High blood pressure and other health problems
High blood pressure often goes hand in hand with other health problems. If you have certain health conditions in addition to high blood pressure, it's likely your physician will take this into consideration when selecting treatment. Those conditions include:
- Heart failure
- Previous heart attack
- High risk of coronary artery disease
- Enlarged or thickened left chamber of the heart (left ventricular hypertrophy)
- Chronic kidney disease
- Previous stroke
High blood pressure itself puts you at higher risk of having one of these conditions. If you already have one or more of these conditions plus high blood pressure, your chance of developing complications increases. A targeted treatment approach may reduce your risk of these complications.
For example, if you have chest pain (angina), your doctor may recommend a beta blocker, which can lower your blood pressure and also prevent your chest pain, reduce your heart rate and decrease your risk of death. If you have diabetes and high blood pressure, taking a diuretic plus an ACE inhibitor can decrease your risk of heart attack and stroke. If you have diabetes, high blood pressure and kidney disease, you may need an ACE inhibitor or an angiotensin II receptor blocker.
Resistant high blood pressure
Sometimes high blood pressure can be difficult to treat. If your high blood pressure doesn't decrease despite taking at least three different types of high blood pressure drugs, one of which should be a diuretic, you may have resistant hypertension. Resistant hypertension is blood pressure that's resistant to treatment. People who have controlled high blood pressure and are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension.
Adding a potassium-sparing diuretic, such as spironolactone (Aldactone), can often restore control of blood pressure in people who have resistant hypertension. A procedure that interrupts the nerve supply (denervation) to the arteries in the kidney is being studied as a promising new technique to help control resistant high blood pressure.
Keep trying to reach your blood pressure goal
It's not unusual to try several different medications or doses before finding what works best for you. Home monitoring of your blood pressure can help your doctor decide if your blood pressure treatment is working, or if a different dose or medication is necessary. If you and your doctor can identify what's behind your persistently high blood pressure, there's a good chance you can meet your goal with the help of treatment that's more effective.
In most cases, a combination of lifestyle changes and medication can help you successfully control your blood pressure. Once that's done, your doctor may recommend a gradual decrease in medications while monitoring the effect on your blood pressure; however, don't attempt to do this on your own.
Keeping your blood pressure under control may take some time, but in the long run it may mean a longer life, with fewer health problems.
Jan. 31, 2014
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- The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Bethesda, Md.: National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.htm. Accessed July 3, 2013.
- Hypertension diagnosis and treatment. Bloomington, Minn.: Institute for Clinical Systems Improvement. https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_cardiovascular_guidelines/hypertension/. Accessed July 3, 2013.
- Mann JFE. Choice of therapy in essential hypertension: Recommendations. http://www.uptodate.com/home. Accessed July 9, 2013.
- FDA drug safety communication: New warning and contraindication for blood pressure medicines containing aliskiren (Tekturna). U.S. Food and Drug Administration. http://www.fda.gov/drugs/drugsafety/ucm300889.htm. Accessed July 8, 2013.
- Calhoun DA, et al. Resistant hypertension: Diagnosis, evaluation and treatment — A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;117:e510.
- Sheps SG (expert opinion). Mayo Clinic, Rochester, Minn. July 12, 2013.