Month: October 2011

Treatment for high blood pressure will depend on your blood pressure levels and your associated risk of developing a cardiovascular disease, such as a stroke.

There are seven main risk factors for developing a cardiovascular disease. These are:

age, high blood pressure, smoking (or a previous history of smoking), obesity, lack of exercise, having a high level of cholesterol in your blood, and having a family history of cardiovascular disease.

If your blood pressure is slightly high and your GP feels that the risks of cardiovascular disease are low, you should be able to get your blood pressure under control by making some simple changes to your lifestyle, such as modifying your diet and taking regular exercise.

If your blood pressure is moderately high, or your GP feels that your risks of developing a cardiovascular disease in the next ten years is higher than one in five, you will be given medicines, as well as being advised to make changes to your lifestyle.

If your blood pressure is severely high (180/110 mmHg or above) you will be referred to a specialist in the treatment of high blood pressure.

Changes in lifestyle

The following changes in lifestyle are known to reduce blood pressure:

regular exercise of at least 30 minutes a day, five times a week, moderating your alcohol intake to recommended levels (less than 21 units per week for men; and less than 14 units per week for women), eating a low-fat, balanced, healthy diet, restricting your consumption of salt to less than 6g (0.2oz) a day, losing weight if you are overweight or obese, restricting caffeine consumption to less than five cups of coffee or tea a day, and relaxation therapies, such as meditation.

It should be stressed that even achieving a relatively low drop in blood pressure can have significant health benefits. For example, a reduction of 5 mmHg in your diastolic blood pressure will reduce the chances of you having a stroke by 34%, and of developing heart disease by 20%.

See the ‘prevention’ section for more information about the possible changes that you can make to your lifestyle in order to lower your blood pressure.

Medicines

There are a number of medicines that can be used to treat high blood pressure. You may be given a combination of different medicines to take to bring your blood pressure under control.

For many people with high blood pressure, it is recommended that they take blood pressure lowering medicines for the rest of their lives. However, if your blood pressure levels remain under control for several years, it may be possible to discontinue treatment.

The most widely used medicines for treating high blood pressure are outlined below.

Angiotensin-converting enzyme (ACE) inhibitors

Angiotensin-converting enzyme (ACE) inhibitors work by blocking the actions of some of the hormones that help regulate blood pressure. By stopping these hormones from working, the medicines help reduce the amount of water in your blood and also widen your arteries, both of which will bring your blood pressure down.

ACE inhibitors are not suitable for pregnant or breastfeeding women, people with conditions that affect the blood supply to their kidneys, or people with a history of heart disease.

ACE inhibitors have been known to reduce the supply of blood to the kidneys which can reduce their efficiency. Therefore, blood and urine tests may be carried out before you start taking ACE inhibitors to make sure that there are no pre-existing problems with your kidneys.

Annual blood and urine tests may be required if you continue to use ACE inhibitors.

Side effects of ACE inhibitors include:

dizziness, tiredness or weakness, headaches, and a persistent dry cough.

Most of these side effects should pass in a few days, although some people find that they continue to have a dry cough.

If side effects become troubling, a medicine that works much in a similar way to ACE inhibitors, known as an angiotensin-2 receptor antagonist, may be recommended.

ACE inhibitors can cause unpredictable effects if taken with other medications, including over-the-counter (OTC) medicines. Check with your GP or pharmacist before taking anything in combination with this medicine.

Calcium channel blockers

Calcium channel blockers work by relaxing the muscles that make up the walls of your arteries. This causes your arteries to widen, reducing your blood pressure.

Calcium channel blockers are not recommended for people with a history of heart disease, liver disease, or circulation problems. Side effects of calcium channel blockers include:

flushed face, headaches, swollen ankles, dizziness, tiredness, and skin rashes.

However, these side effects should pass within a few days, once your body gets used to the medicine.

You should not drink grapefruit juice if you are taking calcium channel blockers because this can cause a drop in your blood pressure.

Thiazide diuretics

Thiazide diuretics work by reducing the amount of water in your blood, and widening the walls of your arteries. They are not recommended for pregnant women, or people who have gout.

Thiazide diuretics have been known to reduce the level of potassium in your blood, which can interfere with your heart and kidney functions. They can also raise the level of sugar in your blood which could lead to diabetes.

Therefore, you will probably be recommended to have blood and urine tests every six months so that your potassium and blood sugar levels can be monitored.

A few people have reported that they could not get, or maintain, an erection while taking thiazide diuretics, but this particular side effect was resolved once the medicines were withdrawn.

Beta-blockers

Beta-blockers used to be a popular treatment for high blood pressure, but now they only tend to be used when other treatments have not proved successful. This is because beta-blockers have more potential side effects than the other medicines that are used to treat high blood pressure.

Beta-blockers work by slowing down your heart rate, and the force of your heart. This reduces the pressure at which the blood is pumped out of your heart and around your body.

Common side effects of beta-blockers include:

tiredness, cold hands and feet, slow heartbeat, and diarrhoea and nausea.

Less common side effects of beta-blockers include:

sleep disturbances, nightmares, and impotence.

Beta-blockers can also interact with other medicines, causing possible adverse side effects. You should check with your GP or pharmacist before taking other medicines in combination with beta-blockers.

Medicines and ethnic groups

Research has shown that different blood pressure lowering medicines work better for different ethnic groups. For example, ACE inhibitors are a more effective as a first choice medicine for treating high blood pressure in white people, whereas calcium channel blockers, or thiazide diuretics, tend to work better as a first choice medicine for black people.

It is thought that this is due to the fact that black people tend to have a lower level of renin in their blood. Renin is an enzyme that helps to regulate blood pressure. ACE Inhibitors work best where there is a high level of renin in the blood, so they often prove not as effective in treating black people with high blood pressure.

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