What is high blood pressure?
A doctor can explain why most diseases occur. Not so with hypertension, which is often a complex result of who you are (genetics), what you eat (diet counts), and how you live (the healthy lifestyle choices you make). There are three main ways your body raises its blood pressure:
- Your heart can change the rate and strength of its beats, forcing blood to move more vigorously through your system.
- Your small arteries (arterioles) can constrict for various reasons—plaque on your vessels, for instance, or emotional stress — so higher pressure is needed to circulate your blood.
- Your kidneys can retain more water in your body, creating more blood volume to pound through your vessels. The kidneys do this by releasing hormones that increase your body’s supply of sodium (and a salty diet provides a ready source).
When blood pressure is routinely high, doctors diagnose it as hypertension. Most people with high blood pressure have primary (once called essential) hypertension. Even though its cause is unknown, it accounts for about 90 per cent of cases. In only a few people (about 10 per cent) can high blood pressure be linked to something specific, such as kidney disease or long-term use of certain drugs (NSAIDs, corticosteroids, oral contraceptives). This is secondary hypertension, and eliminating the underlying problem that causes it may be the only treatment you’ll need.
Blood pressure fluctuates throughout the day, reflecting what you’re doing. It drops during sleep, for instance, and spikes during exercise or in times of stress or pain. Most people know their “normal” blood pressure is supposed to be 120/80. The systolic number on the top (120) indicates the highest pressure exerted on your artery walls as the heart contracts to pump the blood out. The diastolic on the bottom (80) reflects the moment of lowest pressure, when it relaxes between contractions.
Over time, high blood pressure can inflict lasting damage. Your overworked heart muscle may become flabby and inefficient, causing heart failure. Vessels that supply blood to your eyes, brain, and various organs may become so stretched or strained that they leak or burst, causing stroke or internal bleeding.
Treatment for high blood pressure and hypertension
There are now many options for lowering high blood pressure, especially given recent drug advances. Treatment usually depends on how severe your condition is. If your numbers are only slightly elevated (130 to 139 mm Hg over 85 to 89 mm Hg), you may be able to avoid drugs altogether by making some sensible lifestyle changes. These might include altering how much you eat, exercise, and weigh, as well as how much alcohol you drink and how you deal with stress. As you work on lowering your blood pressure, check your levels often to be sure you’re on course. Daily readings on a home monitor are good for more serious cases of high blood pressure; biweekly checks on a do-it-yourself machine at a local pharmacy are fine for milder ones.
As a rule, many experts say if blood pressure in the range of 140 to 159 mm Hg systolic or 90 to 99 mm Hg diastolic hasn’t responded to lifestyle changes after six months to a year, you’ll need to start taking medication. A single drug is often very effective, although a second drug may be needed. If you’re able to control your blood pressure very well for a few years, weaving lifestyle changes into your daily routine, your doctor might give you the green light to lower your dose or even stop taking the drugs.
Medications for high blood pressure
You can’t ever go wrong with good lifestyle choices, but sometimes medications (known as antihypertensives) are your best option. When you find the right drug—and take it regularly—you’ll likely see your blood pressure return to normal, no matter how high it once was.
Drug side effects are a consideration, of course. They make some people feel worse than the hypertension itself, though if you’re lucky, you won’t notice any side effects at all. Everyone reacts differently, so be prepared for some trial and error. Eventually you’ll zero in on the drug that’s best for you and that has the fewest side effects. If side effects still are a problem, be sure to talk with your doctor. You might be surprised at how many options you have if a beta-blocker is making you feel blue, or an ACE inhibitor is changing your sense of taste.
You probably won’t need more than one or two antihypertensive drugs. Only a few people (typically those with diabetes or high systolic pressure) use three or more medications. A good doctor will be aware of how certain antihypertensives might harm—or even simultaneously benefit—any other ailments you may have. Until you find the right medication, be prepared to see your doctor every four to six weeks to discuss side effects and check your blood pressure levels.
If you need to start on an antihypertensive medication and are otherwise healthy, you’ll probably be given a diuretic to eliminate excess fluid and sodium, or a beta-blocker, which eases the heart’s workload by tempering the force and frequency of your regular heartbeats. Many studies have shown both of these drug groups to be safe and effective for high blood pressure.
Diuretics prompt the kidneys to excrete excess salt and water. This reduces the volume of blood in your body and, therefore, the amount of fluid that needs to be forced through potentially narrowed arteries. Although they affect different sites in the kidneys, the three types of diuretics produce essentially the same reaction. Such drugs include thiazides (Diuril, Hygroton, Esidrix), loop diuretics (Bumex, Lasix, Edecrin), and potassium-sparing diuretics (Midamor, Aldactone, Dyrenium). Diuretics are particularly effective if you have fairly straightforward hypertension and are older or African-American.
The other top drug choice for high blood pressure is beta-blockers (Inderal, Tenormin, or Corgard). When combined with other antihypertensives, beta-blockers are known for reducing heart-disease related deaths. In fact, these drugs are a good choice if you’ve already had a heart attack, are suffering from angina (chest pain), or have heart rhythm disturbances, tremors, hyperthyroidism, or migraine. They work because they mute the effects of adrenaline and slow your heart down, so it doesn’t have to work so hard. Your doctor is unlikely to select a beta-blocker if you’re prone to asthma (the drug can narrow bronchial airways), depression or have diabetes.
Over the past few years, research has homed in on another class of useful drugs, angiotensin-converting enzyme (ACE) inhibitors (such as Capoten, Vasotec, Prinivil). They lower blood pressure while they help control congestive heart failure and prevent stroke and heart attack in high-risk individuals. Because they reduce the risks and complications of diabetes, ACE inhibitors are an especially wise choice if you have that disease. This medication works by reducing the formation of angiotensin, a substance known to constrict blood vessels. Somewhat costly, ACE inhibitors are commonly taken along with certain other antihypertensives.
About 25 per cent of those who take ACE inhibitors develop an annoying cough. If this side effect becomes overwhelming, a good alternative is angiotensin II receptor blockers (Cozaar, Avapro), which work in much the same way. They are associated with a high risk of birth defects, so tell your doctor if you’re pregnant or trying to conceive.
Another option is calcium channel blockers (calcium antagonists), which include Norvasc, extended-release Cardizem CD, Dilacor-XR, Tiazac, and Procardia XL. They work by widening arteries and lightening the heart’s workload. They’re quick to reduce blood pressure and can ease angina (chest pain). You may find you like calcium channel blockers because they’re so easy to take: just once a day. They’re also pricey and not as effective as other drugs in preventing stroke and heart or kidney problems. As a first drug, your doctor probably won’t prescribe vasodilators, which lower blood pressure by widening blood vessels, or alpha-blockers or central alpha-agonists, which block nerve impulses that constrict small arteries. These medications are typically reserved for times when other antihypertensives have failed, or when a second drug is needed to round out a treatment regime.
Lifestyle choices you can make
The Heart & Stroke Foundation of Canada has some tips. But the most powerful thing you can do to naturally lower mild hypertension is to slash your dietary sodium. There’s a 50 per cent chance that you have the type of hypertension that is salt-sensitive. If that’s the case, the more sodium you take in (through table salt and foods high in sodium), the higher your blood pressure will be. Anyone with hypertension can probably benefit from keeping sodium intake below 2,400 mg daily. Eat lots of foods high in potassium. Potassium helps to lower blood pressure by relaxing the arteries.
In addition to diet, you need to get a handle on reducing your stress. Even mild tension or anger can raise blood pressure by triggering the release of hormones that constrict blood vessels. Stress sometimes accompanies depression and anxiety, conditions that can more than double your risk for hypertension. The best ways to de-stress are different for everyone: Find what works for you and stick with it. Studies have found that yoga or tai chi lower blood pressure almost as much as moderate-intensity exercise. Whether you do tai chi or ride a bike, getting regular exercise is an essential part of any blood pressure reduction program. Vigorous exercise increases the feel-good hormones known as endorphins and lowers stress, anxiety, and depression. Getting your blood flowing helps keep your vessels flexible and less prone to narrowing, important in keeping blood pressure down. Exercise for at least 30 minutes, no fewer than three times a week. If you’re concerned that exercise will raise your blood pressure more than a safe 20 per cent, check it periodically with a monitor. Opt for aerobic exercises that get large muscles moving — brisk walking, swimming, bicycling — over strength training (weight lifting), which can temporarily but dramatically increase blood pressure.
Coupled with a reasonable diet, aerobic exercise will help you lose extra pounds. Being just slightly overweight doubles the risk that you’ll have high blood pressure. Be aware that processed diet shakes and snacks often load up on salt to compensate for reduced fat and sugar.
Other smart moves include getting plenty of sleep (insufficient sleep can raise blood pressure) and limiting alcohol and caffeine. More than one or two alcoholic drinks or five cups of coffee a day can raise blood pressure, too.
Questions for your doctor
- Will the drug you just prescribed change the effectiveness of my other medications? Could it affect my sex life?
- Is it safe for me to exercise? My blood pressure levels went way up when I took a stress test.
- At what point do I need to see a heart specialist?
- How likely is it that I will be able to stop taking hypertension medication? What would I have to do?
Living with high blood pressure
If you suffer from High Blood Pressure, we strongly recommend you consider making some lifestyle changes. In addition, the following will also help guide you towards managing your blood pressure:
- Choose nutrients with blood vessels in mind. Omega-3 fatty acids found naturally in oily fish such as salmon will benefit hypertension by keeping your blood vessels flexible. Eat fish three times a week.
- Stay alert for symptoms.
- Although high blood pressure has a reputation as a mysterious “silent” condition, some people develop recognizable symptoms. If you have headaches and vision problems, see your doctor.
- Watch for seasonal changes. The weather affects blood pressure in some people.
- If you notice a significant increase during cold winter months, talk with your doctor about altering your treatment to compensate.
- Keep an eye on your top number. For years, doctors focused on the lower number—the diastolic. Now research indicates the top number—the systolic—is even more strongly linked to heart-related illness and death. If your top number begins to rise, ask your doctor what can be done.
- Don’t drink too much grapefruit juice if you’re taking a calcium channel blocker. It can boost the effects of this hypertension drug by inhibiting a small intestine enzyme that helps metabolize a number of medications. Not everyone has this problem and it doesn’t happen with all grapefruit juice. It’s most likely to occur when the medication is taken with the juice. Whole grapefruit may not have the same effect as the juice.