Blood pressure control can be within reach by following a few simple steps: knowing your blood pressure goals and the steps to reach them will help you manage hypertension, but sticking with your medications, diet and exercise are the keys.
And rather than become daunted by the prospect of a lifelong commitment to controlling your hypertension, consider the results of a study that showed small, yet focused, initiatives can lead to big improvements in blood pressure management. In a study published June 16 in Circulation: Cardiovascular Quality and Outcomes, researchers found that patients who were given clearcut blood pressure goals and who monitored their blood pressure regularly, followed through on clinic visits and adhered to their medications saw significant improvements in their blood pressure control.
Cleveland Clinic hypertension expert Donald Vidt, MD, adds that while it's critical that patients track their blood pressure regularly, they should realize that even small improvements in weight loss and exercise also have a role in treating their hypertension. He urges patients to talk openly with their doctors about what's needed to improve their blood pressure and just what their targets should be, because patients who have diabetes or who are very elderly may have different targets.
"The treatment of blood pressure should be individualized with every patient," Dr. Vidt says. "The efforts should not be based just on the numbers, but on minimizing other heart risks as well. If a patient is obese, the goal is not just to reduce blood pressure, but for the patient to lose weight and reduce the risk of diabetes and other problems. We have to look at all the risk factors and how they're inter-related."
Risk factors for hypertension include obesity, smoking, inactivity, family history, age, stress, and too much sodium in the diet, among others.
Understanding your risk
Dr. Vidt notes that as your blood pressure increases, so too does your risk of heart attack or stroke, even if the numbers are still considered within the healthy or normal range. For every 20 mmHg increase in systolic pressure (the top number) and 10 mmHg increase in diastolic pressure (the bottom number), your risk of mortality from stroke or ischemic heart disease doubles.
"You don't have to be at 200/120 to be at an increased risk," Dr. Vidt says. "If your blood pressure goes from 115/70 to 135/80, there's an increased risk, even though that's when blood pressure is still considered in the borderline range."
He adds that all factors should be considered in determining your overall risk. "When you're at extremely low risk, doubling your risk doesn't mean as much as when you're older, diabetic and severely hypertensive," Dr. Vidt says.
If you've just started on a regimen aimed at lowering your blood pressure, Dr. Vidt recommends you be realistic in your expectations, particularly about the time involved to reach your targets.
"If you're just looking at lifestyle changes (without medication), it may be months before you start to see real improvement," Dr. Vidt says. "If you're talking about also treating a patient with hypertensive medications, I would say within several weeks you should start to see improvements."
But Dr. Vidt says improvements can easily be derailed if patients don't take blood pressure control seriously. It's all too common, he says, for a patient to fill a prescription for hypertension medications once and then not bother to refill it once the pills are gone.
"This is where the education comes in," Dr. Vidt says. "Blood pressure is the leading cardiovascular risk factor we have, and patients have got to understand the importance of staying on their medications. And they also need to know that if they have any indication of a side effect, they shouldn't just stop taking their medications. They should call their doctor's office and at least have a conversation with a nurse or nurse practitioner about it."
Dr. Vidt also strongly recommends an investment in a home blood pressure monitoring device and regular checks. It only takes a few minutes, but keeping track of your blood pressure and any changes that take place between doctor visits can go a long way toward controlling hypertension.
Dr. Vidt recommends sitting in a comfortable chair with your arm supported at heart level for five minutes. Take your blood pressure, wait two or three minutes and then take it again. When you start out, Dr. Vidt suggests taking your blood pressure a couple of times a day, perhaps in the morning and the evening.
"Once a patient's blood pressure is under control, you can drop the frequency down to two or three times a week," Dr. Vidt says. "You get down to once a week and patients start to forget about it. With the small improvements you see, just keep your goal in mind and know what it takes to get there."
WHAT YOU CAN DO
To help lower your blood pressure:
* Quit smoking.
* Maintain a healthy weight.
* Eat a low-fat, low-cholesterol diet and limit sodium intake.
* Exercise for 30 to 40 minutes most days of the week.
* Limit alcohol intake to no more than two drinks per day for a man and one for a woman.
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|Date:||Sep 1, 2009|
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