This information will help you understand
your choices, whether you share in the decision-making process or rely on your
doctor's recommendation.
Key points in making your decision
When you have
high blood pressure, the chances that you will have a heart attack or stroke
are higher. Your high blood pressure needs to come down. It would be great if
we all could avoid taking blood pressure pills by changing the way we eat and
getting more exercise. That works for some people, but most people need pills
as well.
It's not always easy to decide when it is time to start
taking blood pressure pills. Doctors don't agree on a general rule for people
whose blood pressure is only slightly high. Consider the following when making
your decision:
If your high blood pressure is very
high-greater than 160/100, or when either number is higher-you do not have a
decision to make. You definitely need medicine to lower your blood
pressure.
If your blood pressure is lower than 160/100 and your
overall risk for heart disease is low, you may be able to lower your blood
pressure without taking pills. Your overall risk for heart disease is low if:
Your cholesterol is
normal.
You do not have diabetes.
You are not
overweight.
You do not smoke.
You haven't had heart or
blood vessel problems.
And there is no heart disease in your
immediate family-your parents, siblings, or children.
Lifestyle changes are as important as medicine
in lowering blood pressure and lowering the risk for heart attack and stroke.
For some people, quitting smoking, lowering cholesterol, losing weight, or
getting more exercise can work as well as or better than taking
pills.
It can be very hard to make lasting changes in your habits.
In order to succeed, you have to be ready to make those changes. Think about
how important it is to you to lower your blood pressure. Then start taking
small steps toward change.
If healthy habits aren't enough to bring
your blood pressure down, you will need to take pills.
Most people
who take pills for high blood pressure need to take two or more kinds of pills
that work together.
Even with pills, you will need healthy habits
for the rest of your life to lower your risk for heart attack and
stroke.
Medical Information
What is high blood pressure?
Blood pressure is a
measure of how hard the blood pushes against the walls of your arteries and
veins as it moves through your body. It's normal for blood pressure to go up
and down throughout the day, but if it stays up when you are resting, you have
high blood pressure.
Adult blood pressure is broken into
categories:
Normal blood pressure-less than
120/80
Prehypertension-120/80 or higher but less than
140/90
Stage 1 high blood pressure-140/90 to
159/99
Stage 2 high blood pressure-160/100 or higher
What are the risks of not lowering your blood pressure?
When blood pressure is higher than normal most of the time, it starts to
damage the blood vessels, heart, and kidneys. This can lead to heart attack,
stroke, and other problems.
High blood pressure is just one of
several risk factors that make heart attack and stroke more likely. If you have
high blood pressure plus another risk factor, heart attack and stroke are even
more likely. Some risk factors are things you can control, others aren't.
Besides high blood pressure, these risk factors include:
Smoking cigarettes.
Having high total cholesterol, high LDL ("bad") cholesterol, or
low HDL ("good") cholesterol.
Having diabetes.
Having a
parent, sister, or brother with early heart disease (before age 45 for men or
before age 55 for women).
Being male.
Being
black.
Being overweight.
Not
exercising.
Having an enlarged left ventricle (the lower left
chamber in the heart).
What is the treatment for high blood pressure?
Treatment depends on if you have a health problem that is causing your
high blood pressure, how high your blood pressure is, and whether you have
other health problems, such as heart failure, coronary artery disease, kidney
disease, or diabetes. Some people may only need lifestyle changes to control
their blood pressure, while others need to take pills as well. Either way,
controlling high blood pressure is something you will have to work at all your
life.
There are several different kinds of high blood pressure
pills. Many people need to take more than one. You may have to try several
before you find a combination that works well and has the fewest side effects.
Some pills cause very few side effects. Others may cause side effects such as
dry mouth, weakness or dizziness, a cough, or erection problems.
Why are lifestyle changes so important?
Changes in
lifestyle or behavior can help control high blood pressure. You may be able to
avoid taking pills. If you are already taking blood pressure medicine, making
some lifestyle changes may let you take a lower dose.
Losing as little as 10 lb (4.5 kg) can help
lower blood pressure.
Physical activity lowers blood pressure,
especially if you have been inactive until now. Exercise also helps you manage
your weight, but it can lower your blood pressure even if you don't lose
weight.
Reducing salt in your diet can help control high blood
pressure.
Some people may be able to lower their blood pressure by
eating more foods that contain potassium. These foods include lean meat, fish,
nonfat and low-fat dairy products, and many fruits and
vegetables.
Drinking more than 3 alcohol drinks a day may raise
your blood pressure. It can also interfere with some blood pressure medicines.
Limiting alcohol to 2 drinks a day for men and 1 drink a day for women may help
lower blood pressure.
Quitting smoking is important. Nicotine in
tobacco temporarily increases blood pressure and heart rate with each use.
Smoking also causes the arteries to tighten, which also increases blood
pressure.
It can be very hard to change lifelong habits. If you
have not been very active for a long time, for example, you may find it hard to
start exercising. If you are used to eating whatever you want, it may be hard
for you to change your diet.
In order to be successful, you have
to understand why the change is necessary and then be ready to change. If your
doctor thinks you should make some changes, be honest about whether you think
you can do it. You may need to take blood pressure pills until you decide you
are ready to make lifestyle changes. But the combination of medicine and
lifestyle changes will have the biggest effect on lowering your risk of heart
attack or stroke.
If you decide to try lifestyle changes first,
you and your doctor may want to set a deadline. For example, you might decide
that you will try lifestyle changes for 3 to 6 months. Then, if your blood
pressure does not come down in that time, you may decide to start taking
pills.
Use this worksheet to help you make your decision.
After completing it, you should have a better idea of how you feel about taking
medicine for high blood pressure. Discuss the worksheet with your
doctor.
Circle the answer that best applies to you.
My blood pressure is higher than 140/90 but lower
than 160/100.
Yes
No
Unsure
My doctor has told me that my risk for heart
attack and stroke is low.
Yes
No
NA*
I have enough money and insurance to pay for
medicine.
Yes
No
Unsure
I believe that medicines can help me.
Yes
No
Unsure
I am comfortable with the idea of taking medicines
for the rest of my life.
Yes
No
Unsure
Medicines that I'm currently taking will not
interfere with blood pressure medicines.
Yes
No
Unsure
Diet and exercise have helped me lower my blood
pressure.
Yes
No
NA
I have trouble staying on a diet.
Yes
No
Unsure
I have trouble staying with an exercise
program.
Yes
No
Unsure
I want to try lifestyle changes first, before I
take pills.
Yes
No
NA
I worry about having a stroke or heart attack and
want to do everything I can to prevent it.
Yes
No
NA
*NA = Not applicable
Use the following space to list any other important concerns you have
about this decision.
What is your overall impression?
Your answers in
the above worksheet are meant to give you a general idea of where you stand on
this decision. You may have one overriding reason to take or not take medicines
for high blood pressure.
Check the box below that represents your
overall impression about your decision.
Leaning toward taking medicine for high blood pressure
Leaning toward NOT taking medicine for high blood pressure
Call the American Heart Association (AHA) to find your
nearest local or state AHA group. AHA can provide brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support. AHA's Web site also has information on
physical activity, diet, and various heart-related conditions.
National Heart, Lung, and Blood Institute
(NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:
(301) 592-8573
Fax:
(240) 629-3246
TDD:
(240) 629-3255
E-mail:
nhlbiinfo@nhlbi.nih.gov
Web Address:
www.nhlbi.nih.gov
The U.S. National Heart, Lung, and Blood Institute (NHLBI)
information center offers information and publications about preventing and
treating heart, lung, and blood diseases.
Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC Express
(NIH Publication No. 03-5233). Bethesda, MD: U.S. Department of Health and
Human Services.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
