Understanding the “Three Pillars” of Hypertension Treatment

High blood pressure is a common chronic disease and an “invisible killer” in Hong Kong. It usually has no obvious symptoms, but if it persists, it will greatly increase the risk of coronary heart disease, heart failure and stroke, so it should be taken seriously and controlled promptly. Current treatment options can mainly be divided into three directions, including improving lifestyle habits, drug treatment, or undergoing renal sympathetic denervation.

Hypertension refers to a systolic blood pressure of 140mmHg or above, and/or a diastolic blood pressure of 90mmHg or above. However, if blood pressure has long been around 135mmHg systolic and 85mmHg diastolic, it also warrants closer attention and follow-up where necessary.

Clinically, nearly 90% of cases are primary hypertension, meaning the cause is unknown. That said, there are several risk factors to note, including age-related vascular stiffening, a family history of hypertension, obesity, lack of exercise, smoking, a diet high in salt, sugar and fat, and prolonged stress.

It should be noted that if hypertension is not properly treated or is poorly controlled, it may lead to serious complications such as coronary heart disease, stroke, heart failure or kidney disease. In particular, for every 20mmHg increase in systolic blood pressure and every 10mmHg increase in diastolic blood pressure, the mortality rate from cardiovascular disease doubles, which is a matter of concern.

When it comes to hypertension, many people ask whether medication is always necessary. In fact, the first step is usually to advise patients to change their exercise and dietary habits, including eating a light diet (such as reducing salt and preserved foods), quitting smoking and alcohol, controlling weight, and doing moderate aerobic exercise.

However, if blood pressure remains high after improving the above habits, or if these habits cannot be controlled, different antihypertensive medications will be recommended depending on the patient’s condition, for example whether they also have heart disease or diabetes. Commonly used medications include angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics, beta-blockers, etc. These can help lower blood pressure, reduce the heart’s workload, and prevent complications.

For some cases of difficult-to-control hypertension, renal sympathetic denervation may be an effective treatment option. This minimally invasive procedure uses thermal ablation to destroy the nerves around the kidneys, blocking nerve conduction and thereby reducing the blood-pressure-regulating signals generated by the kidneys, which in turn lowers blood pressure. This procedure is suitable for patients who have taken three or more antihypertensive medications but still have uncontrolled blood pressure, while having normal kidney function; or for those who, after assessment, are considered to have a higher overall cardiovascular risk and a higher risk of hypertension-mediated organ damage (Hypertension-mediated organ damage, abbreviated as HMOD). 

1. Moderate exercise
Engage in at least 150 minutes of moderate aerobic exercise each week, such as brisk walking, swimming, cycling, etc. This can enhance the elasticity of blood vessels.

2. Avoid unhealthy habits
Quitting smoking and drinking less alcohol, for example, can help reduce damage to cardiovascular health.

3. Regular check-ups
It is generally recommended to begin regular blood pressure checks from the age of 40, to help detect and control high blood pressure early and reduce the risk of complications. 

Written by: Dr Tsang Chun-fung, Specialist in Cardiology

This English version of this article has been generated by machine translation powered by AI. It is provided solely for reference purposes. In the event of any discrepancy or inconsistency between this translation and the original Chinese version, the Chinese version shall prevail.