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High Blood Pressure

High Blood Pressure Treatment

Several lifestyle changes help people reduce their high blood pressure. High blood pressure medications (antihypertensive drugs) are prescribed when lifestyle changes aren't able to lower a person's blood pressure to normal levels.

If a person's high blood pressure is caused by another medical disorder or a medication the person is taking, treating the disorder or discontinuing the medication helps reduce the person's blood pressure.

Common high blood pressure treatments include:

Lifestyle Changes

The first step in treating high blood pressure is for people to identify their controllable risk factors and make any needed lifestyle changes. Lifestyle changes may also make it possible for people to take lower doses of their high blood pressure medications.

Lifestyle changes that help lower a person's blood pressure include:

Managing weight

Losing weight helps most people lower their blood pressure. People should eat sufficient calories to maintain a healthy weight as determined by their healthcare provider. A healthcare provider can recommend an appropriate diet and physical activity program for people who are overweight.

Exercising

In 2007, the American Heart Association and the American College of Sports Medicine issued new exercise guidelines. Their new recommendation is for healthy adults to engage in moderate-intensity aerobic physical activity for at least 30 minutes five days each week, or vigorous-intensity aerobic exercise for at least 20 minutes three days a week. In addition, the guidelines add that exercise above the recommended minimum amounts provides even greater health benefits.

  • Moderate-intensity aerobic activity is any exercise that noticeably accelerates the heart rate, such as a brisk walk or light jogging.
  • Vigorous-intensity exercise is any exercise that causes rapid breathing and a substantial increase in heart rate, such as jogging.

It's important for people to discuss all exercise modifications in advance with their healthcare provider.

Eating a healthy diet

The National Heart, Lung, and Blood Institute of the National Institute of Health (NIH) recommends the DASH diet (Dietary Approaches to Stop Hypertension), which is based on a study that showed blood pressure can be significantly lowered through diet. The DASH diet:

  • Emphasizes fruits, vegetables, whole grains, and low fat dairy foods.
  • Is low in saturated fat, total fat, and cholesterol.

To eat a healthy diet when eating out:

  • Avoid dishes with sauces, dressings, and creams.
  • Replace fried dishes with baked dishes.
  • Replace high-calorie appetizers and desserts with fruits and vegetables.
  • Ask about healthy substitutions when eating out.

Limiting dietary salt

Salt (sodium chloride) can increase a person's blood pressure. Moreover, salt-sensitive people have a heightened blood pressure response to salt.

To lower dietary salt:

  • Check all labels of packaged food carefully for sodium content.
  • Replace salt with salt substitutes and herbs.
  • Increase dietary potassium (such as fruits and vegetables).

Stop smoking

According to the Centers for Disease Control and Prevention (CDC):

  • Cigarette smokers are 2 to 4 times more likely to develop coronary heart disease than nonsmokers.
  • Cigarette smoking approximately doubles a person’s risk of having a stroke.

According to the American Heart Association:

  • The health benefits of smoking cessation start almost immediately.
  • Within a few years of quitting, a person's risk of coronary artery disease and stroke are similar to non-smokers.

Reducing alcohol consumption

Alcohol has been shown to raise blood pressure in some people.

  • Men should limit their alcohol to no more than two alcoholic beverages a day.
  • Women should limit their alcohol to no more than one alcoholic beverage a day.
  • Because alcohol is high in calories and low in nutrients, it should be limited by people who are trying to lose weight.

Limiting stress

Too much stress can raise a person's blood pressure. To lower stress:

  • Get sufficient rest and sleep.
  • Exercise regularly.
  • Try using a relaxation technique (such as deep breathing and self-hypnosis).

Checking medications

It's important to check all prescription, over-the-counter medications, and street drugs with a healthcare provider to check if any of the medications are known to raise a person's blood pressure.

Measuring blood pressure at home

Home blood pressure monitors help people check that their blood pressure medication is working and warn them if their blood pressure is getting too high. The devices are available without prescription.

Using hot tubs and saunas

Although people with high blood pressure can use hot tubs and saunas, they should not be used by people experiencing symptoms (such as chest pain or shortness of breath) or when drinking alcohol. It's also inadvisable for people to switch back and forth between cold baths and hot tubs or saunas.

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Prescription medications

Some people are prescribed high blood pressure medications (antihypertensives) when lifestyle changes, such as a healthy diet and physical activity, are unable to lower their blood pressure below 140/90 mm Hg. People with diabetes or a kidney disorder may need to keep their blood pressure below 130/80 mm Hg.

There are several classes of high blood pressure medications. People are often prescribed two or more medications from different classes of drugs. Different medications are often tried until the appropriate regimen is identified.

The medication prescribed depends on the following factors:

  • The blood pressure stage.
  • The blood pressure type.
  • Additional medical conditions (such as, diabetes, heart disease, kidney disease, or stroke).
  • The medications' effectiveness and side effects.

People should take high blood pressure medications at the same time and correct dose each day. It's important not to stop taking these medications without consulting a doctor in advance. People should also ask their doctor or pharmacist about possible drug side effects or interactions.

The following list of high blood pressure medications isn't inclusive. Additional information, side effects, and drug interactions can be obtained by clicking the name of the highlighted medications. A doctor should be notified if any severe reactions occur.

Diuretics

Diuretics are often the first medication used to reduce high blood pressure. They work by helping the kidneys remove excess fluids and sodium from the body. If a person's blood pressure remains above normal, diuretics are used in addition to other medications, sometimes in a combination pill. Examples include:

Angiotensin-converting enzyme inhibitors (ACE inhibitors)

ACE inhibitors lower blood pressure by preventing the body from converting angiotensin I to angiotensin II, which is a natural hormone that causes blood vessels to constrict (narrow). This enables a person's blood to flow more easily through the expanded blood vessels, causing less strain on the heart. Examples include:

Angiotensin-2 receptor blockers

Angiotensin-2 receptor blockers are a newer medication that lowers blood pressure by blocking the effects of angiotensin II on the blood vessels. These medications also relax a person's blood vessels, which further reduces a person's blood pressure. Examples include:

Beta-blockers

Beta-blockers reduce stress on the heart by slowing the heart rate and the force of the heart contractions. Beta-blockers are also used for heart arrhythmias (irregular heartbeats) and angina (chest pain). Examples include:

Calcium channel blockers

Calcium channel blockers lower blood pressure by preventing calcium from entering the muscle cells of the blood vessels. This action prevents blood vessel constriction, causing the blood vessels to relax. Examples include:

Direct renin inhibitors

Early in 2007 the FDA approved the first direct renin inhibitor for the treatment of high blood pressure. Direct renin inhibitors lower blood pressure by inhibiting renin, which is a kidney enzyme associated with the regulation of blood pressure. The approved drug is:

  • aliskiren (Tekturna)

Tekturna may be combined with hydrochlorothiazide (a diuretic) to reduce blood pressure levels even further.

Combination Therapies

Combination therapies include:

Beta-blocker + diuretic

ACE inihibitor + diuretic

Angiotensin II receptor antagonist + diuretic

ACE inihibitor + calcium channel blocker

Additional medications

The following medications may be prescribed when traditional blood pressure-lowering medications don't bring a person's blood pressure within normal levels.

Alpha blockers

Alpha blockers lower blood pressure by reducing nerve impulses that constrict blood vessels and slow the heartbeat. Examples include:

Alpha-beta blockers

Alpha-beta blockers lower blood pressure by both reducing nerve impulses to the blood vessels (alpha blocker component) and slowing the heartbeat (beta-blocker component). Examples include:

Central-acting agents (central alpha agonists)

Central-acting agents lower blood pressure by preventing signals to the nervous system that increase heart rate and narrow blood vessels. Examples include:

Vasodilators

Vasodilators lower blood pressure by preventing the blood vessel muscles from constricting (narrowing). Examples include:

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Non-Drug Therapies

The following non-drug therapies used in addition to medications may help people with high blood pressure.

Support groups

High blood pressure support groups provide coping suggestions, education, emotional support, social interaction, and help avoid feelings of isolation.

Surgery

Although there is no surgical treatment for high blood pressure, surgery may be required to treat some of the complications of high blood pressure or the risk factors of secondary high blood pressure.

  • Angioplasty with stenting (tube) widens blood vessels.
  • Bypass surgery reroutes blood flow around blocked arteries in the heart or kidney.
  • Kidney dialysis cleans and filters blood.
  • Kidney transplantation surgery replaces a diseased kidney with a healthy donor kidney.

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Complementary and Alternative Medicine

Complementary and alternative medicine refers to those medical and healthcare treatments that are not part of traditional medicine. Whereas, complementary medicine is used with traditional medicine, alternative medicine is used in place of traditional medicine.

The following nontraditional therapies help high blood pressure. Some of these therapies haven't been well studied, and little information is available about their effectiveness, side effects, and drug interactions. It's important to discuss any of these therapies with a doctor before trying them. 

Relaxation techniques

The following relaxation techniques are designed to relieve stress and may help lower blood pressure levels:

  • Acupuncture
    Acupuncture inserts sharp, thin needles into the body to adjust the body's energy flow into healthier patterns.
  • Deep breathing
    Deep breathing (diaphragmatic breathing) is a relaxation technique that involves breathing deeply into the lungs by flexing the diaphragm instead of the shallower flexing of the rib cage.
  • Qi gong
    Qi gong is an ancient Chinese system of breathing techniques, exercises, meditations, and postures designed to improve and enhance the body's health and vitality.
  • RESPeRATE Blood Pressure Lowering Device
    RESPeRATE is an FDA-approved portable electronic device that helps lower blood pressure naturally by helping people to master the technique of paced breathing.
  • Yoga
    Yoga is a Hindu system that is believed to prevent diseases by a combination of breathing techniques, meditation, and physical exercises designed to strengthen the body and calm the nervous system.

Biofeedback

Biofeedback uses special equipment to train people how to regulate their involuntary body functions related to stress, such as heart rate, blood pressure, or brain wave patterns. Biofeedback techniques are able to produce a modest reduction in blood pressure.

Coenzyme Q10

Coenzyme Q10 (CoQ10 or ubiquinone) is a naturally occurring anti-oxidant compound and is used for energy production within cells. CoQ10 may help lower blood pressure.

Folate

Folate is a B vitamin that has been shown to reduce blood pressure in women. People can obtain folate in their diets by eating dark, leafy green vegetables, citrus fruits and juices, and dried beans and peas. They can also obtain folate in pill form as folic acid.

Omega-3 fatty acids

Omega-3 fatty acids are a group of polyunsaturated fatty acids (such as fish oil) that are not made by the body. Studies have found that omega-3 fatty acids may lower blood pressure, help people with cardiovascular disease, and slow the progression of atherosclerosis (narrowing and hardening of the arteries). People can take fish oil pills eat oily fish (such as salmon, mackerel and sardines), or eat vegetable sources (canola oil, soybean oil, flaxseeds, and walnuts).

Vitamin D

Low blood levels of vitamin D appear to be associated with higher blood pressure levels.