Hypertension Treatment · High Blood Pressure

Hypertension Treatment — Explained Properly

Hypertension treatment aims for a home reading under 130/80 mmHg in most adults, using salt reduction, weight loss and one or more of an ACE inhibitor or ARB, a calcium channel blocker and a diuretic. Treatment is confirmed with home or 24-hour readings, and reviewed with kidney function, ECG and cardiac risk assessment.

How high blood pressure is actually treated: confirming the diagnosis with home readings, the baseline tests that must be done, how the four drug classes are chosen, when doses can be reduced, and what to do about resistant BP. From the practice of Dr. Sanjay Sachdev (MBBS, MNAMS), South Delhi.

WhatsApp the ClinicCall +91 98110 78388

Step 1 — confirm before you treat

One high clinic reading is not hypertension. Diagnosis rests on averaged home readings — twice daily for 5–7 days — or ambulatory monitoring. This also identifies white-coat hypertension (high in clinic, normal at home) and masked hypertension (the reverse, and more dangerous).

Step 2 — baseline tests, always

ECG, kidney function (urea, creatinine, eGFR), urine routine plus albumin-creatinine ratio, electrolytes, fasting glucose or HbA1c, lipid profile and thyroid. Young, severe or resistant cases add a secondary-cause screen: primary aldosteronism, renal artery stenosis, sleep apnoea, thyroid disease.

Step 3 — lifestyle that measurably moves BP

Salt below 5 g/day (roughly 10–12 mmHg in salt-sensitive patients), 7–10% weight loss, 150 minutes of weekly aerobic activity, potassium-rich diet unless kidney disease restricts it, alcohol reduction, and treating snoring or witnessed apnoea.

Step 4 — drug selection and combination

ACE inhibitors or ARBs for younger patients, diabetes and proteinuria; calcium channel blockers and thiazide-like diuretics for older patients; beta-blockers where there is angina, prior infarct, heart failure or arrhythmia. Low-dose two-drug single-pill combinations are preferred over maximum-dose monotherapy — better control, fewer side effects.

Step 5 — resistant hypertension

Still above target on three drugs including a diuretic? The review covers adherence, salt load, NSAIDs and steroids, decongestants, alcohol, sleep apnoea, renal artery disease and primary aldosteronism — before a fourth tablet (usually spironolactone) is added.

Step 6 — de-escalation and long-term review

Where weight loss and lifestyle change have held for 6–12 months, a supervised dose taper is offered with home BP monitoring. Otherwise review every 6 months with BP, weight, kidney function, electrolytes and a side-effect check.

Frequently asked

6 answers
What is the treatment for hypertension?
Confirmed hypertension is treated with lifestyle change plus, in most cases, medication. Lifestyle: salt below 5 g/day, 7–10% weight loss where relevant, 150 minutes of weekly activity, alcohol moderation, better sleep. Drugs are chosen from four main classes — ACE inhibitors or ARBs, calcium channel blockers, thiazide-like diuretics, and beta-blockers for specific indications.
Which BP medicine is best?
It depends on age, kidney function, diabetes and heart history. Under 55 with diabetes or protein in urine, an ACE inhibitor or ARB is usually first. Over 55, a calcium channel blocker or thiazide-like diuretic. Two drugs at low dose in a single pill often control BP better, with fewer side effects, than one drug at maximum dose.
Can hypertension be cured without medication?
Stage 1 hypertension (140–159 / 90–99) with no organ damage can sometimes be controlled by lifestyle alone over 3–6 months, with home BP logs to prove it. Higher readings, diabetes, kidney disease or previous cardiac events need medication from the start. Existing medication should only be reduced under supervision, never stopped abruptly.
What BP target should I aim for?
For most adults, below 130/80 on home readings. Below 140/90 is acceptable for the frail elderly or where lower targets cause dizziness. Targets are set on averaged home readings across 5–7 days, not one clinic measurement.
What happens if high BP is left untreated?
Stroke, heart attack, heart failure, kidney failure, retinal damage and vascular dementia — usually with no symptoms until damage is done. This is why annual BP checks matter even when you feel completely well.
Where can I get hypertension treatment in South Delhi?
Dr. Sanjay Sachdev (MBBS, MNAMS) manages hypertension at Friends Colony East (C-58) and Maharani Bagh Community Centre (E-64), Monday to Saturday, 10:00 AM – 7:00 PM. Bring 5–7 days of home BP readings to the first visit. WhatsApp or call +91 98110 78388.

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Consultations are by appointment at Friends Colony East and Maharani Bagh, South Delhi.

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