The following is an excerpt from the Mayo Clinic Press book Mayo Clinic on High Blood Pressure by Gary L. Schwartz, M.D.
There are two basic approaches to lowering high blood pressure: adopting healthy lifestyle habits and taking medi- cations. Depending on your health and risk factors, lifestyle changes may include losing weight, getting more active, making diet changes, quitting smoking, limiting alcohol and managing stress.
In terms of medications, there are several types to choose from. Each type affects blood pressure in different ways. It’s important not to share the drugs pre- scribed for you with anyone else. Some- one else’s medication may not be thesame type as yours or the dosage may be different.
LATEST GUIDELINES
In November 2017, the American College of Cardiology and the American Heart Association, working with nine other U.S. health care organizations, released a new guideline for the prevention, detection, evaluation and management of high blood pressure. The new guideline — the first comprehensive U.S. national blood pressure guideline since 2003 — lowered the threshold of what is defined as high blood pressure. The change was made to account for new data indicating that complications can occur at lower blood pressure levels and that controlling blood pressure to lower levels provides added protection from cardiovascular damage.
Treatment for elevated blood pressure and hypertension depends on several factors, including your systolic and diastolic blood pressure levels and whether you have additional heart disease risk factors, which put you at a higher risk of heart attack and stroke.
While the treatment goal is the same — to lower your blood pressure — your number of risk factors determines when blood pressure drugs will be used to lower blood pressure alongside lifestyle changes. That’s because the more factors you have, the greater the risk of complica- tions, such as heart attack and stroke.
Special attention will be given to address- ing risk factors you can change, such as tobacco use, high cholesterol levels and diabetes.
The 2017 guideline recommends reducing blood pressure to less than 130/80 millimeters of mercury (mm Hg) if you have a history of heart disease, stroke, kidney disease or diabetes. If you don’t have any of these conditions, aim for a blood pressure goal of less than 130/80 mm Hg. A slightly higher reading may be OK while you work on lifestyle changes.
If lifestyle changes alone can’t lower your blood pressure to recommended levels, medication should be considered. If yourblood pressure is within the range for stage 2 hypertension — a systolic reading of 140 mm Hg or higher or a diastolic reading of 90 mm Hg or higher — or you have other cardiovascular risk factors, you may need to start taking medication right away.
The most important message here is to work with your health care team to develop a treatment plan that’s suited to your specific situation. There are many opinions about which blood pressure goals are best to reach for optimal health, especially for older adults and those who have kidney disease or diabetes. And not all experts agree on the blood pressure level that’s best for every person. When setting your blood pressure goal, you and your health care team should consider:
- Your overall health.
- Your risk of heart disease, stroke and kidney disease.
- Any other medical conditions you have.
- Prescription and over-the-counter therapies you’re taking.
- Your gender and ethnicity.
Together, you and your health care team can decide on your treatment goal and medications you should take. Your plan should fit your lifestyle, give you good quality of life, and help you reduce your risk of heart disease, stroke and other consequences of high blood pressure.
Pressure in Adults.
Elevated blood pressure
If your systolic pressure (top number) is between 120 and 129 mm Hg and your diastolic pressure (bottom number) is less than 80 mm Hg, you have elevated blood pressure.
Having elevated blood pressure means that you have a higher risk of developing hypertension and cardiovascular complications. Lifestyle changes such as a healthier diet and more exercise may reduce your blood pressure.
Stage 1 hypertension
If your systolic pressure (top number) is between 130 and 139 mm Hg or your diastolic pressure (bottom number) is between 80 and 89 mm Hg, you have stage 1 hypertension. Lifestyle changes are part of the first-line treatment for stage 1 hypertension.
You’ll likely also need medication to bring your blood pressure under control. Angiotensinconverting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs) and thiazide diuretics are all commonly recommended first-choice medications, including for those who have diabetes.
Stage 2 hypertension
If your systolic pressure is 140 mm Hg or higher or your diastolic pressure is 90 mm Hg or higher, you have stage 2 hypertension.
People who have stage 2 hypertension are at the greatest risk of heart attack, stroke or other problems related to high blood pressure.
A combination of two blood pressure medications along with changes in lifestyle is typically recommended for stage 2 hypertension. Medications used to treat stage 2 hypertension may include a thiazide diuretic or a CCB in combination with an ACE inhibitor or ARB. Learn more about medications used to treat high blood pressure in Chapter 8.
Your treatment plan will include specific goals that take into account other factors in addition to your blood pressure level and unhealthy behaviors. For example, your health care team will consider your overall health and the other diseases and conditions you have when discussing your goals and treatment.
MEDICATION STILL REQUIRES LIFESTYLE CHANGES
Many people who take high blood pressure medication think that’s all they have to do — that taking medication means they don’t have to make lifestyle changes. But this isn’t true.
Sometimes, medication can reduce blood pressure by only a certain amount. And that amount may not be enough to reach your blood pressure target level. For example, if you take in too much salt, your medication may not lower your blood pressure enough. Following a low-sodium diet, on the other hand, can help blood pressure medication work more effectively. Successfully making lifestyle changes in addition to taking medication often can help you reach your target blood pressure level.
In addition, if you can reach your blood pressure goal with medication, making lifestyle changes may help reduce the amount of medication you need. Less medication usually means less cost.
Also, with many blood pressure-lowering drugs, side effects increase with higher doses, so a lower dose may mean fewer or less severe side effects.
Plus, lifestyle changes are important for everyone with high blood pressure. They reduce risk of stroke, heart attack, heart failure, kidney failure and dementia.
LEAN ON YOUR HEALTH CARE TEAM
Achieving your blood pressure goals requires your full involvement. Meet with your health care team regularly to assess your progress and adjust your treatment plan. Reaching your goal sooner results in lower risk of cardiovascular events occurring, so don’t wait for more than a few months for lifestyle changes or medications to work.
If your medication causes side effects, talk to your health care team about cutting back on the dosage to reduce them. Some people who’ve significantly changed their lifestyles have been able to stop taking medications entirely.
You can live a long and healthy life with high blood pressure. But to do so, it’s important to recognize that high blood pressure is a serious condition — and it’s also one that you can bring under control.
If you’re diagnosed with high blood pressure or considered to be at high risk for the condition, you may need to make fundamental changes to your lifestyle. This makes you an active participant inyour health care.
Recognize that it takes a team effort to treat high blood pressure. You can’t do it alone, and you can’t depend on your health care team to do it for you. Everyone working together and supporting you, including family and friends, can help you achieve your goals.
Relevant reading
Mayo Clinic on High Blood Pressure
Mayo Clinic on High Blood Pressure offers information and tools to help you keep blood pressure from building to dangerous levels. By taking specific steps, you can live well with high blood pressure – and even keep it from ever forming. In this book, you’ll learn how high blood pressure develops, what puts you at risk, how it’s diagnosed and treated, and how to reduce your risk of conditions associated with it.
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