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Disease & Conditions >>> Blood Pressure Articles & News

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Treatment Options For High Blood Pressure

You and your health care provider have options for treating your high blood pressure.

Many people can lower their blood pressure significantly with lifestyle changes, but most still need medication to keep their blood pressure in the healthy range.

Alternative therapies can also help lower your blood pressure.

Whichever therapy you choose, it is important to have your blood pressure checked regularly to make sure that your treatment is working.

Uncontrolled high blood pressure is a leading cause of heart disease, heart attacks, heart failure, kidney failure, vision problems, and stroke.

Blood Pressure Machines
You may have wondered whether the blood pressure machines  at the pharmacy or supermarket are accurate.

A recent study showed that they can be accurate, but sometimes are not.

It usually is not possible to tell whether a particular machine is working properly. The cuff should inflate and fit snugly around your arm.

Use the machine as directed.

Measure your blood pressure three times, 2 minutes apart. The third measurement is usually the most accurate.

If your blood pressure is high on the third reading, even borderline, have it checked by another machine that you know is accurate (for example, at the office of your health care provider).

Do not rely on the machines in stores alone to check your blood pressure. Have it checked regularly by a trained medical professional with a machine that is known to be accurate.

Self-Care at Home
The management and control of high blood pressure involves 2 major options, lifestyle modification (detailed here) and medications (detailed in Treatment).

Lifestyle options include changing what you eat and your activity level.

Quitting smoking and moderating alcohol consumption will help keep your blood pressure in the healthy range.

Maintain a healthy weight

If you are overweight or obese, lose weight. Aim for a healthy weight range for your height and body type. Your health care provider can help you calculate a target weight.

Even a small amount of weight loss can make a major difference in lowering or preventing high blood pressure.

To lose weight, you must burn more calories than you take in.

Crash or fad diets are not helpful and may be dangerous.

Some weight loss medications also carry major risks, and great caution is advised in using these drugs.

The healthiest and longest-lasting weight loss requires slow loss, such as losing one-half to 1 pound each week. Eating 500 calories less than you burn every day may help achieve this goal. In a week, you will eat 3500 calories less than you burn, which is enough to lose 1 pound.

Increasing your physical activity will help you burn more calories.

Lose weight and keep it off

Choose foods low in calories and fat. Fat is a concentrated source of calories. You should cut down on butter, margarine, regular salad dressing, fatty or red meats, the skin of poultry, whole milk, cheese, fried foods, ice cream, many cookies, cakes, pastries, and snacks.

Instead, choose baked, broiled, or poached chicken and turkey (without skin), fish, lean cuts of meat (such as round or sirloin); skim, 1%, or evaporated milk; lower fat, low-sodium cheeses; fresh, frozen, or canned fruit or vegetables (without butter, cream, or cheese sauces); plain rice and pasta; English muffins; bagels; sandwich bread and rolls; soft tortillas; cold (ready-to-eat) and hot whole-grain cereals (avoid "instant" types, which are high in sodium).

Choose foods high in starch and fiber: These foods are low in fat and also good sources of vitamins and minerals. Try fruits, vegetables, whole-grain cereals, pasta and rice, and dry peas and beans.

Limit serving sizes: You should especially try to take smaller helpings of high-calorie foods such as meats and cheeses. Try to avoid the temptation of going back for seconds.

Write down what you eat and when: It may be helpful to track your habits. You should note where you are and what you are doing when you snack on high-calorie foods. For instance, many people snack while watching television. Or do you skip breakfast and then eat a large lunch? Identifying your eating patterns can help you overcome the situations in which you overeat.

Replace high-calorie, high-fat snacks with fresh fruits, air-popped popcorn (without salt or butter), or unsalted pretzels. If there is no time for breakfast, take a low-fat muffin, a bagel (without cream cheese), or cereal along to eat at work. This will reduce the craving for a large lunch.

Exercise or increase physical activity

Physical activity burns calories, helps you lose weight, and reduces stress.

Physical activity reduces total cholesterol, raises the good (HDL) cholesterol, and reduces the risk of heart disease.

The American Heart Association (AHA) recommends at least 30 minutes of exercise every other day for cardiovascular fitness. The Surgeon General recommends 30 minutes of physical activity on most days of the week.

Physical activity doesn't have to mean running a marathon. House cleaning or playing golf or baseball can burn as many as 300 calories per hour; brisk walking (at 3.5 mph), cycling (at 5.5 mph), gardening, dancing, or playing basketball burns as many as 450 calories per hour; jogging (9 min/mile), playing football, or swimming can burn as many as 730 calories per hour; and running (7 min/mile), racquetball, or skiing can burn as many as 920 calories per hour.

Fit physical exercise into your daily routine

Use the stairs instead of the elevator.

Get off the bus 1 or 2 stops early and walk the rest of the way.

Park farther away from the store or office.

Ride a bike.

Work in the yard or garden.

Clean house.

Wash the car the old-fashioned way.

Go dancing.

General tips for controlling blood pressure include the following:

Reduce sodium (salt) intake.

Limit alcohol to no more than 2 drinks a day.

Quit smoking.

Take medicines as directed.

Medication is an important part of blood pressure control for almost everybody with high blood pressure. Many people cannot keep their blood pressure in the healthy range by lifestyle changes alone.

Only 21% of people with high blood pressure are on blood pressure medicines and have their pressure adequately controlled.

At least 16% of people with high blood pressure are not on any medication.

Approximately 28% are taking medicines incorrectly, and their blood pressure is uncontrolled.

Therefore, the biggest challenge in the treatment of high blood pressure is taking the medication correctly.

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Medical Treatment
In about half of people with high blood pressure, limiting sodium intake by eliminating table salt, cooking salt, and salty and processed foods can reduce blood pressure by 5 points. Losing weight and doing regular physical activity can reduce the blood pressure further.

If these lifestyle changes and choices donít work, medications should be added. The medications have been proven to reduce the risk of stroke, heart disease, and kidney problems. Do not stop taking your medications without talking to your health care provider.

Medications most often prescribed for high blood pressure include the following:

Water pills (diuretics)
Diuretics are used very widely to control mildly high blood pressure.

They increase urine output, decrease blood volume, and dilate the arteries. These actions lower blood pressure.

Usually diuretics are given in combination with other classes of blood pressure medications.

Examples - Hydrochlorothiazide (HydroDIURIL), furosemide (Lasix)

Beta-blockers reduce heart rate and decrease the force of heart contraction, thereby reducing the pressure generated by the heart.

They are preferred in people who have associated coronary heart disease, angina, or recent heart attack.

Examples - Propranolol (Inderal), metoprolol (Lopressor), atenolol (Tenormin)

Side effects - Fatigue, depression, impotence, nightmares

Calcium channel blockers
Calcium channel blocking agents work by relaxing the muscle in the walls of the arteries.

They also reduce the force of contraction of the heart.

Examples - Nifedipine (Procardia), diltiazem (Cardizem), verapamil (Isoptin, Calan), nicardipine (Cardene), amlodipine (Norvasc), felodipine (Plendil)

Side effects - Ankle swelling, fatigue, headache, constipation, flushing

Angiotensin-converting enzyme (ACE) inhibitors and ACE receptor blockers (ARBs)
ACE inhibitors stop the production or block the action of a chemical called angiotensin II, a very potent chemical that causes blood vessels to contract, a cause of high blood pressure.

Blockage of this chemical causes the blood vessels to relax.

Examples - Captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril, Prinivil), quinapril (Accupril), fosinopril (Monopril). ARBs include losartan (Cozaar), candesartan (Atacand), valsartan (Diovan), irbesartan (Avapro), olmesartan (Benicar)

Side effects are infrequent but sometimes they can worsen kidney function. ACE inhibitors sometimes cause dry cough. ARBs usually have fewer side effects.

Alpha-blockers relax blood vessels by blocking messages from the nervous system that cause muscular contraction.

Examples - Terazosin (Hytrin), doxazosin (Cardura)

Blockers of central sympathetic (autonomic nervous) system
These agents block messages from the autonomic nervous system that contract blood vessels. The autonomic nervous system is the part of the nervous system that is automatic and controls heart rate, breathing rate, and other basic functions.

Their effect is to relax blood vessels, thus lowering blood pressure.

Example - Clonidine (Catapres)

Direct vasodilators
Direct vasodilators relax (dilate) the blood vessels to allow blood to flow under lower pressure.

These medications are often given through an IV line in an emergency (that is, in malignant hypertension).

Examples - Nitroprusside (Nitropress), diazoxide (Hyperstat)

Other medications
Labetalol (Normodyne, Trandate) - Both an alpha- and beta-blocker

Eplerenone (INSPRA) - Aldosterone blocker, works on a principle similar to ACE inhibitors

Other Therapy
Alternative therapies may be helpful to people trying to control their blood pressure.

Acupuncture and biofeedback are well-accepted alternative techniques that may help some people with high blood pressure.

Techniques that induce relaxation and reduce stress are recommended. These include meditation, yoga, and relaxation training.

These techniques alone will not keep the blood pressure in the healthy range for many people. Do not use these as a substitute for medical therapy without first talking this over with your health care provider.

Dietary supplements and alternative medications and therapies are sometimes recommended for high blood pressure.

Examples are vitamins, garlic, fish oil, L-arginine, soy, coenzyme Q10, herbs, phytosterols, and chelation therapy.

While these substances may be beneficial, the exact nature of their benefits is not known.

Scientific studies have produced no evidence that these therapies lower blood pressure or prevent the complications of high blood pressure.

Most of these substances are harmless if taken in moderate doses. Most people can take them without problems.

Talk to your health care provider if you are considering any of these treatments. Substituting these therapies for medical therapies that have been shown to lower blood pressure and the risk of complications may have a harmful effect on your health.

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