These treatments are the first option for most hypertensive patients. Lifestyle changes may include diet modification, weight loss, exercise, or quitting smoking.
For those who are unsuccessful in controlling their blood pressure through diet and lifestyle changes alone, medications can be prescribed. There are a large number of available therapies, including diuretics, beta blockers, ACE inhibitors, vasodilators, and other classes. Numerous combinations of agents can be prescribed in varying doses, and almost all patients require more than one agent to achieve their goal. The complexity of the regimen and the associated side effects often lead to non-adherence. In general, however, ACC/ AHA guidelines recommend early prevention.
Blood pressure regulation is a complex, multifactorial process involving multiple systems, including the sympathetic nervous system, endothelium, immune system, the renin-angiotensin-aldosterone system, and natriuretic peptides.
The kidneys are an especially interesting pathway due to their ability to control blood pressure through two kinds of electrical signals. Afferent nerves send signals from the kidneys to the brain, elevating norepinephrine and the release of other secreted factors, raising the heart rate and increasing vasoconstriction. Efferent nerves send signals to the kidneys from the brain, increasing vascular resistance, sodium/water retention, and renin release.