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The ABCs of High Blood Pressure (Hypertension)

hypertensionHigh Blood Pressure Treatment

Hypertension, or high blood pressure, is dangerous because it can lead to strokes, heart attacks, heart failure, or kidney disease. The goal of hypertension treatment is to lower high blood pressure and protect important organs, like the brain, heart, and kidneys from damage. Treatment for hypertension has been associated with reductions in stroke (reduced an average of 35%-40%), heart attack (20%-25%), and heart failure (more than 50%), according to research.

 

High blood pressure is classified as:

  • Normal blood pressure: less than 120/80
  • Prehypertension: 120-139/80-89
  • Hypertension: greater than 140/90
  • Stage 1 Hypertension:140-159/90-99
  • Stage 2 Hypertension: 160 or greater/100 or greater

All patients with blood pressure readings greater than 120/80 should be encouraged to make lifestyle modifications, such as eating a healthier diet, quitting smoking, and getting more exercise. Treatment with medication is recommended to lower blood pressure to less than 140/90. For patients who have diabetes or chronic kidney disease the recommended blood pressure is less than 130/80.

Treating high blood pressure involves lifestyle changes and possibly drug therapy.

Lifestyle Changes to Treat High Blood Pressure

A critical step in preventing and treating high blood pressure is a healthy lifestyle. You can lower your blood pressure with the following lifestyle changes:

  • Losing weight if you are overweight or obese.
  • Quitting smoking.
  • Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy products, less saturated and total fat).
  • Reducing the amount of sodium in your diet to less than 1,500 milligrams a day if you have high blood pressure. Healthy adults need to limit their sodium intake to no more 2,300 milligrams a day (about 1 teaspoon of salt).
  • Getting regular aerobic exercise (such as brisk walking at least 30 minutes a day, several days a week).
  • Limiting alcohol to two drinks a day for men, one drink a day for women.

In addition to lowering blood pressure, these measures enhance the effectiveness of high blood pressure drugs.

Drugs to Treat High Blood Pressure

There are several types of drugs used to treat high blood pressure, including:

  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers (ARBs)
  • Diuretics
  • Beta-blockers
  • Calcium channel blockers
  • Alpha-blockers
  • Alpha-agonists
  • Renin inhibitors
  • Combination medications

Diuretics are often recommended as the first line of therapy for most people who have high blood pressure.
However, your doctor may start a medicine other than a diuretic as the first line of therapy if you have certain medical problems. For example, ACE inhibitors are often a choice for a people with diabetes. If one drug doesn't work or is disagreeable, other types of drugs are available.

If your blood pressure is more than 20/10 points higher than it should be, your doctor may consider starting you on two drugs or placing you on a combination drug.

High Blood Pressure Treatment Follow-Up

After starting high blood pressure drug therapy, you should see your doctor at least once a month until the blood pressure goal is reached. Once or twice a year, your doctor will check the level of potassium in your blood (diuretics can lower this, and ACE inhibitors and ARBs may increase this) and other electrolytes and BUN/creatinine levels (to check the health of the kidneys).

After the blood pressure goal is reached, you should continue to see your doctor every three to six months, depending on whether you have other diseases such as heart failure.

High Blood Pressure and Diuretics (Water Pills)

For high blood pressure, diuretics, commonly known as "water pills," help your body get rid of unneeded water and salt through the urine. Getting rid of excess salt and fluid helps lower blood pressure and can make it easier for your heart to pump. Diuretics may be used to treat a number of heart-related conditions, including high blood pressure, heart failure, kidney and liver problems, and glaucoma.

Thiazide diuretics, such as Esidrix or Zaroxolyn, can be used to lower blood pressure, or to treat edema in heart failure.

Loop diuretics (Lasix, Bumex) are often used when people have congestive heart failure symptoms and are especially useful in emergencies but do not significantly lower blood pressure.

Potassium-sparing diuretics (like Aldactone, Dyrenium) help your body retain potassium and are used more often in congestive heart failure patients. They are often prescribed in conjunction with the other two types of diuretics, but also do not significantly lower blood pressure.

What Are the Side Effects of Diuretics?

Like any drug, diuretics come with potential side effects. They can include:

  • Frequent urination. This may last for several hours after a dose.
  • Arrhythmia (abnormal heart rhythm)
  • Electrolyte abnormalities -- Blood test monitoring of blood chemistries or electrolytes, such as potassium, sodium, or kidney function, is important before and during drug use.
  • Extreme tiredness or weakness. These effects should decrease as your body adjusts to the medication. Call your doctor if these symptoms persist.
  • Muscle cramps or weakness. If you take potassium supplements, be sure that you are taking your potassium supplement correctly, if prescribed. Contact your doctor if these symptoms persist.
  • Dizziness, lightheadedness. Try rising more slowly when getting up from a lying or sitting position.
  • Blurred vision, confusion, headache, increased perspiration (sweating), and restlessness. If these effects are persistent or severe, contact your doctor.
  • Dehydration. Signs include dizziness, extreme thirst, excessive dryness of the mouth, decreased urine output, dark-colored urine, or constipation. If these symptoms occur, don't assume you need more fluids, call your doctor.
  • Fever, sore throat, cough, ringing in the ears, unusual bleeding or bruising, rapid and excessive weight loss. Contact your doctor right away.
  • Skin rash. Stop taking the medication and contact your doctor right away.
  • Loss of appetite, nausea, vomiting, or muscle cramps. Be sure that you are taking your potassium supplement correctly, if prescribed.

Complementary and Alternative Treatments for High Blood Pressure

There are many different types of complementary and alternative treatments believed to be effective for treating high blood pressure (hypertension). Scientific evidence indicates that a diet that is low in saturated fat and salt and rich in complex carbohydrates (vegetables, whole grains, legumes, and fruits), increased physical activity, and regular practice of relaxation techniques such as yoga, Tai Chi, or Qigong, can help to lower high blood pressure.

Diet to Lower High Blood Pressure

One of the simplest and most effective ways to lower your blood pressure is to eat a healthy diet, such as the DASH diet. Doctors recommend:

  • Eating more fruits, vegetables, and low-fat dairy foods
  • Cutting back on foods that are high in saturated fat, cholesterol, and total fat
  • Eating more whole grain products, fish, poultry, and nuts
  • Eating less red meat and sweets
  • Eating foods that are rich in magnesium, potassium, and calcium

Physical Activity to Lower Blood Pressure

A solid body of evidence shows that men and women of all age groups who are physically active have a decreased risk of developing high blood pressure. Findings from multiple studies indicate that exercise can lower blood pressure as much as some drugs can. People with mild and moderately elevated blood pressure who exercise 30 to 60 minutes three to four days per week (walking, jogging, cycling, or a combination) may be able to significantly decrease their blood pressure readings.

Blood Pressure, Breathing, and Stress Management

Blood pressure increases when a person is under emotional stress and tension, but whether or not psychological interventions aimed at stress reduction can decrease blood pressure in patients with hypertension is not clear.

Nevertheless, recent studies suggest that ancient relaxation methods that include controlled breathing and gentle physical activity, such as yoga, Qigong, and Tai Chi, are beneficial. People with mild hypertension who practiced these healing techniques daily for two to three months experienced significant decreases in their blood pressure, had lower levels of stress hormones, and were less anxious.

The results of a recent small study suggest that a daily practice of slow breathing (15 minutes a day for 8 weeks) brought about a substantial reduction in blood pressure. However, these findings need to be confirmed in larger and better-designed studies before these ancient healing techniques are recommended as effective non-pharmacological approaches to treating hypertension. Still, possible benefits, coupled with minimal risks, make these gentle practices a worthwhile activity to incorporate into a healthy lifestyle.

Note: It is important that inactive older people or those with chronic health problems be evaluated by their doctor before starting a program of any physical activity, including Tai Chi, Qigong, or yoga.

Herbal Therapies for High Blood Pressure

The efficacy and safety of herbal therapies, such as Rauwolfia serpentina (snakeroot), Stephania tetrandra (tetrandrine), Panax notoginseng (ginseng), and Crataegus species (hawthorn) for treating high blood pressure have not been extensively studied. Because of potential health risks associated with these herbs, it is imperative that you inform your doctor if you plan to use or are already using them. This is even more important if these herbs are used in combination with high blood pressure drugs. Some herbs, such as licorice, ephedra (Ma Huang), and yohimbine (from the bark of a West African tree) should not be used by people with hypertension, because they can increase blood pressure.

Supplements to Lower Blood Pressure

Some supplements have been evaluated as blood pressure-lowering options, including:

  • Coenzyme Q10 (CoQ10): People with mild high blood pressure who were taking CoQ10 experienced a significant drop in their blood pressure without appreciable side effects. In addition, CoQ10 appears to reduce blood pressure by a different mechanism than major antihypertensive drugs.
  • Omega-3 fatty acids: Some studies report that EPA and DHA may reduce blood pressure in people with mild hypertension. However, other studies have had conflicting results. Current evidence suggests that modest reductions of blood pressure may occur with significantly higher doses of omega-3 fatty acids.
  • Amino acids: It has been suggested that the diet supplement L-arginine may lower blood pressure; however, the few studies conducted to date were small and not well-controlled, and suggest that L-arginine may lower blood pressure for only a short period of time. Another amino acid, L-taurine, may also have blood pressure-lowering qualities.

Talk to your doctor before starting any medication, including these supplements, which may be available without a prescription. The risks and benefits of every medicine (including over-the-counter drugs) must be carefully weighed on an individual basis.

Acupuncture for High Blood Pressure

Extensive research on the effectiveness of acupuncture for lowering blood pressure has been reported, but many studies have considerable weaknesses. More rigorously controlled research is needed to determine the value of acupuncture as a treatment for hypertension. At this time, there is no evidence that acupuncture reliably lowers high blood pressure.

 

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