How is high blood pressure (hypertension) managed?

Thomas Li, MD
Internal Medicine
High blood pressure, or hypertension, is a common condition that can have many causes. In this video, Thomas Li, MD, in Advanced Internal Medicine of Rose Medical Center in Denver describes how the cause of hypertension determines its treatment.
High blood pressure can be managed with lifestyle changes, such as reduced sodium (salt) intake, exercise, and a healthy diet. It may also be managed with medication.
High blood pressure or hypertension is usually managed with a combination of lifestyle modifications and medications. Lifestyle modifications include maintaining a healthy weight, eating a healthy diet (DASH diet), exercising on a regular basis, avoiding tobacco use and limiting caffeine and alcohol intake. Medications would be prescribed by your physician if these measures were not sufficient to control your blood pressure. There are a variety of medications, and selection would be guided by any other health issues you may have. As high blood pressure is a risk factor for heart disease, you should be monitored for any other possible risk factors such as diabetes or high cholesterol. High blood pressure can affect other organs such as the eyes, brain and kidneys, so these should be monitored as well.
Suzanne Steinbaum, DO
Cardiology (Cardiovascular Disease)
The lifestyle choices we make are critical to managing high blood pressure; diet and exercise are key, followed by medication, if directed. Watch as cardiologist Suzanne Steinbaum, DO, discusses how to manage hypertension and why it's important.
Sameer A. Sayeed, MD
Cardiology (Cardiovascular Disease)
High blood pressure can be managed with medications in most cases, especially if it is due to age and hardening of the arteries. In some rarer cases, high blood pressure is caused by problems within the kidney or adrenal glands or from some other endocrine abnormality and in this case, treating the underlying cause may help. Renal artery stenosis or narrowing of the kidney arteries can also cause high blood pressure and this can be treated with a balloon angioplasty where a balloon is inserted into the renal artery and used to dilate the artery back to a normal diameter. Sometimes, high blood pressure can be due to a problem in the nervous system where the nerves connect to the arteries of the kidneys and by eliminating this condition with ablation, this type of high blood pressure can be treated.
Judy Caplan
Nutrition & Dietetics
There are many ways to manage hypertension. Since it sometimes has no symptoms, you need to check your pressure regularly. You need to be under the care of a physician who will determine if you need medication and a low sodium diet. Once those are determined and no underlying other causes are found, eating a healthy plant based diet and regular exercise are recommended.
Jessica Crandall
Nutrition & Dietetics

Blood pressure is often associated with sodium intake for many people. If this is the case for you, a low sodium diet is recommended (1500 mg/day). Please speak with your dietitian to figure out how to implement this into your lifestyle.

Intermountain Healthcare
Administration
Typically there are 2 main ways: lifestyle changes, and medication when needed.

In most cases it is recommended that someone with high blood pressure first try a few months of diet modification (the DASH diet is helpful) and cardiovascular exercise. After 2-3 months of this if satisfactory reduction in blood pressure is not accomplished, then medications should be added. I like to try to use medications that have no / few side effects, are inexpensive, and most importantly that work. Sometimes if blood pressure is exceptionally high, medication in addition to lifestyle changes is advised right away. With persistence and diligence to a doctor-recommended regimen most individuals can get their blood pressure under control.
 
RealAge
Administration

About 75 million adults in the United States (1 in 3 adults) have high blood pressure, but a quarter of these people don't know they have the condition. There are a number of self-care techniques you can use to manage your high blood pressure, including losing weight, exercising regularly, increasing your intake of potassium-rich foods, avoiding salt if you are salt sensitive and practicing relaxation techniques. Your doctor may ask you to check your blood pressure regularly at home using a blood pressure monitoring device. Your doctor may also prescribe medication, such as an ACE inhibitor or beta blocker, to lower your high blood pressure.

Amy Jamieson-Petonic
Nutrition & Dietetics

High blood pressure may be managed with a combination of medications that help improve blood flow, as well as a healthy diet such as the DASH Diet. Dash stands for Dietary approaches to Stop Hypertension. This diet is high in fruits, vegetables, lean proteins and low fat diary. The DASH diet has been shown in research to help lower blood pressure with or without medication.

According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the following guidelines should be followed for the treatment of hypertension or high blood pressure:
  • Normal blood pressure: Systolic pressure (mm Hg) less than 120 and diastolic pressure (mm Hg) less than 80: Lifestyle changes encouraged to maintain normal levels.
  • Prehypertension: Systolic pressure (mm Hg) 120 -- 139 and diastolic pressure (mm Hg) less than 80 - 89: Lifestyle changes are necessary. Drugs are given for compelling indications (diabetes, chronic kidney disease, previous heart attack, heart failure, previous stroke, high cardiac risk).
  • Stage 1 hypertension: Systolic pressure (mm Hg) 140 -- 159 and diastolic pressure (mm Hg) less than 90 - 99: Lifestyle changes are necessary. Thiazide diuretics are used for most people. Consider other blood pressure drugs alone or in combination. Drugs are indicated for compelling indications (diabetes, chronic kidney disease, previous heart attack, heart failure, previous stroke, high cardiac risk).
  • Stage 2 hypertension: Systolic pressure (mm Hg) 160 or higher and diastolic pressure (mm Hg) 100 or higher: Lifestyle changes are necessary. Two or more blood pressure drugs are given for most people. Drugs are indicated for compelling indications (diabetes, chronic kidney disease, previous heart attack, heart failure, previous stroke, high cardiac risk).
Note: When systolic and diastolic pressures fall into different categories, physicians rate overall blood pressure by the higher category. For example, 150/85 mm Hg is classified as stage 1 hypertension, not prehypertension.
Laura Motosko, MSEd, RD
Nutrition & Dietetics

Diet, exercise and medications are used to treat high blood pressure. I recommend the DASH (Dietary Approaches to Stop Hypertension) diet developed by the National Heart, Lung and Blood Institute. The DASH diet has been shown to be effective in reducing blood pressure. The nutrient dense DASH diet promotes whole grains, low fat dairy products, poultry, fish, and nuts with limited added salt in your diet, high sodium packaged and processed foods, red meat, sweets, saturated fat and sweetened beverages.

Lona Sandon
Nutrition & Dietetics

Managing blood pressure typically requires a combination of strategies: lifestyle, diet, and medication.  Adopting a DASH diet is just one piece of the puzzle to help manage your blood pressure. The DASH diet is a way of eating that helps you increase the nutrients you need for a healthy blood pressure while lowering the nutrients you need less of.  It may even help you lose weight which also helps lower blood pressure.  You can get started on the DASH diet by visiting this website: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/introduction.html.  A Registered Dietitian can also help you create a DASH diet plan just for you.  To find a Registered Dietitian, visit www.eatright.org.

Teneisha C. Davis, MD
Family Medicine

Hypertension is managed by two methods, lifestyle modifications and medications.  Sometimes patients are able to lower their blood pressures with lifestyles changes, but most patients need medication in addition to the latter to help lower their blood pressures.

Lifestyle modifications include: reducing the amount of salt in one's diet; losing weight if someone is overweight or obese; avoiding drinking alcohol in excess; smoking cessation; and exercising for a minimum of 30 minutes per day most days of the week. 

If lifestyle changes are not enough a patient may be placed on anti-hypertensive medications to help lower their blood pressure. 

Johns Hopkins Medicine
Administration

The first line of treatment for high blood pressure (hypertension) involves adopting healthy lifestyle measures. Mild hypertension may respond positively to these measures and require no further medical therapy.

Some studies indicate that as many as 30 percent of those with high blood pressure (specifically, the type known as sodium-sensitive hypertension) can control it by lowering their salt intake.

If lifestyle changes prove inadequate, your doctor may prescribe one or more of the many available medications. Here are the "ABCs" of drugs for hypertension:

  • Ace inhibitors or angiotensin receptor blockers prevent the formation of a hormone that constricts blood vessels.
  • Beta blockers interfere with nerve receptors in the heart, causing the heart rate and blood pressure not to rise as quickly in response to exercise.
  • Calcium channel blockers reduce the ability of arterial walls to constrict.
  • Diuretics help increase the elimination of salt and water from the body.

There are also combination drugs to pair ace inhibitors with diuretics or angiotensin receptor blockers with diuretics. Your doctor will determine which course of treatment will most benefit your condition.

For secondary hypertension, the underlying disease must be identified and treated.

The first step in managing your hypertension is to know your blood pressure levels. There are monitoring devices you can use at home. If your doctor prescribes medication, make sure to take it exactly as directed. Eating a healthy diet and exercising are also a part of controlling your hypertension.

Continue Learning about High Blood Pressure Treatment

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.