Hypertension Management: Questions About Diagnosis and Treatment

Hypertension screening

I started experiencing daily blood pressure readings around 140/98 and symptoms of dizziness and headaches at the end of February, so I went to see a cardiologist.
The doctor prescribed antihypertensive medication before waiting for the test results.
A week later, the blood tests and electrocardiogram were normal, but the doctor still advised me to continue taking the blood pressure medication.
Is this approach correct? Why didn't the doctor perform an echocardiogram? My colleague at another hospital had an echocardiogram for hypertension, but I did not.
What is the primary purpose of an echocardiogram? Additionally, my blood pressure readings consistently show elevated diastolic pressure (close to 100), which seems different from typical hypertension.
What could be the reason for this? Once I start taking blood pressure medication, is it possible to discontinue it through dietary control and exercise? Thank you for your response.

nini, 40~49 year old female. Ask Date: 2012/07/13

Dr. Zhang Guoji reply Internal Medicine

1.
If you have concerns about the original physician's management, you should discuss it with the physician during the outpatient visit to understand their perspective and resolve your issues, as each physician may have different thoughts and approaches.
Asking other physicians afterward may not be objective.

2.
Patients with hypertension do not require routine echocardiograms; the physician will determine the necessity based on each patient's situation, including medical history, family history, medication history, physical assessment, blood test results, electrocardiogram, etc.
3.
Blood pressure measured using the correct technique is considered hypertension if the systolic pressure is greater than 140 mmHg or the diastolic pressure is greater than 90 mmHg.
Each individual has different physiological characteristics; some may have slightly elevated systolic pressure while others may have elevated diastolic pressure.
The key is to keep these pressures within the normal range.
4.
Hypertension treatment is divided into pharmacological and non-pharmacological approaches.
Dietary control and exercise are indeed part of non-pharmacological treatment that can improve blood pressure.
However, can blood pressure be adequately controlled solely through non-pharmacological means? It is not impossible, but individual circumstances vary, so please discuss with your physician and do not discontinue medication on your own.

Reply Date: 2012/07/13

More Info

Managing hypertension effectively requires a comprehensive understanding of the condition, its causes, and the various treatment options available. Your experience of consistently elevated blood pressure readings (around 140/98 mmHg) accompanied by symptoms like dizziness and headaches prompted you to seek medical attention, which is a prudent step. The fact that your doctor prescribed antihypertensive medication even before the results of your blood tests and electrocardiogram (ECG) were available is not uncommon in clinical practice, especially if the blood pressure readings are significantly high and symptomatic.

Is the Treatment Approach Correct?
The decision to start antihypertensive medication is often based on the severity of the blood pressure readings and the presence of symptoms. In your case, with a diastolic pressure nearing 100 mmHg and associated symptoms, the doctor likely deemed it necessary to initiate treatment promptly to prevent potential complications such as stroke or heart disease. The guidelines for hypertension management recommend starting medication if blood pressure readings are consistently above 130/80 mmHg, especially if there are symptoms or risk factors present.

Why No Echocardiogram?
Regarding the absence of an echocardiogram (ultrasound of the heart), it is important to note that not all patients with hypertension require this test. Echocardiograms are typically performed to assess heart structure and function, particularly if there are concerns about heart failure, valvular heart disease, or if the patient has a history of heart problems. If your ECG and blood tests were normal and there were no other indications of heart issues, your doctor may have felt that an echocardiogram was not immediately necessary. However, if you have concerns or if your blood pressure remains uncontrolled, discussing the need for further imaging with your healthcare provider is advisable.

Understanding Your Blood Pressure Readings
Your observation that your diastolic pressure is consistently high is noteworthy. Hypertension can be classified into different types, including isolated systolic hypertension (where only the systolic number is elevated) and diastolic hypertension. The reasons for elevated diastolic pressure can vary and may include factors such as increased peripheral resistance, stress, obesity, or even hormonal influences. It is essential to monitor your blood pressure regularly and discuss these readings with your healthcare provider to understand the underlying causes better.

Can Lifestyle Changes Lead to Discontinuation of Medication?
Regarding the potential to stop medication through lifestyle changes, it is indeed possible for some individuals to manage their blood pressure effectively with diet, exercise, and other lifestyle modifications. The DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes fruits, vegetables, whole grains, and low-fat dairy, along with regular physical activity, can significantly impact blood pressure control. However, this varies from person to person. Some may find that they can reduce or even discontinue their medication with significant lifestyle changes, while others may still require medication to maintain optimal blood pressure levels.

It is crucial to work closely with your healthcare provider to monitor your blood pressure and adjust your treatment plan as necessary. Regular follow-ups will help determine the effectiveness of your current regimen and whether lifestyle changes are having the desired impact.

Conclusion
In summary, your treatment approach appears appropriate given your symptoms and blood pressure readings. While an echocardiogram may not have been deemed necessary at this stage, it is essential to maintain open communication with your healthcare provider about your concerns and any changes in your condition. Lifestyle modifications can play a significant role in managing hypertension, and with proper guidance, you may be able to achieve better control of your blood pressure, potentially leading to a reduction in medication. Always consult your doctor before making any changes to your treatment plan.

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