Treatment of Hypertension at Mayo Clinic in Jacksonville

Hypertension means high blood pressure. A person's blood pressure normally varies during the day. It can even vary slightly with each beat of the heart. It increases during activity and decreases with rest. The more blood the heart pumps and the narrower the arteries, the higher the blood pressure. A blood pressure reading consists of two numbers:

• The higher number indicates systolic pressure, the amount of pressure the heart generates when pumping blood out through the arteries.
• The lower number indicates diastolic pressure, the amount of pressure in the arteries when the heart rests between beats.

A resting blood pressure reading of 120/80 millimeters of mercury (mm Hg) is normal. If your resting blood pressure is consistently 140/90 mm Hg or higher, you have high blood pressure. Only one of the two numbers needs to be consistently high for a person to have hypertension.

Hypertension is evaluated primarily by physicians in the departments of Nephrology & Hypertension and Cardiovascular Diseases. Mayo Clinic specializes in treating patients who have complicated hypertension problems that may be coupled with other medical conditions. The conditions include:

Secondary Hypertension
This means the high blood pressure is caused by another disease or condition, such as kidney disease. Mayo Clinic has expertise in diagnosing and treating endocrine hypertension (pheochromocytoma, aldosteronism).

Transplant Hypertension
Because severe (especially overnight) hypertension is a side effect of many immunosuppressant drugs, Mayo offers a program to help patients with this complication of organ transplantation. Patients undergoing heart, lung, liver, kidney, pancreas or bone marrow transplants are followed closely thereafter with a high success in excellent blood pressure control and decreased morbidity and mortality.

Treating High Blood Pressure

The goal of treatment is to prevent health complications that may occur as a result of high blood pressure. If disorders such as diabetes and high blood cholesterol are contributing to the problem, they also will be evaluated for treatment. Many studies show a direct relationship between uncontrolled high blood pressure and increased risk of stroke, heart attack, heart failure, kidney failure and eye problems.

Blood pressure goals are not the same for everyone. Mayo physicians carefully evaluate patients to determine realistic goals based on their individual health needs.

If proper diet, exercise and other lifestyle changes are not enough to reduce blood pressure, many types of medications are available. They lower blood pressure in different ways. They include:

Diuretics
These medications act on the kidneys to help the body eliminate sodium and water, reducing blood volume.

Beta blockers
These medications block the effects of certain adrenaline-related chemicals, causing the heart to beat more slowly and less forcefully.

Angiotensin-converting enzyme (ACE) inhibitors
These medications help relax blood vessels by blocking the formation of a naturally occurring chemical that narrows blood vessels. These medications are especially important in treating high blood pressure in people with coronary heart disease, heart failure or kidney failure.

Angiotensin II receptor blockers
These medications help relax blood vessels by blocking the action -- not the formation -- of a naturally occurring chemical that narrows blood vessels.

Calcium antagonists, also known as calcium channel blockers (CCBs)
These medications help relax the muscles of blood vessels. Some slow the heart rate. (People taking these medications should not eat grapefruit or drink grapefruit juice, because this puts them at greater risk of side effects.)

Multiple drugs may be recommended. In fact, low-dose medications in combination can lower blood pressure equally well as larger doses of one drug. This strategy may reduce the number of doses patients need per day. Most people can control their blood pressure with long-acting drugs, so the medications need be taken only once or twice daily. Aspirin may be recommended once blood pressure is under control to reduce the risk of cardiovascular disorders.

Other drug classes may be used in addition to combinations of the above medications, when blood pressure has not reached a set goal level. These drug classes may include:

Alpha blockers
These medications prevent muscle contractions in smaller arteries and reduce the effects of naturally occurring body chemicals that narrow blood vessels.

Central-acting agents
These medications prevent the brain from signaling the nervous system to increase the heart rate and narrow the blood vessels.

Direct vasodilators
These medications work directly on the muscles in the walls of the arteries, preventing the muscles from tightening and the arteries from narrowing.