Treat, Don't Tolerate High Blood Pressure

Last Editorial Review: 1/31/2005

 A major risk factor for deadly disease, high blood pressure often goes under- or even untreated. Much of the treatment relies on lifestyle changes but getting the right prescription is key, too.

By Martin Downs
WebMD Feature

Reviewed By Michael Smith

If you are like most Americans with high blood pressure , you -- and your doctor -- aren't doing enough to bring it under control.

Studies show that high blood pressure often goes untreated, or isn't treated aggressively enough, even though it's a major cause of heart disease, stroke, and kidney failure.

"The magnitude of the problem can't be overstated," says Daniel Jones, MD, associate vice chancellor of the University of Mississippi Medical Center, speaking on behalf of the American Heart Association.

It's well known that high blood pressure is deadly -- according to CDC statistics, nearly 24,000 Americans died as a direct result in 2000 -- but it's a slow and silent killer. That could be one reason why we don't take it as seriously as we ought to. "Both patients and physicians get cavalier about it," Jones says.

Jean Olson, MD, of the National Heart Lung and Blood Institute (NHLBI), agrees. "It doesn't hurt, so people aren't motivated to treat it," she says.

Current NHLBI guidelines call for aggressive treatment when a person's blood pressure is 140/90 or higher. "High-to-normal" blood pressure is in the range of 130/85 to 139/89, and "optimal" is 120/80 or lower.

According to the guidelines, most people with high-to-normal blood pressure should try to lower it by changing their lifestyle. Those with blood pressure ranging between 140/90 and 159/99 may try to lower it with lifestyle changes before taking drugs, depending on their unique circumstances. But if after six months to one year there isn't improvement, they should begin taking medication.

People with diabetes, kidney problems, or an existing heart condition should begin taking drugs sooner rather than later. Anyone whose blood pressure is 160/100 or higher also should start taking medication right away.

The guidelines are clear, but "not all physicians buy into those," Olson says. "Some physicians are comfortable to tolerate a higher blood pressure." And those who might follow the guidelines to the letter otherwise, she says, focus on treating other problems that seem more urgent, so they end up neglecting high blood pressure.

"I would like to encourage them to treat it anyway," she says.

Take Charge

If you fall into one of the categories in the NHLBI guidelines that call for drug treatment, make sure you get the medication you need.

The first line of treatment is usually diuretics or drugs called beta-blockers. If these don't work, newer drugs, such as those called calcium-channel blockers and ACE inhibitors, may be needed. Some people will need a combination of various types.

The newer classes of drugs, which are brand-name pills not sold in generic form, can be expensive. That may discourage some patients from taking them, or some doctors from prescribing them. But the results of a large clinical trial, published in December 2002 in The Journal of the American Medical Association, show that diuretics, available as cheap generic prescriptions, often work better than newer drugs do.

Olson says another part of the problem could be that many people don't know they have to stay on medication after their blood pressure has come under control. "I have had numerous patients who took their first month of medication and then stopped because their blood pressure measured in the normal range," she says. High blood pressure isn't something that can be "cured" by medication, like an infection can be cured by antibiotics.

If you think your high blood pressure isn't getting the attention it deserves, "Don't be shy," Olson says. "Be an advocate for your own health."

Moderation in Most Things

Changing your lifestyle isn't as simple as taking a pill (although for people on multiple medications, pill-taking is no simple matter, either) but it is important for treatment and prevention.

Here's no surprise: Lose weight, exercise, eat healthy food, don't drink heavily, and don't smoke.

When doctors talk about weight loss, they don't mean you must be rail-thin, but you should lose some of the excess fat you carry on your upper body.

If your body mass index (BMI) is over 27, you should lose weight. If you don't know your BMI, use WebMD's BMI calculator.

Thirty to 45 minutes of exercise every day can help you burn fat, and it has a good effect on your blood pressure. Again, this doesn't mean you have to go to extremes. A brisk walk counts as exercise -- but don't confuse brisk walking with a leisurely stroll.

Your diet should be heavy on fruits and vegetables, and light on processed foods. Processed foods are bad for people with high blood pressure, because they tend to be high in sodium (salt and other preservatives), and low in potassium. You want a lot of the latter, and little of the former.

You may see big blood-pressure benefits from limiting your sodium intake, or you may not. Jones says, "It helps most people with high blood pressure, but hurts none."

Having enough potassium in your diet can help bring down your blood pressure, just as getting too little can raise your blood pressure. So, seek out sources of potassium. It's abundant in fresh fruit and vegetables, which are also low in sodium.

The moderation mantra applies to alcohol, too. Many studies have shown that drinking some alcohol can be good for your overall heart health, so experts don't recommend strict abstinence. But men should have no more than two drinks a day, and women should have no more than one drink a day.

When it comes to alcohol, Jones says, "You can't take the attitude that if a little is good, a lot is better." Heavy drinking causes blood pressure to rise precipitously.

Lastly, when doctors urge you to change your lifestyle, they always say, "don't smoke." You have a short-term rise in blood pressure every time you smoke a cigarette, so if you smoke a lot, you're keeping your blood pressure up, which makes any medication you're on less effective. That doesn't mean that smoking just a little is OK, however. No one can say enough about the damage tobacco does to your health.

SOURCES: Jean Olson, MD, project officer, Division of Epidemiology and Clinical Applications, National Heart Lung and Blood Institute • Daniel Jones, MD, associate vice chancellor, University of Mississippi Medical Center; spokesman, American Heart Association • The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, NHLBI, 1997 • The Journal of the American Medical Association, Dec. 18, 2002 • WebMD Medical News: "Getting Vigilant About High Blood Pressure" • WebMD Medical News: "Docs Undertreating High Blood Pressure" • WebMD Medical News: "Beating High Blood Pressure" • CDC.

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