Symptom Finder - Treatment of Essential Hypertension
HYPERTENSION, ESSENTIAL
1. Rule out adrenal and renal causes.
2. If patient is obese, place on a weight reducing diet with plenty of fresh fruits and vegetables and salt restriction (which is an appetite suppressant).
3. Cut out caffeinated beverages, chocolate, nicotine, and alcohol if possible.
4. Encourage physical activity such as walking at least 1 mile 3 times a week.
5. Start a diuretic such as hydrochlorothiazide (Hydro-DIURIL): 12.5–50 mg daily or chlorthalidone (Hygroton): 25–50 mg daily. Watch serum potassium.
6. Add spironolactone (Aldactone): 50–100 mg daily or potassium chloride supplement if potassium drops on above diuretics.
7. If blood pressure still high, add ACE inhibitor, such as Lisinopril (Zestril) 5–40 mg daily or Enalapril (Vasotec) 2.5–40 mg daily. If patient cannot tolerate an ACE inhibitor, try an ARB such as Losartan (Cozaar) 25 to 100 mg daily or Valsartan (Diovan) 80– 320 mg daily.
8. When blood pressure is still resistant to control with the above, add a β-blocker such as atenolol (Tenormin) 25–50 mg bid or metoprolol (Lopressor) 25–100 mg bid. Patient or Clinician should monitor pulse to be sure it does not drop below 50.
9. A calcium channel blocker may be substituted for the β-blocker. Suitable alternatives are Verapamil SR (Calan): 120–240 mg bid or amlodipine (Norvasc): 2.5–10 mg daily.
10. Finally, a vasodilator such as hydralazine (Apresoline): 25–75 mg qid may be added.
11. If the above drugs are unsuccessful in lowering the blood pressure, a thorough re-evaluation for renal and adrenal causes of hypertension should be done and a nephrologist consulted.
12. Monitor patients regularly for renal, ocular, and cardiac complications of hypertension.
1. Rule out adrenal and renal causes.
2. If patient is obese, place on a weight reducing diet with plenty of fresh fruits and vegetables and salt restriction (which is an appetite suppressant).
3. Cut out caffeinated beverages, chocolate, nicotine, and alcohol if possible.
4. Encourage physical activity such as walking at least 1 mile 3 times a week.
5. Start a diuretic such as hydrochlorothiazide (Hydro-DIURIL): 12.5–50 mg daily or chlorthalidone (Hygroton): 25–50 mg daily. Watch serum potassium.
6. Add spironolactone (Aldactone): 50–100 mg daily or potassium chloride supplement if potassium drops on above diuretics.
7. If blood pressure still high, add ACE inhibitor, such as Lisinopril (Zestril) 5–40 mg daily or Enalapril (Vasotec) 2.5–40 mg daily. If patient cannot tolerate an ACE inhibitor, try an ARB such as Losartan (Cozaar) 25 to 100 mg daily or Valsartan (Diovan) 80– 320 mg daily.
8. When blood pressure is still resistant to control with the above, add a β-blocker such as atenolol (Tenormin) 25–50 mg bid or metoprolol (Lopressor) 25–100 mg bid. Patient or Clinician should monitor pulse to be sure it does not drop below 50.
9. A calcium channel blocker may be substituted for the β-blocker. Suitable alternatives are Verapamil SR (Calan): 120–240 mg bid or amlodipine (Norvasc): 2.5–10 mg daily.
10. Finally, a vasodilator such as hydralazine (Apresoline): 25–75 mg qid may be added.
11. If the above drugs are unsuccessful in lowering the blood pressure, a thorough re-evaluation for renal and adrenal causes of hypertension should be done and a nephrologist consulted.
12. Monitor patients regularly for renal, ocular, and cardiac complications of hypertension.