Taking Charge of Your Health

– [Voiceover] So the 8th
Joint National Committee, or JNC-8, has recently
proposed some useful guidelines for when to treat patients
with high blood pressure and what blood pressure
you should be shooting for. So if you’re over 60 years
old, treatment should be administered to try
and lower your systolic blood pressure to less than
150 millimeters of mercury, and also lower a
diastolic pressure to less than 90 millimeters of mercury. If you’re less than 60 years old, though, it’s recommended to aim
to get the blood pressure to lower than 140 millimeters of mercury on the systolic side, and again, less than 90 millimeters of
mercury on the diastolic side. In addition, if you’re above 18 years old and have either a chronic kidney disease or diabetes, it’s also recommended to try and get your blood pressure to lower than 140 on the systolic side and lower than 90 on the diastolic side. To hit these targets, there
are various treatment regimens that might be recommended or prescribed, and firstly and very
importantly, lifestyle changes might be suggested, and
these will almost always be used together with
some sort of medication. But one suggestion is to
use something called DASH, which stands for dietary
approaches to stop hypertension. As the name kind of suggests,
this is a diet-based lifestyle change, where we
really emphasize eating foods with less sodium as well
as eating whole grains, fruits, vegetables, and
low fat dairy products. Another lifestyle change,
a huge, huge, huge one, is to quit smoking and
a bit on the same lines, alcohol consumption should really be done only in moderation. Also, exercising 30 minutes
most days of the week and losing weight if already
obese is generally suggested as an important lifestyle change. Now again, medications will
also likely be prescribed alongside these lifestyle changes. And there are both first line
and second line medications for treating hypertension. The first line medications
are often recommended as a first, or initial form of therapy because studies have shown that
they are the most effective in preventing complications
from hypertension, and they’re generally safe, and in most cases, pretty inexpensive. So since your blood pressure
is related to the flow, or the fluid volume in your body, right, and the resistance in the vessels, these medications will target
one of these two factors. And the first are thiazide diuretics. Now these guys increase the
excretion of sodium and water by the kidneys, therefore
they reduce your fluid volume and so, your blood pressure. You could also be prescribed
calcium channel blockers, and these block the channels
in your vascular smooth muscles that let calcium ions go through. So, in effect, they
reduce the contractions of your blood vessels, and relax them. And this essentially makes them larger and reduces their
resistance, which reduces the blood pressure, right? There’s also ACE inhibitors,
and these prevent the renin-angiotensin-aldosterone
system from taking effect. So basically these inhibitors
block the formation of angiotensin II, which
is a vasoconstrictor. Since vasoconstrictors
constrict your blood vessels, this will end up widening
the blood vessels and basically reduce the resistance, so it’ll also reduce the blood pressure. Not only that though,
it’ll prevent the formation of aldosterone, which reduces
sodium and water retention and reduces blood volume, and so blood pressure goes down as well. And finally there’s angiotensin
II receptor blockers. And basically these give the same result as the ACE inhibitors but
instead of blocking the formation of angiotensin II, they
block the receptors that respond to angiotensin II. But if the first line choices for medications aren’t effective, then the physician might
choose to go to the second line choices for treating hypertension. And some of those are as follows. So first you could have the
aldosterone receptor blockers which do pretty much exactly
what their name suggests. They block the aldosterone receptors, and since aldosterone causes
sodium and water retention, blocking these receptors
will reduce your sodium and water retention and therefore
reduce your blood volume, and so your blood pressure. Now renin inhibitors inhibit
this enzyme called renin, which converts angiotensinogen
to angiotensin I. And this prevents the eventual formation of angiotensin II and aldosterone, which just like the ACE
inhibitors reduces your resistance and your blood volume. Another one might be
alpha-adrenergic blockers. And these guys block
the receptors that sit on your vascular smooth muscles. When these receptors
are blocked, we inhibit the vasoconstriction and
therefore cause the vessels to widen, which reduces your resistance. Finally you’ve got your
central adrenergic inhibitors. And these work to prevent your brain from sending sympathetic
nervous system signals that would normally cause
your heart to beat faster and your blood vessels to constrict. So when we inhibit this response, your blood vessels widen,
your resistance goes down, and the blood pressure goes down as well.

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