High blood pressure (hypertension or HTN) requires a combination of treatments and lifestyle changes to effectively manage the condition. Discuss these factors with your physician, as each person’s treatment may be different depending on many factors. Reducing your blood pressure will reduce your risk of heart attack and stroke.
If you have been diagnosed with hypertension, you are not alone! This article is the last in a series that will focus on explaining how our cardiovascular system works, understanding blood pressure readings, the causes of hypertension, your blood pressure numbers, how to measure correctly, lifestyle changes, and the treatment and management of the condition.
Measure Your Blood Pressure on a Regular Basis
The first step in managing high blood pressure is to know and understand your numbers. High blood pressure often has no symptoms. The only way to know your numbers is to take your blood pressure.
According to research from the American Heart Association, roughly half of U.S. adults should be taking their blood pressure routinely at home. Taking your blood pressure at home can give your health care provider a more accurate representation of your blood pressure than the occasional office visit. Tips for taking your blood pressure at home or at your local supermarket or pharmacy.
Lifestyle changes can have a positive effect on high blood pressure. The list below contains general recommendations for lifestyle changes. It is important to always consult with your health care provider.
- Eating a heart-healthy diet with less salt.
- Getting regular physical activity.
- Maintaining a healthy weight or losing weight.
- Limiting alcohol consumption.
- Quitting smoking.
- Getting seven to nine hours of sleep daily.
- Finding ways to manage stress.
I Have High Blood Pressure: Do I Need Medication?
Often, the first question after being diagnosed with hypertension is, “Do I have to take medication?” For some, lifestyle changes aren’t enough to treat high blood pressure. In that case, your provider may recommend medication. When discussing blood pressure medication with your provider, the following factors should be part of the discussion:
- The stage of elevation as indicated by the American Heart Association “Blood Pressure Categories” chart.
- Causes and risk factors such as a family history of high blood pressure, diet, exercise, smoking, age, and other factors.
- Any existing or underlying health conditions, like diabetes, that you may have.
- Medications and supplements you may be taking.
- Your lifestyle, which includes your diet, exercise, and social behaviors such as smoking or drinking.
The type of medicine used to treat hypertension depends on your overall health and how high your blood pressure is. When discussing medication with your health care provider, it is important to set a blood pressure goal. The ideal blood pressure goal can vary depending on age and health condition, but a common goal is achieving a blood pressure of less than 120/80 mm Hg if:
With some individuals, two or more blood pressure drugs often work better than one. It can take some time to find the right medication or combination of medications that work best for you.
Blood Pressure Medications
- Water Pills (Diuretics) – Remove sodium and water from the body. They are often the first medicines used to treat high blood pressure.
- Angiotensin-converting Enzyme (ACE) Inhibitors – Drugs used to help relax blood vessels. They block the formation of a natural chemical that narrows blood vessels. Examples include lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril, and others.
- Angiotensin II Receptor Blockers (ARBs) – These drugs also relax blood vessels. They block the action, not the formation, of a natural chemical that narrows blood vessels. angiotensin II receptor blockers (ARBs) include candesartan (Atacand), losartan (Cozaar) and others.
- Calcium Channel Blockers – Drugs that help relax the muscles of the blood vessels. Some slow your heart rate. They include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others. Calcium channel blockers may work better for older people and Black people than do angiotensin-converting enzyme (ACE) inhibitors alone. Don’t eat or drink grapefruit products when taking calcium channel blockers. Grapefruit increases blood levels of certain calcium channel blockers, which can be dangerous. Talk to your provider or pharmacist if you’re concerned about interactions.
If you’re having trouble reaching your blood pressure goal with combinations of the above medicines, your provider may prescribe:
- Alpha Blockers – Medicines that reduce nerve signals to blood vessels. They help lower the effects of natural chemicals that narrow blood vessels. Alpha blockers include doxazosin (Cardura), prazosin (Minipress), and others.
- Alpha-beta Blockers – These drugs block nerve signals to blood vessels and slow the heartbeat. They reduce the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
- Beta Blockers -Medication that reduce the workload on the heart and widens the blood vessels. This helps the heart beat slower and with less force. Beta-blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL, Kapspargo sprinkle), and others. Beta-blockers aren’t usually recommended as the only medicine prescribed. They may work best when combined with other blood pressure drugs.
- Aldosterone Antagonists -These drugs may be used to treat resistant hypertension. They block the effect of a natural chemical that can lead to salt and fluid buildup in the body. Examples are spironolactone (Aldactone) and eplerenone (Inspra).
- Renin Inhibitors – Aliskiren (Tekturna) slows the production of renin, an enzyme produced by the kidneys that starts a chain of chemical steps that increases blood pressure.
- Due to a risk of serious complications, including stroke, you shouldn’t take aliskiren with ACE inhibitors or ARBs.
- Vasodilators – Medications that stop the muscles in the artery walls from tightening. This prevents the arteries from narrowing. Examples include hydralazine and minoxidil.
- Central-acting Agents – Medications that prevent the brain from telling the nervous system to increase the heart rate and narrow the blood vessels. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv) and methyldopa.
It is always important to take blood pressure medications as prescribed. Never skip a dose or abruptly stop taking medications. Suddenly stopping certain ones, such as beta-blockers, can cause a sharp increase in blood pressure called rebound hypertension. Don’t change your treatment without your provider’s guidance. If cost becomes an issue speak with your health care provider or your pharmacist for available programs.
It is important to speak with your health care provider and address a treatment plan for any stage of hypertension, but it is imperative to seek medical attention for blood pressure that exceeds 180/120 mm Hg. With blood pressure this high, you could also experience chest pain, shortness of breath, back pain, numbness or weakness, changes in vision, or difficulty speaking. DO NOT WAIT TO SEE YOUR PHYSICIAN. CALL 911 IMMEDIATELY.
As part of living a healthier life, RPM Healthcare offers remote patient monitoring and care coaching services for those with high blood pressure and other health conditions. This series on hypertension, the RPM365 platform, and care coaches are aimed at working with you to achieve a healthy lifestyle and prevent heart attack, stroke, and other health conditions that can affect your everyday life. Visit RPM365.com for more information and to sign up for our free monthly webinars.
The above article has been reviewed by Irina Koyfman, DNP, NP-C, RN, Chief Population Health Officer, RPM Healthcare.