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HYPERTENSION

When there is an increase in systolic or diastolic blood pressure or both, we call it hypertension. Usually, normal blood pressure is 120/80 or below. Conventionally a blood pressure of 140/90 is the upper limit of normal BP. 

ACC – AHA (American College of Cardiology – American Heart Association) classification of hypertension is as follows.

Normal: Systolic <120, Diastolic <80 mm Hg
Elevated: Systolic 120 - 129, Diastolic 80 mm Hg
Hypertension:

Stage I Systolic: 130 – 139, Diastolic 80 – 89 mm Hg
Stage II Systolic: >140, Diastolic >90 mm Hg

Hypertension is a risk factor for stroke, accelerated coronary and systemic atherosclerosis, heart failure, chronic kidney diseases, and death from cardiovascular causes.

How to take blood pressure?
At least 2 BP measurements with the use of a standardized measurement technique with a cuff of the correct size. Measurements should be made with the back supported, legs uncrossed, feet on the floor and the measuring arm supported on a table at heart level after the patient has sat quietly for 5 minutes. 

Management 
1. Lifestyle modifications
2. Restrict salt (sodium) below 1500 mg/ day
3. If overweight or obese, reduce weight 
4. Aerobic exercises for 90 – 150 mts/ week
5. Increase potassium-rich foods
6. Avoid smoking
7. Reduce alcohol use
8. Eat fresh food, whole grains, and low dairy products 
9. Minimize drugs like NSAIDS & decongestants

Drugs
1. Thiazide type diuretics
2. ACE inhibitors like Lisinopril 
3. ARBs like Losartan
4. Calcium channel blockers like Amlodipine
5. Non-dihydropyridine like Diltiazem 

Prof. Dr. M Haneef, MBBS, MD
Senior consultant, Internal medicine