Do You Really Need That Blood Pressure Medication?
High blood pressure, otherwise known as hypertension, is extremely common in the general population. It is important to have lower blood pressure because of potential consequences associated with higher blood pressure. For example, for every 20 points of blood pressure systolic (top number) and every 10 points of blood pressure diastolic (bottom number) there is a 100% increase in risk of heart disease and stroke. In other words, someone with a blood pressure of 140/90 has double the risk of heart attack or stroke as somebody with a blood pressure of 120/80. Other potential risks of having elevated blood pressure include brain bleeding, ruptured aorta, chronic kidney disease, and congestive heart failure. Certainly, failure to control blood pressure adequately can lead to a shortened lifespan.
Overtreatment of blood pressure is also a common issue. Unfortunately, in many doctors’ offices, blood pressure is not taken appropriately, and even more unfortunately, sometimes high blood pressure is diagnosed inappropriately and medication is started that may actually be unnecessary. Overtreatment of blood pressure can lead to fatigue, dizziness, or falls not to mention the potential for medication side effects, cost, and more pills.
Many times, blood pressure at the doctor’s office is often higher than blood pressure when taken at home. There are a variety of reasons for this including: patients being nervous or “white-coat hypertension”, patients not being allowed to rest for 5 minutes prior to blood pressure being taken, or having blood pressure checked over the top of clothing.
For this reason, I put so much more stock in reviewing patients home blood pressure recordings over several weeks (after appropriately counseling them how to do so). The following recommendations are very important while checking blood pressure at home:
Using an appropriate sized cuff. If you have a larger upper arm, it may be necessary to purchase an additional larger cuff that may not have come with your home blood pressure monitor. Upper arm cuffs are preferred over the wrist cuff monitors.
Taking blood pressure while resting. It is important to rest for at least 5 minutes before checking blood pressure. I usually advise patients to place the cuff on their arm, then sit and relax with their arm supported on a table or armrest.
Stop worrying! If you’re thinking “I hope it’s not high, I hope it’s not high, I hope it’s not high” for the time while you’re resting, it’s very likely going to be high. During the resting period, I usually advise patients to read or watch television. During a commercial when you’ve successfully forgotten that the blood pressure cuff is attached to your arm, that is a good time to then press the button and check your blood pressure.
Refrain from caffeine, exercise, or smoking (the latter you shouldn’t be doing anyways) for 30 minutes prior to checking blood pressure.
Avoid upsetting conversations or stressful thoughts prior to checking blood pressure. If you’re a Republican, don’t watch CNN before checking your blood pressure. If you’re a Democrat, don’t watch Fox News before checking your blood pressure.
Check blood pressure on your bare skin instead of over clothing. Refrain from talking while checking blood pressure.
Avoid continually repeating your blood pressure if it is high. It’s likely only to go higher and cause more anxiety with repeat measurements.
What are the risk factors for developing hypertension?
Age - as we age, blood vessels lose their elasticity (allows them to relax/dilate) and can develop calcium deposits making them stiff. Older patients tend to end up with higher systolic (top number) blood pressure readings. If you are under age 50, both the top and bottom numbers are important, but the bottom number is more important in younger patients.
Weight - blood pressure generally decreases by 1 point for each pound of weight that a person loses. Someone with a blood pressure of 130/90 can get their blood pressure back to perfect with just 10 pounds of weight loss.
Family history - not always, but a strong family history of high blood pressure can sometimes be the only cause as to why someone’s blood pressure is high.
Race – Black, Hispanic, Filipino, and some other races have more predisposition to having high blood pressure.
What can YOU do if your blood pressure readings at home are high?
Reduce sodium
Processed foods, canned foods, and most restaurant foods are loaded full of sodium. Restaurants tend to not care about your health but rather care about your pocketbook. Their food tastes better than the food that you make at home because they tend to add more salt, sugar, and butter to their meals than you would at home.
Watch out for medications
Oral contraceptives, nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and Aleve used chronically, over-the-counter decongestants like Sudafed, weight loss medications, and ADHD medications all can contribute to high blood pressure.
Increase physical activity
Blood pressure actually increases during exercise which is physiologically normal and wanted, but this should not dissuade someone with high blood pressure from exercising. Actually, regular cardiovascular exercise reduces resting blood pressure long-term.
Reduce alcohol intake
Even modest alcohol intake on a daily basis can really elevate blood pressure. Females should not have more than one alcoholic beverage per night while males should not have more than two. Sorry ladies, I know it’s not fair, but you don’t metabolize alcohol as well as men. Don’t blame me, I didn’t make the rules.
Treat underlying sleep apnea
If you’re snoring or having pauses in your breathing at night time, you may have a very common condition called obstructive sleep apnea. Diagnosis and treatment for obstructive sleep apnea can be somewhat cumbersome, but the benefits of treating sleep apnea can literally be life-altering in regards to quality of life. Also, blood pressure improves when sleep apnea is treated and your heart is happier that it doesn’t have to work so hard pumping against increased pressure.
While both me and my patients prefer lifestyle modification changes over medications for treatment of high blood pressure, sometimes medication is required to reduce risk. If you find yourself in need of better blood pressure control, please reach out to us at Simplicity Health Direct Primary Care and we would be happy to get you back on track!
Dr. Opperman
