VI -
What to do in case of a high blood pressure
6.1
- First of all, to eliminate a false high blood pressure
6.2
- To eliminate an obvious cause responsible for a high blood pressure
6.3
- To start a treatment without drug: life style modifications
6.4 - According to the circumstances, to treat
by using drugs
6.5
- Anti-hypertensive therapy
6.6
- Why does the doctor prescribe a given anti-hypertensive drug and not
another? The choice of the first treatment.
6.4-
According to the circumstances, the physician has to use an antihypertensive
drug therapy
6.4.1- Indications of
this treatment
According to the initial
level of the high blood pressure, the existence of other cardiovascular
risk factors and of the damage of high blood pressure on the heart,
the arteries and the kidney, a antihypertensive drug will be prescribed.
CARDIOVASCULAR
RISK FACTORS |
DAMAGE
ON CARDIOVASCULAR SYSTEM |
• Tobacco
• Too high Cholesterol level
• Diabetes
• Age > 60 years
• Sex (Men, post-menopausal women)
• Previous family of cardiovascular disease for women aged < 65 years
and men aged < 55 years |
• Damage
of the heart
- Hypertrophy on echography
- Pectoral angina/Infarction of the myocardium - cardiac Insufficiency • Stroke
• Damage of the kidney
• Damage of the arteries (including that of the eye) |
The table below, extract from the last recommendations (1999), specifies the
indications of the life style modifications and the antihypertensive drug
therapy of a high blood pressure:
Level
of Blood Pressure
(mmHg) |
Risk
A •No cardiovascular risk factor •No organic
damage or cardiovascular disease |
Risk
B • 1 cardiovascular risk factor or more (not diabetes) •No
organ damage or cardiovascular disease |
Risk
C •Organ damage or cardiovascular disease and/or diabetes |
High
normal
130-139/85-89 |
life
style modifications |
life
style modifications |
Antihypertensive
drug therapy |
Stage
1
140-159/90-99 |
life
style modifications up to 1 year |
life
style modifications up to 6 months |
Antihypertensive
drug therapy |
Stages
2 and 3
>160 / >100 |
Antihypertensive
drug therapy |
Antihypertensive
drug therapy |
Antihypertensive
drug therapy |
These recommendations really help the practitioner in his attitude towards
the treatment of his patient.
For a person of more than
60 years, high blood pressure is defined as a blood pressure higher
than 160/90 millimetres of mercury (16/9). A pressure of 140/90 mmHg
being the ideal.
The optimum blood pressure
are the following:
- Subjects without diabetes,
renal insufficiency and of less than 60 years: 140/90 millimetres
of mercury (14/9),
- Subjects with diabetic
mellitus and/or a renal insufficiency: 130/85 mmHg,
- Old subjects of more than
60 years: 160/90 mmHg.
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last modified on : 28 sep 2003 |
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