What other factors are important in causing hypertension?

1. Obesity
2. Sedentary lifestyle
3. Alcohol consumption in excess of 3 or more drinks.
4. Very high sodium intake.

“Reducing my salt intake has had no effect on my blood pressure?”

In many patients the blood pressure is not sensitive to sodium intake as opposed to those who are “salt sensitive”.

Are any additional investigations required for newly diagnosed patients with high blood pressure?

If the hypertension is mild and is the only problem then a limited investigation is all that is required. If the patient has severe hypertension then more extended evaluation is required. The limited investigation should at least include routine blood chemistry, a hemogram, an electrocardiogram and a chest X–ray.

What are the different drugs used in the management of hypertension?

They can broadly be classified as follows.

1. Diuretics: e.g. Hydrochlorothiazide
2. Beta blockers: e.g. Propranolol, Metoprolol, Atenolol
3. Calcium channel blockers: e.g.: Diltazem, Nifedipine, Verapamil, Amlodipine, felodipine.
4. ACE (Angiotensin Converting Enzyme Inhibitors) e.g. Lisinopril, Enalapril.
5. Alpha blockers: Prazosin

What are the side effects of blood pressure medicines?

For all classes of blood pressure lowering medicines if the blood pressure is reduced too much the patients complain of dizziness and fainting. Side effects can be class specific.
Beta Blockers
Decreased heart rate, bronchospasm, depression, sexual dysfunction, peripheral vascular disease, lipid abnormalities.
Calcium Channel Blockers
Headache, flushing, palpitation, edema formation on the feet, constipation.
ACE Inhibitors
Cough, Hyperkalemia, skin rash, taste impairment.
Diuretics
Dehydration, High blood sugar level, increased lipids.

Which of the anti–hypertnsive medicines should be used first?

Many physicians will use medicines based upon the overall condition of the patient taking into account the cardiac status, the renal status etc. It should be remembered that beta blockers and diuretics are generally used as first line agents. The ACE inhibitors have also been used in many instances as first line drug therapy. The choice generally depends upon the physician who is treating the patient.

What is Malignant Hypertension?

Malignant Hypertension is a syndrome which results from very high elevated blood pressures, generally the diastolic is above 140mm of Hg. The patient has hemorrhage in the eyes swelling of the optic disk (papilledema), coma, fluid in the lungs. This is a medical l emergency and it needs to be treated in an intensive care unit. So the medicines generally are given intravenously to reduce blood pressure. These medicines usually include sodium nitroprusside, hydralazine, labetalol.