Lower blood pressure

Hypertension is managed using lifestyle modification and antihypertensive medications. Hypertension is usually treated to achieve a blood pressure of below 140/90 mmHg to 160/100 mmHg. According to one 2003 review, reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischaemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease.For most people, recommendations are to reduce blood pressure to less than or equal to somewhere between 140/90 mmHg to 160/100 mmHg. Attempting to achieve lower levels have not been shown to improve outcomes while there is evidence that it increases side effects. In those with diabetes or kidney disease some recommend levels below 120/80 mmHg; however, evidence does not support these lower levels.The first line of treatment for hypertension is identical to the recommended preventive lifestyle changes and includes dietary changes, physical exercise, and weight loss. These have all been shown to significantly reduce blood pressure in people with hypertension. Their potential effectiveness is similar to and at times exceeds a single medication. If hypertension is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction with medication.Several classes of medications, collectively referred to as antihypertensive medications, are available for treating hypertension. Use should take into account the person's cardiovascular risk (including risk of myocardial infarction and stroke) as well as blood pressure readings, in order to gain a more accurate picture of the person's risks.Treating moderate to severe hypertension decreases death rates and cardiovascular morbidity and mortality in people aged 60 and older. The recommended BP goal is advised as <150/90 mm Hg with thiazide diuretic, CCB, ACEI, or ARB being the first line medication in the United States, and in the revised UK guidelines calcium-channel blockers are advocated as first line with targets of clinic readings <150/90, or <145/85 on ambulatory or home blood pressure monitoring.Resistant hypertension is defined as hypertension that remains above goal blood pressure in spite of using, at once, three antihypertensive medications belonging to different drug classes. Guidelines for treating resistant hypertension have been published in the UK and US. It has been proposed that a proportion of resistant hypertension may be the result of chronic high activity of the autonomic nervous system; this concept is known as 'neurogenic hypertension'. Low adherence to treatment is an important cause of resistant hypertension.One avenue of research investigating more effective treatments for severe resistant hypertension has focused on the use of selective radiofrequency ablation. It employs a catheter-based device to cause thermal injury to the sympathetic nerves surrounding the renal arteries, with the aim to reduce renal sympathetic overactivity (so-called 'renal denervation') and thereby reduce blood pressure. It has been employed in clinical trials for resistant hypertension. However, a prospective, single-blind, randomized, sham-controlled clinical trial failed to confirm a beneficial effect. Infrequent renal artery dissection, femoral artery pseudoaneurysm, excessive decreases in blood pressure and heart rate have been reported. A 2014 consensus statement from The Joint UK Societies recommended radiofrequency ablation not be used for the treatment of resistant hypertension, but supported continuing clinical trials. Patient selection, with attention to measurement of pre- and post-procedure sympathetic nerve activity and norepinephrine levels, may help differentiate responders from non-responders to this procedure.