From the Guidelines
I strongly recommend that you seek immediate medical attention for your dangerously high blood pressure (224/117), which is considered a hypertensive crisis, even if you feel okay. While it's good news that your echocardiogram and stress tests were normal, this blood pressure reading requires urgent evaluation 1. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline, proper blood pressure measurement is crucial, and your reading is significantly higher than normal 1.
Your doctor may prescribe medications like amlodipine (5-10mg daily), lisinopril (10-40mg daily), or hydrochlorothiazide (12.5-25mg daily), often in combination, to manage your blood pressure 1. Additionally, you should:
- Monitor your blood pressure at home twice daily
- Reduce sodium intake to less than 2,300mg daily
- Exercise moderately for 30 minutes most days
- Limit alcohol
- Quit smoking if applicable
- Manage stress
These extremely high readings can damage blood vessels and organs even without symptoms, potentially leading to stroke, heart attack, or kidney damage 1. The normal tests suggest you haven't yet developed complications, but without proper treatment, this level of hypertension will likely cause serious problems over time. It's essential to follow the recommendations for follow-up based on initial blood pressure measurements, and in your case, evaluation and treatment should be done immediately or within 1 week, depending on the clinical situation and complications 1.
From the FDA Drug Label
1 INDICATIONS & USAGE 1. 1 Hypertension Amlodipine besylate tablets is indicated for the treatment of hypertension, to lower blood pressure.
INDICATIONS & USAGE 1. 1 Hypertension Lisinopril tablets USP are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure.
Given your high blood pressure of 224/117, treatment with an antihypertensive medication such as amlodipine 2 or lisinopril 3 may be considered to lower blood pressure and reduce the risk of cardiovascular events.
- Amlodipine and lisinopril are both indicated for the treatment of hypertension.
- It is essential to follow the guidance of a healthcare professional for proper diagnosis and treatment.
From the Research
Blood Pressure Management
- The patient's blood pressure reading of 224/117 is considered severely elevated, and management of such cases can be challenging in primary care 4.
- According to the American Family Physician, treatment of hypertension reduces morbidity and mortality due to coronary artery disease, myocardial infarction, heart failure, stroke, and chronic kidney disease 5.
- The use of ambulatory and home blood pressure monitoring can improve diagnostic accuracy, and assessment of adults with hypertension should focus on identifying complications of the condition and comorbid cardiovascular risk factors 5.
Lifestyle Interventions
- Physicians should counsel all patients with elevated blood pressure about effective lifestyle interventions, including:
- The Dietary Approaches to Stop Hypertension (DASH) diet
- Dietary sodium restriction
- Potassium enrichment
- Regular exercise
- Weight loss
- Moderation of alcohol consumption 5
Pharmacologic Intervention
- First-line antihypertensive medications include:
- Angiotensin-converting enzyme inhibitors
- Angiotensin receptor blockers
- Calcium channel blockers
- Thiazide diuretics 5
- Combination therapy of two or more antihypertensives is recommended for treatment of hypertension where monotherapy is ineffective 6, 7
- The effectiveness of add-on low-dose diuretics in combination therapy for hypertension has been studied, with losartan/hydrochlorothiazide and candesartan/amlodipine being compared 6
Blood Pressure Targets
- The standard blood pressure target in clinical practice is less than 140/90 mm Hg for the general population of patients with elevated blood pressure 8
- Lowering blood pressure to less than 135/85 mm Hg may further reduce the risk of myocardial infarction, but the benefits of lower targets do not outweigh the harms as compared to standard blood pressure targets 8