Hypertension

Managing Blood Pressure: Lifestyle Changes and Medication Options

High blood pressure (hypertension) affects a large portion of the population and can increase the risk of heart disease, stroke, and kidney damage if left untreated. Blood pressure is typically classified as high if it’s consistently at or above 140/90 mmHg (or 135/85 mmHg for home readings). Management usually begins with lifestyle adjustments, but medications are available for those who need additional support.

Lifestyle Changes to Help Lower Blood Pressure

For many people, making lifestyle changes can significantly lower blood pressure and reduce the need for medication.

1. Dietary Changes

• Reduce Salt Intake: High salt intake is linked to elevated blood pressure. Aim for less than 6 grams per day(about one teaspoon) and avoid processed foods, which often contain hidden salt.
• Eat a Balanced Diet: Include plenty of fruits, vegetables, whole grains, and lean proteins. Foods rich in potassium(like bananas, sweet potatoes, and spinach) help counteract sodium’s effects on blood pressure.
• Limit Processed Foods: Processed foods are often high in salt, sugar, and unhealthy fats. Preparing fresh meals at home is a healthier option.

2. Maintain a Healthy Weight

• Weight Loss: Losing even a small amount of weight, if you’re overweight, can reduce blood pressure. Aim for a BMI within the range of 18.5–24.9.
• Waist Measurement: Keeping a waist circumference below 94 cm for men and 80 cm for women can also help lower blood pressure.

3. Get Regular Exercise

• 150 Minutes of Moderate Exercise: Aim for 150 minutes of moderate activity (like brisk walking or cycling) or 75 minutes of vigorous activity per week.
• Regular exercise helps lower blood pressure, reduce stress, and improve heart health. Even simple daily activities, such as walking, can make a significant difference.

4. Limit Alcohol and Stop Smoking

• Limit Alcohol: Keep to the recommended maximum of 14 units per week, spread over several days. Excessive drinking can raise blood pressure.
• Stop Smoking: Smoking raises blood pressure and increases the risk of cardiovascular disease. Quitting can lower your blood pressure and improve overall health.

5. Manage Stress

• Practice Relaxation Techniques: Activities like yoga, deep breathing exercises, or mindfulness can reduce stress, which in turn helps lower blood pressure.
• Limit Caffeine: Caffeine can cause short-term spikes in blood pressure. Try to limit coffee, tea, and energy drinks.

When Lifestyle Changes Are Not Enough: Blood Pressure Medications

If lifestyle adjustments aren’t sufficient, we may recommend medication to help control blood pressure.

Blood pressure medications work in different ways, so we may prescribe one or a combination based on your individual needs.

1. ACE Inhibitors (e.g., Ramipril, Lisinopril)

How They Work: ACE inhibitors relax blood vessels by blocking the formation of angiotensin II, a substance that causes blood vessels to narrow. They’re commonly used for patients under 55 who don’t respond well to other medications.

Common Side Effects:

• Persistent dry cough (in some people).
• Dizziness or lightheadedness, especially when starting.
• Increased potassium levels, which could lead to irregular heartbeats.

Important Precautions:

• ACE inhibitors are not recommended during pregnancy or for people with certain kidney conditions.
• Avoid potassium supplements or salt substitutes with potassium.

Types of Blood Pressure Medications

1. Angiotensin II Receptor Blockers (ARBs) (e.g., Losartan, Candesartan)

   • How They Work: ARBs work similarly to ACE inhibitors but don’t cause a cough.
   • Common Side Effects: Dizziness, headache, and fatigue.

2. Calcium Channel Blockers (e.g., Amlodipine, Felodipine)

   • How They Work: These medications relax blood vessels by blocking calcium entry into heart and blood vessel cells.
   • Common Side Effects: Swelling in the ankles, headache, and flushing.

3. Diuretics (Water Pills) (e.g., Indapamide, Bendroflumethiazide)

   • How They Work: Diuretics help the body expel extra salt and water, reducing blood volume and pressure.
   • Common Side Effects: Increased urination, low potassium levels (particularly with thiazide diuretics), and dizziness.

4. Beta-Blockers (e.g., Bisoprolol, Atenolol)

   • How They Work: Beta-blockers reduce blood pressure by slowing the heart rate and reducing the force of heart contractions.
   • Common Side Effects: Fatigue, cold hands and feet, and occasionally, depression or erectile dysfunction.

5. Aldosterone Antagonists (e.g., Spironolactone, Eplerenone)

   • How They Work: These medications block aldosterone, a hormone that raises blood pressure by causing salt and fluid retention.
   • Common Side Effects: Raised potassium levels, breast tenderness in men and women, and menstrual irregularities.

Starting and Adjusting Blood Pressure Medications: Titration Guidelines

1. Starting Medication:

• Begin at the Lowest Dose: Blood pressure medications are typically started at the lowest effective dose to reduce side effects.
• Monitor Side Effects: Be mindful of any new symptoms like dizziness or lightheadedness, especially in the first few days. If side effects are persistent, inform your doctor.

2. Titrating the Dose Safely:

• Follow Your Pharmacist or Doctors' Instructions: Doses are usually adjusted every 2-4 weeks based on blood pressure readings.
• Home Monitoring: Regularly monitor your blood pressure at home, and keep a log of your readings for your GP to review.
• Avoid Abrupt Changes: Never increase or decrease your medication dose without consulting your doctor, as abrupt changes can cause fluctuations in blood pressure.

3. Combination Therapy:

• Using Multiple Medications: Some people need a combination of medications to effectively control their blood pressure. Each type of medication targets a different mechanism, so combining them can lead to better results with fewer side effects.
• Regular Check-Ups: Attend regular check-ups so your doctor can monitor your progress, adjust medications as necessary, and check for side effects.

Monitoring and Long-Term Management

Managing blood pressure is a long-term commitment, even if you feel well. Regular monitoring at home, attending check-ups, and making lifestyle changes can help you maintain healthy blood pressure and prevent complications.

If you have any concerns about your treatment or side effects, don’t hesitate to speak with your GP or pharmacist. With the right support, many people successfully manage their blood pressure and improve their overall health.