High Blood Pressure

Managing High Blood Pressure


The goal of any treatment plan is to prevent or reduce the impact of high blood pressure and the onset of complications, including stroke, heart attack, heart failure and chronic kidney disease.

Lower is Better

Your health care provider may talk with you about setting a “target goal.” Based on new guidelines released in November 2017, normal blood pressure has been lowered to less than 120/80 mmHg.

Research shows that lower blood pressure goals improve heart health. For individuals who are at high risk because of a previous heart attack or stroke, chronic kidney disease, diabetes, or because of a high ASCVD risk score, lower blood pressure measures are better. 

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What is ASCVD?

Heart attack and stroke are often caused by atherosclerotic cardiovascular disease (ASCVD). ASCVD develops because of a buildup of sticky cholesterol-rich plaque. Over time, this plaque can harden and narrow the arteries.

These targets are now lower because research has shown that people with elevated or stage 1 high blood pressure—previously called “prehypertension”—are already at a higher risk of having a heart attack or stroke.

Lifestyle Changes are Key

Lifestyle changes  are the main treatment for those with elevated or stage 1 high blood pressure. They are also important in treating individuals with stage 2 high blood pressure (>140 mmHG/>90 mmHG) and for good health overall. Healthy choices can go a long way in helping to lower your numbers and include:

  • getting regular physical activity
  • maintaining a healthy body weight
  • focusing on healthy eating (follow the Dietary Approaches to Stop Hypertension diet, limit sodium and eat potassium-rich foods)
  • limiting alcohol (no more than one drink per day for women, two drinks per day for men)
  • smoking cessation

It’s important to cut back on the amount of salt (sodium) you consume, particularly if you are already eating a diet that is high in salt. The latest Dietary Guidelines for Americans recommend people consume no more than 2,300 mg of sodium per day—less than a teaspoon of salt. However, for people with high blood pressure or at risk for it, less than 1,500 mg of sodium per day is often the goal.

How Much Salt?

1/4 teaspoon salt = 575 mg sodium
1/2 teaspoon salt = 1,150 mg sodium
3/4 teaspoon salt = 1,725 mg sodium
1 teaspoon salt = 2,300 mg sodium
Stress also can cause your blood pressure levels to spike, so make sure to do things that help you relax and reset; for example, listen to your favorite music, go for a walk or take a yoga class.

Medications Play Role

Some people also will need one or more medications to help lower their blood pressure. For example:

  • People with stage 1 high blood pressure who are likely to develop cardiovascular disease (those with an ASCVD risk score of 10% or higher, a formal calculation of the likelihood you will have a heart attack or stroke in the next 10 years) or other known risk factors (for example, chronic kidney disease or diabetes).
  • People with stage 2 high blood pressure.

Some common medications used in treating high blood pressure include thiazide-type diuretics, calcium channel blockers, ACE inhibitors, aldosterone antagonists and beta blockers, which may be considered specifically if the person has coronary artery disease after heart attack or heart failure. You may need multiple medications, especially if your numbers are significantly above your goal.

The new guidelines lower the threshold for when treatment is needed. If you’re already being treated for high blood pressure, it’s a good time to review your treatment plan and decide with your care team whether your target blood pressure numbers should be lower. You might need to step up your lifestyle changes or medication, or both.

It’s important to take medications exactly as prescribed and report any side effects. Be sure to share a complete list of all the medications you take, including over-the-counter drugs and supplements.

Track Your Blood Pressure

Tracking your blood pressure is a key part of managing it. Find out how often you should take and keep a record of your blood pressure readings. Having this information in hand can help your health care professional know what is working and when to adjust your treatment plan.

Other conditions, sometimes called secondary causes, might be triggering high blood pressure and should be taken into consideration. These conditions include sleep apnea, chronic kidney disease, certain medications, and adrenal or thyroid disorders.

Talking to Your Care Team

It’s important to talk with your health care provider about your blood pressure and any other factors that put you at risk for heart disease. Knowing your numbers can help you take steps to either prevent or lower high blood pressure.

Some questions you might want to ask:

  • What is my blood pressure? What do my numbers mean?
  • My blood pressure has always been under 140/90 mmHg, and I was never told I have high blood pressure What’s different now?
  • What might be causing my blood pressure to be elevated?
  • How does my risk of heart disease or stroke factor into how my blood pressure is treated?
  • Can exercise make a difference? What type of physical activity is best for me?
  • How can I change my diet to lower my blood pressure?
  • Should I be limiting salt? What are common sources of salt (sodium)?
  • Why should I eat more potassium? What are examples of foods that contain potassium?
  • Should I consult a dietitian or nutritionist? Is there one you would recommend?
  • At what point might I need medication?
  • I’m already on a cholesterol-lowering medication and have been doing well. Now based on the new guidelines, my blood pressure is no longer considered controlled. What do I need to do now?
  • How often should I have my blood pressure rechecked?
  • Should I be writing my blood pressure down and sharing it with you? If so, how  frequently?
  • Would you suggest that I use a home blood pressure machine? Is there one you recommend?
  • What are my blood cholesterol and glucose levels?

 

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Updated: November 2017 | Published: June 2016
Editorial Team Lead: Keith C. Ferdinand, MD, FACC, FAHA
Medical Reviewer: John D. Bisognano, MD, PhD, FACC

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