High blood pressure is one of the leading causes of death in Canada. High blood pressure can cause strokes, heart attacks, and heart and kidney failure; it is also related to dementia and sexual dysfunction. These problems can be prevented if they are well treated and controlled.
A normal blood pressure allows blood to flow and deliver oxygen and food to different parts of the body. We measure blood pressure with two numbers (ie, 124/84 mmHg). The first number is called the systolic blood pressure and the second is called the diastolic blood pressure. These two numbers are written as ‘systolic/diastolic’ followed by the unit of measurement. Systolic blood pressure is your highest blood pressure measurement and is recorded when your heart contracts. Diastolic blood pressure is your lowest blood pressure measurement and is recorded when your heart relaxes and fills with blood. The higher your systolic or diastolic pressure is, and the longer it stays high, the more damage is made to your blood vessels. Strokes and heart attacks are caused by damaged blood vessels.
Have your blood pressure measured regularly
Have your blood pressure measured regularly and know what your blood pressure is. Remember that both numbers are important. If either the systolic or diastolic number is high (more than 135/85 mmHg when measured at home or more than 140/90 mmHg when measured in a doctor’s office), then your doctor will need to further check your blood pressure. A blood pressure measurement of less than 120/80 mmHg is very good unless it causes dizziness.
Stop high blood pressure and stop your blood pressure from increasing
There are several things you can do to stop hypertension and keep your blood pressure lower. Blood pressure increases with age, and more than nine in 10 Canadians will develop hypertension unless they follow a healthy lifestyle.
Be physically active for 30 to 60 minutes on most days of the week. Try walking, biking, swimming, cross-country skiing or any other physical activity that you enjoy. Remember that even a little bit of physical activity is better than no activity at all.
Eat a lot of fresh fruits and vegetables, low-fat dairy products and other foods low in fat and salt. Avoid fast foods, canned foods or foods that are bought prepared, as well as any foods where you can see the fat in them.
Eat less salt in your diet. This is made easier by eating the diet described above, by avoiding eating at restaurants and by not adding salt to your cooking or keeping salt at the table. Most of the salt we consume is from packaged or prepared foods and from food cooked in restaurants.
If you drink more than two alcoholic drinks each day, drinking less will help to lower your blood pressure. A regular-sized bottle or can of beer, 1.5 ounces of hard liquor or a regular-sized glass of wine are each equal to a single alcoholic drink.
Keeping your body weight within a healthy range also prevents high blood pressure. If you are overweight, losing about 10 lbs (5 kg) will lower your blood pressure, and reducing your weight to within a healthy range will lower your blood pressure even more.
It is important to stop smoking if you have high blood pressure. Smoking increases the risk of developing heart problems and others diseases. Ensuring that you live and work in places that are smoke-free is also important.
One high blood pressure reading is not enough for a diagnosis of hypertension. Most people will have higher readings when under physical or emotional stress. Blood pressure should be measured when you are relaxed and rested. Listed below are several ways to find out whether you have hypertension.
A doctor will diagnose hypertension right away if your blood pressure is extremely high (higher than 200/120 mmHg). If your blood pressure is higher than 180/110 mmHg, then your doctor will be able to diagnose you with hypertension after just two visits over a short period of time. If your blood pressure is higher than 160/100 mmHg, then three visits are enough. If your blood pressure is higher than 140/90 mmHg, then five visits are needed before a diagnosis can be made. If either your systolic or diastolic blood pressure stays high, then the diagnosis of hypertension can be made. The diagnosis can also be made if you have diabetes or kidney disease and a blood pressure higher than 130/80 mmHg.
Measuring your blood pressure at home
You can also diagnose yourself with hypertension by measuring your blood pressure at home. If readings are high over two visits at the doctor’s office, and if your blood pressure is higher than 135/85 mmHg when properly measured at home, then the diagnosis of hypertension can be made. This requires you to measure your blood pressure twice a day, in the morning and evening, for one week. Pay no attention to the measurements from the first day. Measuring blood pressure at home requires accurate equipment and proper measuring techniques. Measure the blood pressure of others in your house; their blood pressure may also be high.
Buying a blood pressure instrument to measure your blood pressure at home
Blood pressure instruments can be purchased in most pharmacies. Buy a blood pressure instrument that has been approved by the Association for the Advancement in Medical Instrumentation (AAMI), the British Hypertension Society (BHS) or the International Protocol (IP). These labels will be marked clearly on the box. If you are unsure whether an instrument is approved, ask your pharmacist for help. Once you have bought the instrument, ask your doctor or pharmacist to check it to make sure the instrument measures your blood pressure accurately.
Measuring ambulatory blood pressure
High blood pressure can also be diagnosed through a special device called an ambulatory blood pressure monitor. A doctor, nurse or pharmacist will get you to wear the device for a full day. The device measures blood pressure every 20 to 30 minutes and gives the doctor an average of your blood pressures during the day and while you are sleeping. These devices are not available everywhere and can be uncomfortable to wear.
SO YOU HAVE HIGH BLOOD PRESSURE –WHAT ELSE COULD BE WRONG?
If you have high blood pressure, get checked for diabetes and high cholesterol. Most people who have high blood pressure also have some of the other risks for heart disease and stroke, such as not getting enough physical activity, having unhealthy eating habits, smoking, being overweight or drinking too much alcohol. Ask your doctor to test your kidney function through a blood and urine test, and through the electrolytes (salts) in your blood; kidney problems can cause high blood pressure.
Target your high blood pressure
Once you have been diagnosed with hypertension, remember that high blood pressure can be lowered. For most people, blood pressure readings should be lower than 140/90 mmHg when measured in the doctor’s office. At home, your blood pressure should generally be below 135/85 mmHg. For those people with diabetes or kidney disease, lower blood pressure is even more important and should be below 130/80 mmHg when measured in the doctor’s office.
Most people who lead healthy lifestyles do not suffer from high blood pressure. For those with hypertension, following the steps outlined above (‘Stop high blood pressure and stop your blood pressure from increasing’) will lower their blood pressure.
Taking your medication
Most people with high blood pressure will need two or more medications, together with lifestyle changes, to lower their blood pressure. In many cases, two medications can be taken as a single tablet with both medications in it. It is usually best to start treatment with a single medication. There are many drugs that last over a full day and need to be taken only once a day. Keep in mind that many of these drugs need up to six weeks before they take full effect. In general, these drugs will not make you feel worse or better, but will simply lower your blood pressure. Every drug can have side effects, and you need to keep an eye on these and report them to your doctor. The pamphlets on side effects provided by many pharmacies are often overstated.
It is very important that you take your prescribed drugs regularly and as instructed on the pill bottle. Keep in mind that medications will not work if you do not take them! Place your medication next to something you use regularly and at the same time that you are supposed to take your medication – that way, you are more likely to remember to take it. For medications taken in the morning with food, for example, you could store the pill in the cup or bowl you plan to use for breakfast. If you occasionally forget to take your medication, it may help to keep a second bottle in your car or at work. For those who are already taking many drugs, a plastic medication dosette is inexpensive and can be found at your local pharmacy. Measuring your own blood pressure can also help you remember to take your medication. A lower blood pressure when you are taking your medication is a good reminder, as is a high blood pressure when you forget. Mark on your calendar when your prescription is due to be refilled; if you have pills left on that date, you will know you are having problems remembering to take your medication.
If you are having trouble taking your medication, or if you are forgetting to take your medication altogether, tell your doctor or pharmacist about it. If you do not inform your doctor, he or she will think the drug is not working and may increase the dose of medication or add more medications.
Many drugs that lower blood pressure also prevent heart attacks and strokes. The drugs include diuretics (water pills), beta-blockers in those younger than 60 years of age, angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs) and calcium channel blockers. All of these drugs reduce blood pressure by just about the same amount on average, but some people have better results with one drug than with another. These drugs have different costs and different possible side effects. If you have diabetes or kidney disease, an ACE inhibitor or an ARB is usually recommended first. Often times, diabetes or kidney disease patients also take diuretics. If you have heart disease, then a beta-blocker and ACE inhibitor is commonly used. It is best to ask your doctor or pharmacist what type of medication you are on if you are unsure.
If you need two medications
Many types of blood pressure drugs work best when taken together. When taking two drugs together, diuretics have been shown to lower blood pressure with a beta-blocker, ACE inhibitor and an ARB. A calcium channel blocker lowers blood pressure with the same drugs that work well with a diuretic. Other drug combinations are necessary when taking three or more blood pressure medications. There may be other reasons why your doctor may prescribe two blood pressure medications. For example, after heart attacks, doctors will prescribe a beta-blocker and an ACE inhibitor, but this is not primarily to reduce blood pressure.