drinks per day, or 1 drink per day in women and small men)
6. Aerobic Exercise (30-45 minutes 3 days per week)
7. Limit Sodium Intake (for stage 1 hypertension, limit to 2.4 grams daily)
8. Adequate Potassium Intake (about 3.5 grams daily)

Drug Therapy to Prevent/Treat Hypertension

Cardiovascular risk must be considered when deciding on the type of treatment for hypertension. Three risk groups have been created that, when considered along with blood pressure, assist in the decision of drug therapy. The following is a list of "Cardiovascular Risks" and "Conditions" that are used to determine what risk group a person belongs to.

Cardiovascular Risks:

1. Smoking
2. High Blood Cholesterol
3. Diabetes
4. Age above 60 years
5. Male, or post-menopausal Female
6. Family History of Heart Disease

Conditions:

1. Left Ventricular Hypertrophy
2. Angina (chest pain)
3. Prior Heart Attack
4. Prior Coronary Revascularization
5. Heart Failure
6. Stroke or "mini stroke" (transient ischemic attack)
7. Nephropathy (kidney damage)
8. Peripheral Arterial Disease
9. Retinopathy (eye damage)

Based upon the preceding risk factors, criteria are used to determine the appropriate risk group:

1. Risk Group A -- no cardiovascular risk factors and no conditions.
2. Risk Group B -- at least one cardiovascular risk factor, no conditions, and no diabetes.
3. Risk Group C -- at least one condition, and diabetes (cardiovascular risk factors negligible).

By cross referrencing your risk group with your blood pressure, the list below can give you a good idea of what kind of treatment approach may be best for you. It is important to mention that treatment options should be discussed with a doctor, and in no way should this information be the only information that is considered.

Blood Pressure	Risk Group A	Risk Group B	Risk Group C
(130-139)/(85-89)	Lifestyle Modification	Lifestyle Modification	*Drug Therapy (only if heart failure, kidney insufficiency, or diabetes)
(140-159)/(90-99)	*Drug Therapy (begin only within one year of lifestyle change if blood pressure remains uncontrolled)	*Drug Therapy (Begin within 6 months of lifestyle change if blood pressure remains uncontrolled)	Drug Therapy and Lifestyle Modification
(160+)/(100+)	Drug Therapy and Lifestyle Modification	Drug Therapy and Lifestyle Modification	Drug Therapy and Lifestyle Modification

* All drug therapies should be accompanied by appropriate lifestyle modifications.

When drug use is indicated for the treatment of hypertension, then a decision has to be made as to what type of antihypertensive agent to employ. There are five different categories of drugs, each with their own drugs that may be better or worse depending on the individual and the nature of the drug. The drug categories include:

1. Diuretics
2. Alpha/Beta Adrenergic Blockers
3. ACE Inhibitors (including Angiotensin Receptor Blockers)
4. Calcium Channel Blockers
5. Vasodilators

Usually, diuretics are the first choice in treatment. They work by promoting the elimination of water and sodium from the body. Subcategories of diuretics include; loop diuretics, thiazide diuretics, and potassium-sparing diuretics.

ACE (Angiotensin Converting Enzyme) Inhibitors are very effective drugs that result in the relaxation of blood vessels, thus causing a decrease in blood pressure. Sometimes side effects like coughing can result from the use of ACE inhibitors, in which case, switching to another ACE inhibitor or to an Angiotensin Receptor Blocker may be beneficial.

Alpha/Beta Adrenergic Blockers can be very effective drugs, and differ greatly according to their receptor specificity. Some drugs are very selective for certain types of Beta receptors, causing them to be very cardioselective. Other organ systems throughout the body are not affected as easily with the use of cardioselective drugs. In addition, cardioselective drugs are better options for people with diabetes since non-cardioselective beta blockers can impair the function of the pancreas (the organ that produces insulin).

Calcium channel blockers can also be useful in managing hypertension. It is important to mention that their effectiveness can vary greatly depending on whether they are a long-acting or short-acting calcium channel blocker. In general, short-acting calcium channel blockers are not recommended for the treatment of high blood pressure since their effectiveness tends to be somewhat erratic and are linked to serious adverse effects.

More than 6 million people in the United States take calcium channel blockers. Within the past five years, concerns have been raised regarding the safety of calcium channel blockers. It was thought that calcium channel blockers may increase the risk of heart attack, but these claims remain unsubstantiated.

The decision of what medication to use to help control hypertension can be very difficult. Every drug is associated with its own set of problems and special concerns. Calcium channel blockers can cause side effects that are difficult to tolerate, while diuretics require close monitoring and can cause fluid and electrolyte imbalances. Beta blockers may be effective, but can cause side effects such as depression in some people. And although effective, ACE inhibitors must be used with caution in people with compromised kidney function, which includes the majority of elderly people.

To seek more information regarding the proper drug therapy for hypertension please consult the AgeNet drug reviews below. They give a good summary of the benefits and risks associated with each form of therapy. In any case, treatment options should be discussed with a knowledgeable doctor in order to determine what option may be most effective and the least detrimental.

We hope this review has provided you with information to help you become informed about the prevention/treatment options for hypertension.

Diuretics

Loop Diuretics	Cost	Manufacturer	Generic	Cost
Lasix	$$	brand	Furosemide	$
Bumex	$$$	brand	Bumetanide	$$

Thiazide Diuretics	Cost	Manufacturer	Generic	Cost
Hydrochlorothiazide	$	brand	Hydrochlorothiazide	$
Hygroton	$	brand	Chlorthalidone	$
Zaroxolyn (Metolazone)	$$	brand	no	na
Lozol	$$$	brand	Indapamide	$$

Potassium-Sparing Diuretics	Cost	Manufacturer	Generic	Cost
Aldactazide*	$	brand	Spirinolactone/HCTZ	$
Aldactone	$	brand	Spirinolactone	$
Dyazide/Maxzide*	$	brand	Triamterene/HCTZ	$

* This drug is a combinational drug that includes a potassium-sparing diuretic and a thiazide diuretic.

Alpha/Beta Adrenergic Active Drugs

Alpha Blockers	Cost	Manufacturer	Generic	Cost
Cardura	$$$	brand	Doxazosin	$$
Minipress (Prazosin)	$$	brand	no	na
Tenex (Guanfacine)	$$	brand	no	na

Centrally-Acting Antihypertensive Agents	Cost	Manufacturer	Generic	Cost
Catapres	$$	brand	Clonidine	$
Aldomet	$$	brand	Methyldopa	$
Serpasil	$$$	brand	Reserpine	$

Beta Blockers (cardioselective)	Cost	Manufacturer	Generic	Cost
Lopressor	$$	brand	Metoprolol	$
Tenormin	$$	brand	Atenolol	$

Beta Blockers (non-cardioselective)	Cost	Manufacturer	Generic	Cost
Inderal	$	brand	Propanolol	$
Normodyne*	$$	brand	Labetolol	$

* This drug interacts with both alpha and beta-adrenergic receptors.

ACE (Angiotensin Converting Enzyme) Inhibitors

ACE Inhibitors	Cost	Manufacturer	Generic	Cost
Capoten	$$	brand	Captopril	$
Accupril (Quinapril)	$$	brand	no	na
Prinivil (Lisinopril)	$$	brand	no	na

Angiotensin Receptor Blockers

Drug	Cost	Manufacturer	Generic	Cost
Cozaar (Losartan)	$$$	brand	no	na

Calcium Channel Blockers

Benzothiazepine Ca-Channel Blockers	Cost	Manufacturer	Generic	Cost
Cardizem	$$$	brand	Diltiazem	$$
Tiazac	$$$	brand	Diltiazem CD	$$
Dilacor XL	$$$	brand	Diltiazem XL	$$

Dihydropyridine Ca-Channel Blockers	Cost	Manufacturer	Generic	Cost
Adalat CC	$	brand	Nifedipine	$
Calan	$	brand	Verapamil	$
Norvasc (Amlodipine)	$$	brand	no	na

Vasodilators

Vasodilators	Cost	Manufacturer	Generic	Cost
Apresoline	$	brand	Hydralazine	$

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