Should I take medicine for high blood pressure?
Introduction
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—below 140/90
- High-normal blood pressure—130/85 to 135/89
- 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, First Nations, or South Asian.
- 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 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 behaviour 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 4.5 kg (10 lb) 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, non-fat 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.
If you need more information, see the topic High Blood Pressure.
Your Information
Your choices are:
- Start taking medicine for your high blood pressure.
- Try lifestyle changes first.
The decision whether to take medicine for high blood pressure takes into account your personal feelings and the medical facts.
Deciding about taking medicine for high blood pressure Reasons to take medicine for high blood pressure
Reasons to not take medicine for high blood pressure
- Your blood pressure is 160/100 or higher.
- Your blood pressure is 130/80 or higher and you have diabetes, heart failure, or kidney disease.
- There is heart disease or stroke in your immediate family.
- Medicines lower the risk of heart attack, stroke, and death in people with high blood pressure.
- You would like to work on making lifestyle changes but do not feel ready to do it yet.
- You have tried being more active and making other lifestyle changes, but it has not lowered your blood pressure.
- You feel sure that you and your doctor can find the right pill or combination of pills that will cause the fewest side effects.
Are there other reasons you might want to take medicine for high blood pressure?
- Your blood pressure is lower than 160/100 and you want to try diet, exercise, and other lifestyle changes first.
- Blood pressure medicines are expensive for me if insurance does not pay for them.
- Your overall risk for heart attack and stroke is not high.
- You hate the idea of taking pills and want to try to control your blood pressure another way.
- You feel confident that you can succeed at making lifestyle changes.
- You have tried medicines, but they haven't worked very well.
- You are worried about possible side effects of blood pressure pills.
Are there other reasons you might not want to take medicine for high blood pressure?
These personal stories may help you make your decision.
Wise Health Decision
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
Return to the topic High Blood Pressure (Hypertension).
Other Places To Get Help
Organizations
American Heart Association (AHA) 7272 Greenville Avenue Dallas, TX 75231 Phone: 1-800-AHA-USA1 (1-800-242-8721) Web Address: www.americanheart.org Call the American Heart Association (AHA) to find your nearest local or state AHA group. The AHA can provide brochures and information on support groups and community programs, including Mended Hearts, a nationwide organization whose members visit heart patients and provide information and support. AHA's Web site also has health information on 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.
Related Information
| Author: | Carrie Henley Robin Parks, MS | Last Updated: July 30, 2007 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology Robert A. Kloner, MD, PhD - Cardiology Ruth Schneider, MPH, RD - Diet and Nutrition | |
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