High blood pressure affects about 85 million people in the United States today. The condition occurs when the heart pushes blood through the arteries (blood vessels) in the body with too much force. Many people with high blood pressure have no idea that they have it. High blood pressure has been called “the silent killer” because it does not cause any obvious symptoms on its own.
When blood pressure stays high over a long period of time, it can cause heart failure, heart attack, stroke, kidney failure, or other serious health problems. That is why having your blood pressure monitored every year to two years by a doctor or other healthcare provider is very important. If you have been diagnosed with high blood pressure (also called hypertension), it is important to bring your blood pressure down to a normal range to avoid long-term health problems.
Lifestyle changes to control high blood pressure
Lifestyle changes are critical for controlling high blood pressure, and are recommended for nearly every patient with the condition. These include:
- Weight loss Being overweight can cause high blood pressure. Overweight people are also more likely to have problems breathing during sleep (sleep apnea). Having sleep problems can further raise blood pressure. Even a small weight loss, such as 10 pounds, can significantly lower blood pressure. The goal is to have a body mass index (BMI) of no more than 25, but any weight loss you can achieve will help your blood pressure!
- Exercise Regular exercise, meaning about 30 minutes per day for 5 days per week, can lower blood pressure by 4 to 9 points. It is important not to stop exercising regularly after your blood pressure has dropped, because it is likely to rise again if you do. Good activities for lowering blood pressure include walking, jogging, cycling, dancing, swimming, and some types of strength training. Your doctor can advise you on which activities would be a good fit for your physical abilities and condition.
- Heart-healthy diet The DASH (Dietary Approaches to Stop Hypertension) meal plan can help reduce blood pressure by as much as 14 points. The DASH meal plan focuses on eating more whole grains, fruits, vegetables, beans, fish, and fat-free or low-fat dairy products. The DASH meal plan also calls for a moderate amount of red meat, and very little processed food or added sugar.
- Reduced sodium intake People with high blood pressure seem to be sensitive to sodium (salt) in the diet. For people with high blood pressure, reducing dietary sodium can lower blood pressure by up to 8 points. The goal is to consume no more than 1,500 milligrams (mg) of sodium per day. Some ways to meet this goal are to choose “low-sodium” versions of foods and drinks, to limit processed foods (which are usually very high in sodium), and to use herbs and spices to flavor food instead of adding salt. It is important to read labels, because some foods are high in sodium even when they do not taste salty.
- Limit alcohol intake A small amount of alcohol can lower blood pressure by 2 to 4 points, but too much alcohol can raise blood pressure. Men should have no more than 2 drinks per day, and women should have no more than 1 drink per day. A drink is counted as 12 ounces of beer, or 5 ounces of wine, or 1½ ounces of hard liquor.
- Quit smoking Smoking increases blood pressure, and also increases the risk of heart disease and stroke. Quitting smoking can lower blood pressure and improve overall health.
- Reduce chronic stress Chronic stress can increase blood pressure. In addition, people under chronic stress often choose unhealthy food because it is easy or comforting. They may try to cope with stress through drinking alcohol or smoking, which can raise blood pressure further. Try to reduce stress when possible, or learn techniques for coping with stress such as yoga or meditation. It may help to talk to a therapist or counselor if stress is strongly affecting your life.
Medications to control high blood pressure
When lifestyle changes are not enough to bring your blood pressure into the normal range, your healthcare provider may prescribe medication. There are several different types of medication for high blood pressure. The four most common types of high blood pressure medications are diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, and calcium channel blockers
- Diuretics These are often called “water pills” or “fluid pills”. Diuretics cause your body to lose sodium, which lowers the amount of fluid in the body. Less fluid in the body causes the blood pressure to drop. Diuretics are usually used in combination with other medications. The most commonly used class of diuretics are the thiazides, like hydrochlorothiazide. Other classes of diuretics are loop diuretics and potassium-sparing diuretics.
- ACE Inhibitors Angiotensin-II is a hormone that narrows blood vessels, increasing blood pressure. ACE inhibitors prevent your body from making angiotensin-II. This causes your blood vessels to widen and relax, allowing your blood pressure to drop. Some examples of ACE inhibitors are lisinopril, fosinopril, and enalapril.
- Angiotensin-II Receptor Blockers These medications prevent the angiotensin-II hormone from acting on blood vessels. Even though the body still makes angiotensin-II, the blood vessels do not react to it. This means blood vessels stay relaxed, lowering blood pressure. Some examples of angiotensin-II receptor blockers are valsartan, losartan, and olmesartan.
- Calcium Channel Blockers When calcium enters the muscle cells of your heart and blood vessels, it causes them to tighten. This narrows blood vessels and increases blood pressure. Blocking the channels that allow calcium to get inside the cells makes the muscle cells relax. This can lower blood pressure. Some examples of calcium channel blockers are verapamil, diltiazem, and nifedipine.
Other types of blood pressure medications are less commonly used. They may be used only in certain groups of patients, or in patients who cannot tolerate the more common types of medication. The less common types of blood pressure medications include beta blockers, alpha blockers, centrally acting agents, vasodilators, and direct renin-inhibitors.
- Beta Blockers These medications block the effects of the hormones adrenaline and noradrenaline. These hormones cause the heart to beat faster, so blocking them can slow down your heart rate. This reduces the force of blood pushing through your blood vessels, which lowers blood pressure.
- Alpha Blockers Similar to beta-blockers, these medications block the effects of the hormone adrenaline, lowering blood pressure. They do not block the hormone noradrenaline.
- Centrally Acting Agents Centrally-acting drugs act on the part of the brain that controls blood pressure, causing it to send out nerve signals that lower blood pressure.
- Vasodilators Vasodilators directly act on the muscles in your blood vessel walls, relaxing them. This effect lowers your blood pressure.
- Direct renininhibitors This is a new type of medication for high blood pressure. Direct renin-inhibitors block the body from making a chemical called renin. The body needs renin to make the hormone angiotensin-II. By blocking renin, there is less angiotensin-II made in the body. This relaxes blood vessels and lowers blood pressure.
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American Heart Association. Types of Blood Pressure Medications.
U.S. National Library of Medicine. PubMed Health. Hypertension (High Blood Pressure): Treatments.
National Heart, Lung, and Blood Institute. How is High Blood Pressure Treated?