Managing Hypertension
People with stage 1 hypertension who are otherwise healthy are typically seen by their doctor once a month until they reach their blood pressure goal. Those with other health problems or stage 2 hypertension need to visit their doctor more frequently—every two to four weeks.
Once blood pressure is at goal or stabilizes, doctor visits are usually reduced to every three to six months, though people with other health conditions (such as diabetes or heart disease) may need to visit their doctor more often. Levels of blood sodium, potassium, and creatinine should be measured at least once or twice a year to detect any adverse effects from antihypertensive drugs and any deterioration in kidney function.
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Home monitoring of blood pressure
Home monitoring of blood pressure can help people with hypertension keep track of the effects of lifestyle modifications and medication on their blood pressure. Two types of monitors are available for home measurements: aneroid and electronic. Both types need to be checked annually against a standard mercury sphygmomanometer at the doctor's office to ensure continuing accuracy.
Traditionally, the best way to measure blood pressure at home has been with a manually operated aneroid monitor that consists of a cuff, bulb, and dial gauge to register blood pressure levels. A stethoscope is also required (most monitors come with one). Advantages of aneroid monitors are their accuracy, consistency, and low price ($20 to $30). Users of aneroid monitors must be able to rapidly squeeze the bulb to inflate the cuff, hear the thumping sounds of blood flow with the stethoscope, read the gauge that records the pressure, and loosen a valve to let out the air slowly. Consequently, individuals with hearing or vision problems or limited hand movement may not be able to use an aneroid monitor.
Electronic home monitors are improving and growing in popularity. Some types have a cuff that inflates automatically; those with manually inflated cuffs will deflate automatically. You need only record the numbers that appear on the digital screen. Prices for electronic monitors range from about $35 to $125. Arm monitors are recommended over wrist monitors. Fingertip models are unreliable and should be avoided.
Only about a third of people with hypertension have reached the blood pressure goal of 140/90 mm Hg. One reason is that some doctors are not treating hypertension aggressively enough; another is that some people are not taking their antihypertensive medications as prescribed or are not adopting the recommended lifestyle modifications.
Poor compliance with antihypertensive therapy is understandable, considering that many people with hypertension have minimal symptoms or none at all yet are expected to make lifestyle modifications and take medication that may be costly or cause unpleasant side effects. Nonetheless, compliance is crucial to prevent the complications that may result from high blood pressure. On average, antihypertensive therapy is associated with a 35 percent to 40 percent lower risk of a stroke, a 20 percent to 25 percent reduced risk of a heart attack, and a 50 percent decrease in the risk of heart failure.
Content excerpted from the Johns Hopkins White Paper on Hypertension & Stroke.
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