Stage 1 Hypertension

Newly diagnosed stage-1 HTN? Don’t worry; mild hypertension requires a healthy lifestyle change and medicinal treatment.

It is an early form of high blood pressure consider mild and need medical treatment with blood pressure monitoring on every doctor’s visit to avoid complications.

The main challenge dealing with hypertension diagnosis is its lack of symptoms. Largely there are no noticeable symptoms that conclusively point to the presence of hypertension.

Newly diagnosed stage-1 hypertension! What to do next?

Once you came to know that you have stage-1 hypertension, do not panic (it will not help you); instead, try to manage it smartly, here are some tips.

• You should know your BP has raised (i.e. 150/90 mmHg)
• You should know the importance of the reading and confirm the diagnosis.
• If you are a smoker, plan to quit smoking.
• Check your BP once in every month.
• You should start following hypertension therapeutic lifestyle modification.
• You should commence hypertension medication treatment.
• Discuss with your doctor to choose a best first line antihypertensive drug.
• Based on doctor's assessment, know your target blood pressure and plan to achieve it.

Lifestyle modification for stage-1 hypertension

Everyone, who is diagnosing as hypertension should follow lifestyle modifications. Stage-1 hypertension needs to adhere to hypertension therapeutic lifestyle, which helps the medication to work effectively as well as helps to lower your risk towards hypertension complications. Hypertension lifestyle changes help lower your blood pressure better.

Stage-1 hypertension medicinal treatment

The treatment for stage-1 hypertension is influencing by the associated health condition or by the number of risk factors.

• If you are at low risk of stage-1 hypertension, it is enough to follow just lifestyle modification as a sole therapy.
• If you have any target organ damage (e.g. left ventricular hypertrophy), follow lifestyle modification as well as take hypertension medication treatment.
• If you have chronic kidney disease, you require following lifestyle change as well as medication treatment.
• If you have diabetes, then you should consider both lifestyle and medicinal treatment.

Try to achieve your target; many usually require two or more drugs along with lifestyle changes.

If you are newly diagnosed uncomplicated stage-1 hypertension with no compelling indications, choice of first-line monotherapy includes ACEIs, ARBs, CCBs, and Diuretics. Beta-blockers are no longer considering as first-line monotherapy because the recent study shows it is effect-less in lowering BP and preventing stroke as compared to other medications. There is a higher incidence of new-onset diabetes compared to other medications. Still, you can consider beta-blockers, if you are young, particularly:

• intolerant or contraindication to ACEIs and ARBs,
• childbearing women or planning to,
• Any evidence of an increased sympathetic drive (sympathetic nervous system activates often termed as the fight or flight response).

While numerous studies show that a diuretic and a beta-blocker can reduce cardiovascular morbidity and mortality, another recent study has reported similar benefits with ACEIs and CCBs.

Stage-1 hypertension should start your treatment with a single drug (monotherapy) at a low dose. This mono-therapy can lower your BP below 140/90 mmHg in almost 40 to 60 percent of hypertensive. If even after six weeks of treatment still, your BP is unreachable to your target, three options are available:

• Increase your initial drug dosage,
• Substitute the initial drug by another class of drug,
• Add a second drug.

Increasing the initial hypertension medication dosage or add the second medication if you are responding to the first one but target BP not achieved. The former, however, may produce adverse effects due to increase in dosage. It can overcome by proper drug combination selection so that it mitigates each other adverse effects. If there is no response or not tolerance, then the initial drug is substituting by another drug.

What is your target BP?

The target blood pressure numbers various based on your associated health conditions, below table gives your target blood pressure value.

• If you have isolated systolic hypertension – Target SBP should be less than 140 mmHg.
• If you have hypertension – Target BP should be less than 140/90 mmHg.
• If you have hypertension & diabetes – Target BP should be less than 130/80 mmHg.
• If you have hypertension & chronic kidney disease – Target should be less than 140/90.

However, if possible then it is always better to manage your blood pressure around 110/70 mmHg without or with limited number or dosage of medication.