Initial Management For The Raised Blood Pressure

A 39-year-old African male has a persistent blood pressure readings of 140–150/90–95 mmHg over the past six months. He is a non-smoker . The patient weighs 89 kg and measured 1.7 m Physical examination was normal with the exception of a blood pressure reading of 150/92 mmHg.
Investigations are shown.
Sodium 136 mmol/l, Potassium 4.2 mmol/l
Urea 5 mmol/l
Glucose 4.1 mmol/l
Total cholesterol 4.1 mmol/l, Triglycerides 1.2 mmol/l
12-lead ECG ; Sinus rhythm, Right axis deviation
Urinalysis; Protein 0, Blood 0, Cells 0

What is the best initial management for the raised blood pressure?
A. Beta-blocker.
B. Angiotensin-converting enzyme inhibitor.
C. Low-salt diet, regular exercise.
D. Calcium channel antagonist.
E. Thiazide diuretic.

Answer And Discussion:


C. Low-salt diet, regular exercise

The patient is young and has mild hypertension on presentation. He does not have any other risk factors for cardiovascular disease or evidence of secondary end organ damage as a result of the raised blood pressure.
In this particular case the initial management plan should include a low-salt diet, regular exercise and
weight loss. The patient should be observed carefully for up to a year and should only be commenced on pharmacological therapy if the blood pressure remains
above 140/85 mmHg.
If treatment is indicated after a year, the drugs of choice are thiazide diuretics or calcium channel blockers. Angiotensin-converting enzyme inhibitors and beta-blockers are not particularly effective as monotherapy because both drugs act by suppressing renin levels, which are already relatively low in Afro-Caribbean patients. However, these patients may respond to ACE inhibitors and beta blockers when prescribed with drugs that activate the renin– angiotensin–aldosterone system, i.e. thiazide diuretics and calcium channel blockers.
Both lifestyle modification and pharmacological therapy would be indicated if the patient had a blood
pressure ≥160/100 mmHg, or evidence of secondary end-organ damage, or other risk factors for coronary artery disease at presentation.
There is a high prevalence of hypertension in individuals of Afro-Caribbean origin, with almost 50%
of patients over the age of 40 years being affected. This particular group of patients generally develop hyper - tension at a younger age and are at higher risk of hypertensive complications such as stroke, heart failure and renal failure than Caucasian patients.
 Hypertension in Afro-Caribbean patients is salt sensitive and responds well to a low-salt diet.