Yeah, the medical management of blood pressure, it should be based on a foundation of healthy lifestyle, healthy diet, exercise, avoidance of harmful substances, good sleep. In some people, that may be enough to get them to a goal, they may be at low risk that there may not be any initiation of prescription blood pressure medications at the very beginning. But in higher risk groups, there is a benefit of starting blood pressure meds early...
Yeah, the medical management of blood pressure, it should be based on a foundation of healthy lifestyle, healthy diet, exercise, avoidance of harmful substances, good sleep. In some people, that may be enough to get them to a goal, they may be at low risk that there may not be any initiation of prescription blood pressure medications at the very beginning. But in higher risk groups, there is a benefit of starting blood pressure meds early. This is all contingent upon a proper measurement of blood pressure in the medical office and at home. So if we assume that it’s been done correctly multiple times and you have an average blood pressure reading of 130 over 80, in the young, healthy folks, it’s generally fine to encourage them on lifestyle changes and things first before starting a medication. But folks who have risk factors, other risk factors for cardiovascular disease, or they have known diabetes, or they have chronic kidney disease, things like that that signify a higher risk, then it’s better to start early. And if you’re talking about medications, generally the principles are that there are four first-line classes for treatment of hypertension. And those are the angiotensin receptor blockers, the ACE inhibitors, the thiazide-like diuretics, and the calcium channel blockers. And those have been shown in long-term studies to not only reduce blood pressure, but to reduce risk of cardiovascular outcomes. The choice of particular meds can be influenced by trying to avoid certain side effects or contraindications. On the flip side, if someone has another reason other than blood pressure to be on a particular medication, that can swing us towards that as well. The data on the relationship between blood pressure and dementia and cognitive impairment is pretty clear on lowering blood pressure improves those outcomes. What’s less clear is, are there specific agents that are specifically good for these cognitive outcomes compared to others? And so that hasn’t quite made it into the guidelines yet, but there’s some studies looking at whether it’s suggested that angiotensin receptor blockers and dihydropyridine calcium channel blockers may be associated with a lower risk of dementia when used for blood pressure compared to the other meds. But that’s not quite strong enough for the American Heart Association to recommend those specific ones. The main one is just targeting blood pressure. That’s the main principle.
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