Effective Hypertension Management: Lifestyle, Monitoring, and Advanced Treatments

Jump To Section

• Lifestyle Changes for Hypertension Control
• Importance of Regular Blood Pressure Monitoring
• Medications for High Blood Pressure
• Advanced Treatments: Renal Denervation
• Value of a Second Medical Opinion
• Full Transcript

Lifestyle Changes for Hypertension Control

Dr. Dale Adler, MD, emphasizes that a healthy diet and regular exercise are crucial in managing high blood pressure. He advises patients to maintain a balanced diet and stay physically active to help keep blood pressure levels low. Dr. Adler shares a story of a patient whose blood pressure improved significantly after dietary changes post-stroke, highlighting the strong link between diet and hypertension.

Importance of Regular Blood Pressure Monitoring

Dr. Adler stresses the importance of regular blood pressure monitoring, recommending patients check their blood pressure about three times a week under various conditions. He advises measuring blood pressure in both arms, as a significant difference between the two can indicate underlying vascular issues. Monitoring helps patients and doctors track blood pressure trends and adjust treatment plans accordingly.

Medications for High Blood Pressure

Dr. Adler discusses the role of medications in hypertension management, mentioning drugs like Carvedilol, Spironolactone, and Eplerenone. These medications help control blood pressure, especially in patients with resistant hypertension. Dr. Adler notes that while lifestyle changes are essential, medications are often necessary to achieve optimal blood pressure control.

Advanced Treatments: Renal Denervation

Dr. Adler explores renal denervation, an advanced treatment for resistant hypertension. This procedure involves radiofrequency ablation of sympathetic nerves around the renal artery to reduce blood pressure. Although initial studies showed promise, later blinded clinical trials did not confirm its effectiveness. Dr. Adler suggests that further research is needed to fully understand the potential of renal denervation.

Value of a Second Medical Opinion

Dr. Anton Titov, MD, highlights the importance of seeking a second medical opinion for hypertension diagnosis and treatment. A second opinion ensures that patients receive a comprehensive evaluation and the most effective treatment strategy. Dr. Adler agrees, emphasizing that a second opinion can provide reassurance and confidence in managing high blood pressure.

Full Transcript

Dr. Anton Titov, MD: Good diet and regular exercise are key to controlling blood pressure. Blood pressure should be kept as low as possible. How often should one check blood pressure? Hypertension natural treatment is important. There is a story of a patient with high blood pressure who had a stroke. Renal denervation is a treatment for resistant hypertension. A second opinion ensures that the hypertension diagnosis is correct and complete. It also helps to choose the best treatment strategy for high blood pressure. Seek a second opinion on hypertension to be confident that your treatment is the best.

Dr. Dale Adler, MD: Yes, you are correct. People often do not have good control of their blood pressure. We have so much data linking high blood pressure especially to stroke. Hypertension also causes kidney problems and is linked to definite heart attacks, albeit a little less. But high blood pressure causes hypertensive heart disease. The heart muscle gets thicker, and in patients with hypertension, the heart muscle becomes more rigid and less compliant.

It is always remarkable that even today in the United States, 25% of patients with hypertension do not have good control of their high blood pressure. Treatment of hypertension is so basic, yet many patients do not succeed in its treatment. What is the best way to treat hypertension? The first step is to know how high your blood pressure is. We live in an era when everyone has equipment to measure blood pressure. It's very easy for patients to check their blood pressure.

I always tell my patients not to go crazy checking blood pressure all the time. Check your blood pressure about three times per week in different circumstances. Sometimes you have been very busy and active, or you are under stress. Check it once. Is it useful to check blood pressure on both arms? A difference of blood pressure results of more than 15 mm between two arms has been linked to a higher risk of death. A large difference in blood pressure results between two arms can indicate a problem in the aorta or blockage in different blood vessels.

So it is absolutely true. Check blood pressure in both arms at the same time, at least the first time you take a blood pressure measurement. We also want patients to check their blood pressure in the morning when they wake up. People should also check blood pressure when they are under stress and when they are relaxed. Blood pressure is similar to LDL cholesterol. The lower the level of blood pressure, the better it is for your health. The same is true with LDL cholesterol levels. Lower blood pressure results mean a lower risk of stroke.

It is important not to make blood pressure so low that patients have symptoms. Sometimes the blood pressure is too low, and patients may feel dizzy, have blurred vision, or feel they are about to pass out. We don't need to make blood pressure very low by using medications. People should be really mindful of how they eat, keep their weight in good order, and be really fit. By doing these three things, they can help themselves a huge amount.

I always tell my patients a sad story. It is about a man who always had very high blood pressure. His hypertension was very difficult to treat. I always said to him, "I am worried about your diet." He always replied, "My diet is great." Then unfortunately, one day this man had a stroke. After the stroke, he could not eat on his own. His hand was paralyzed. Since that time, we never had a problem with his blood pressure. Never. Not once.

It is possible that the stroke changed something in his brain, but there is a better explanation for his normal blood pressure after the stroke. What he ate after the stroke was controlled by others, and his food became more healthy. So often, there is a strong dietary component to hypertension. We have strong medications at our disposal to treat hypertension. In some patients with resistant hypertension, we need to use three and four medications. But almost always, we can get a patient's blood pressure under control.

Dr. Anton Titov, MD: What are examples of medicines we use today to treat hypertension? Carvedilol is a nonselective beta blocker and also an alpha blocker. Carvedilol can be very helpful to treat high blood pressure. Medicines that antagonize aldosterone are useful to treat hypertension. For example, Spironolactone or Eplerenone can also be very helpful to treat hypertension in difficult cases.

Dr. Dale Adler, MD: The technology of renal denervation received a lot of attention recently. Can you put a catheter into the renal artery? Can you apply radiofrequency ablation? Ablation of sympathetic nerves around the renal artery can decrease the sympathetic nervous system drive from the renal arteries. Many studies on renal denervation have been done. Very careful studies in animals showed renal sympathetic denervation would have a good effect. There were also small clinical trials in humans. It looked like renal denervation was very effective.

These trials were not “blinded,” which is the usual method to conduct clinical trials. But a "blinded" clinical trial did not show a good effect of the renal denervation procedure on lowering high blood pressure. Maybe one day we will know more about that technology. This clinical trial is SYMPLICITY HTN-3. Hypertension natural treatment by diet and exercise. Can you avoid medications? How to treat resistant hypertension? Medications and renal denervation.