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Finding the Right Medication is Key for Treating High Blood Pressure: Your risks of heart attack, stroke, and heart failure are reduced when your blood pressure is controlled.

Many patients diagnosed with high blood pressure (hypertension) are prescribed medication to bring down their blood pressure. When it comes to blood pressure drugs, there are several options that work in a variety of ways. Here is some information about medication and other strategies you can use to get and keep your blood pressure in a healthy range.

Choosing a Medication

There are numerous classes of medications used to treat high blood pressure; they include diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), beta-receptor blockers, and alpha-receptor blockers. Understanding which mechanism(s) are causing your hypertension can be helpful in selecting the class(es) of drugs most likely to lower your blood pressure, since the drugs work in different ways. The mechanisms responsible for hypertension in most people include:

* Constriction (narrowing) of arteries related to effects of sodium intake

* Constriction of arteries caused by angiotensin II, a hormone stimulated by an enzyme called renin

* Effects of stimulation of the sympathetic nervous system, which increases heart rate and causes blood vessels to constrict.

"It is very important to individualize drug therapy for each patient," says Samuel Mann, MD, a hypertension expert at Weill Cornell Medicine. "The same medication that works for you may not be effective for another patient." Your doctor will consider numerous factors, including your age, weight, lifestyle, medical history, and other health conditions you have to determine the medication regimen that is best suited for you.

"About 80 percent of people with hypertension will have their blood pressure controlled with drugs that address either the sodium volume mechanism or the renin-angiotensin mechanism, or a combination of drugs to address both. And, hypertension can be controlled in almost everyone if they're given the right drugs," Dr. Mann says.

In some cases, the mechanism is relatively easy to diagnose. "For example, swelling due to fluid retention, which occurs most commonly in the legs, indicates that a sodium/volume mechanism is likely, and a diuretic will probably decrease blood pressure," Dr. Mann says. "However the sodium/ volume mechanism is also operative in many patients without obvious fluid retention.

More on Medication

When you start a new medication, your doctor may prescribe a low dose, and then increase the dose if necessary. If your blood pressure is below 160/100 mm Hg, a single medication is usually prescribed; if the first drug is ineffective, a second drug can either be added or substituted, Dr. Mann says. If your blood pressure is higher than 160/100 mm Hg, guidelines recommend starting treatment with two drugs.

Dr. Mann says that the majority of patients with high blood pressure who require medication end up needing two or more drugs to get it under control. However, weight loss, exercise, and, in many patients, lowering sodium (salt) intake can help reduce the number of medications needed to control blood pressure.

Lifestyle Strategies

For many patients with mild hypertension, adopting a healthier lifestyle can lower blood pressure enough to eliminate the need for medication. A healthy diet, regular exercise, and reduced sodium intake can reduce blood pressure in some patients by as much as 20 mm Hg--as much or more than some medications. Choose a dietary pattern that contains whole grains, fruits, vegetables, lean proteins, and low-fat dairy, and avoid highly processed foods which are often high in sodium, , added sugar, and empty calories.

Engaging in aerobic exercise--the type that requires continuous movement of major muscle groups--30 minutes a day for 3 or more days each week can lower your blood pressure by 4 to 9 mm Hg. Aerobic exercises include walking, jogging, cycling, swimming, and dancing. Strength training (using hand weights, exercise machines, resistance bands, or your own body weight for resistance) also can help reduce blood pressure, and it helps strengthen your bones.

If you are overweight, eating a healthier diet and staying physically active will help you lose weight. For many people, reducing carbohydrate and sugar intake is key for weight loss. If you have difficulty losing weight on your own, ask your doctor for a referral to a healthcare provider who specializes in weight loss.

The Role of Sodium

The effect of sodium consumption on blood pressure varies depending on factors such as genetic susceptibility and weight. Current guidelines disagree on how much your sodium intake should be reduced.

"Some maintain that lowering daily sodium intake below 3,000 milligrams (mg) can be harmful; however, it is likely that in patients whose hypertension is salt-sensitive, an intake below 2,300 mg is helpful," says Dr. Mann.

Even if you don't put salt on your food, you are probably getting too much sodium if you frequently eat out or you eat prepared, processed foods. Research has revealed that about 70 percent of the sodium consumed by Americans comes from restaurant meals, fast food, and processed foods.

Getting enough potassium in your diet will help counteract the effects of sodium. Dr. Mann explains that increased sodium intake can cause smooth muscle cells in the arteries to constrict, whereas increased potassium intake can reduce the constriction. Good sources of potassium include various fruits and vegetables.


* The American Heart Association (AHA) and American College of Cardiology (ACC) released new guidelines in late 2017 that set the goal for blood pressure at 130/80 millimeters of mercury (mm Hg), a reduction from the previously recommended goal of 140/90 mm Hg.

* Dr. Mann says that the new blood pressure target will likely mean more diagnoses of hypertension and more prescriptions. He also notes that there is the possibility that patients will be overtreated.

* "It is important that blood pressure readings be taken only after the patient has been sitting for 5 minutes; otherwise, the reading may be inaccurate," advises Dr. Mann. Also, at least two readings are necessary to confirm a diagnosis of high blood pressure. In addition, some patients have "white coat" hypertension--their blood pressure is higher because they are in the doctor's office. Taking readings on a home blood pressure monitor and reporting the results to your doctor can be helpful in determining whether you have hypertension, as well as how effective your medication is if you already have hypertension.

Caption: Most people can get their blood pressure into the normal range if they are given the right medication.

Caption: Foods that are often high in sodium include ham and other processed meats, cheese, soy sauce and other condiments, olives, and snack foods.
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Publication:Women's Health Advisor
Date:Feb 1, 2018
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