Controlling hypertension

If your blood pressure is high, it is important for you to lower it and keep it under control. Your blood pressure reading has 2 numbers. One or both of these numbers can be too high.

• The top number is called the systolic reading. A systolic reading is considered too high if it is 140 or higher.
• The bottom number is called the diastolic reading. It is considered too high if it is 90 or higher.

You are more likely to be told our blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure can lead to stroke, heart attack, heart failure, kidney disease, and early death.

If you have heart or kidney problems, or if you had a stroke, your doctor may want your blood pressure to be even lower than people who do not have these conditions.

Many medicines can help you control your blood pressure. Types of medications include:

• Diuretics
• Angiotensin-converting enzyme (ACE) inhibitors. See also: Ace inhibitors
• Angiotensin receptor blockers (ARBs)
• Beta-blockers
• Alpha blockers
• Calcium channel blockers
• Central alpha agonists
• Renin inhibitors
• Vasodilators
• Combination pills

In addition to taking medicine, you can do many things to help control your blood pressure. Some of them are:

• Limit the amount of sodium (salt) you eat -- aim for less than 1,500 mg per day.
• Limit how much alcohol you drink -- 1 drink a day for women, 2 a day for men.
• Eat a heart-healthy diet -- include potassium and fiber, and drink plenty of water.
• Stay at a healthy body weight -- find a weight-loss program to help you, if you need it.
• Exercise regularly -- at least 30 minutes a day.
• Reduce stress -- try to avoid things that cause stress for you. You can also try meditation or yoga.
• If you smoke, quit -- find a program that will help you stop.

Your doctor can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral from your doctor to a dietitian, who can help you plan a diet that is healthy for you.

Your doctor may ask you to keep track of your blood pressure at home. Make sure you get a good quality, well-fitting home device. It will probably have a cuff with a stethoscope or a digital readout. Practice with your doctor or nurse to make sure you are taking your blood pressure correctly.

It is normal for your blood pressure to be different at different times of the day:

• It is usually higher when you are at work.
• It drops slightly when you are at home.
• It is usually lowest when you are sleeping.
• It is normal for your blood pressure to increase suddenly when you wake up. In people with very high blood pressure, this is when they are most at risk for heart attack and stroke.

Your doctor will give you a physical exam and check your blood pressure regularly. If you monitor your blood pressure at home, keep a written record and bring the results to your clinic visit. Your doctor or nurse may ask you these questions. Having a written record will make them easy to answer:

• What was your most recent blood pressure reading?
• What was the blood pressure reading before that one?
• What is the average systolic (top) number and average diastolic (bottom) number?
• Has your blood pressure increased recently?

Call your doctor if your blood pressure goes well above your normal range.

Also call your doctor if you have any of these symptoms:

• Severe headache
• Irregular heartbeat or pulse
• Chest pain
• Sweating, nausea, or vomiting
• Shortness of breath
• Dizziness or lightheadedness
• Pain or tingling in the neck, jaw, shoulder, or arms
• Numbness or weakness in your body
• Fainting
• Trouble seeing
• Confusion
• Difficulty speaking
• Other side effects that you think might be from your medicine or your blood pressure

Gaziano JM,Manson, JE, Ridker PM. Primary and secondary prevention of coronary heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007:chap 45.

Joint National Committee on Detection, Evaluation, and Treatment of Blood Pressure. The seventh report of the joint national committee on detection, evaluation, and treatment of blood pressure. NIH Publication No. 03-5233, May, 2003.

Kaplan NM. Systemic hypertension: therapy. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007:chap 41.