High Blood Pressure Shouldn't Be Ignored

Wednesday, November 02, 2011

ROCHESTER, Minn. — While high blood pressure is fairly common with age and generally doesn't cause noticeable symptoms, it shouldn't be ignored. The November issue of the Mayo Clinic Health Letter covers many options to manage high blood pressure.

Blood pressure is determined by how much blood the heart pumps and the amount of resistance to blood flow in the arteries. The more blood the heart pumps and the narrower the arteries, the higher the blood pressure. Left uncontrolled, high blood pressure (hypertension) increases the risk of serious health problems including heart attack and stroke.

Getting on top of the problem typically requires diet changes, increased activity levels, loss of excess weight and, for some people, medication.

Healthy diet: The Dietary Approach to Stop Hypertension (DASH) diet can help control and prevent high blood pressure. This diet emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Other diet strategies to manage high blood pressure: Eat less saturated fat and total fat and lower the amount of sodium in your diet. A goal of no more than 1,500 milligrams of sodium is appropriate for people age 51 or older, and for individuals of any age who are black or have hypertension, diabetes or chronic kidney disease.

Physical activity/weight management: At least 30 minutes of physical activity every day can help lower blood pressure and control weight. For people who are overweight, losing 10 pounds can reduce blood pressure.

Other healthy habits: Plenty of sleep and good coping skills for stress are important. For women and people over age 65, alcoholic beverages should be limited to no more than one drink a day. For younger men, the recommendation is no more than two drinks a day. Smokers should stop. Tobacco injures blood vessel walls and speeds the process of hardening of the arteries.

Medications: Often lifestyle changes aren't enough to effectively control high blood pressure. Typically, a physician will recommend low doses of two or more blood pressure medications. This approach often works better than a larger dose of a single medication. Several medications that may be considered include:

• Thiazide diuretics (water pills) — Diuretics help the kidneys eliminate sodium and water, which reduces blood volume. They are often the first choice in high blood pressure medications.
• Angiotensin-converting enzymes (ACE) inhibitors and angiotensin II receptor blockers (ARBs) — These medications work in different ways, but both help relax the blood vessels.
• Direct renin inhibitors — The kidneys produce an enzyme called renin that contributes to high blood pressure. This medication blocks renin activity.
• Calcium channel blockers — They help relax blood vessel walls and may slow the heart rate. Among blacks and older adults, calcium channel blockers and diuretics may work better than ACE inhibitors or ARBs.
• Beta blockers — These medications cause the heart to beat slower and with less force. They are typically prescribed following a heart attack.

Finding the most effective medication or combination of medications may require trying several approaches. When blood pressure is difficult to manage, patients may be referred to a hypertension specialist.

Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today's health and medical news. To subscribe, please call 800-333-9037 (toll-free), extension 9771, or visit Mayo Clinic Health Letter Online.

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