reduce high blood pressure

High blood pressure, or hypertension, occurs when systolic blood pressure is consistently 140 mmHg or greater and/or diastolic blood pressure is consistently 90 mmHg or greater.1 Some guidelines suggest that hypertension can be diagnosed when a patient consistently has a systolic blood pressure of 130 mmHg or higher and/or a diastolic blood pressure of 80 mmHg or higher.1

Types of hypertension

Most cases of hypertension are essential, or primary, hypertension.2 This occurs when the high blood pressure does not have an identifiable cause.2 It is likely caused by a combination of genetic and environmental factors, such as an unhealthy diet, not enough physical activity, and consumption of alcohol.3

Secondary hypertension occurs in about five to ten percent of cases.2 People with secondary hypertension will have high blood pressure that is caused by another condition, such as chronic kidney disease, pregnancy, or primary aldosteronism.2

Complications of uncontrolled hypertension

Hypertension is a major risk factor for numerous diseases, including cardiovascular disease and chronic kidney disease.4 For secondary hypertension, it is possible that the high blood pressure will worsen the underlying condition if uncontrolled.2

Controlling high blood pressure through medical treatments and/or lifestyle changes can help reduce the risk of developing hypertension-related diseases.3 Methods to control blood pressure include a variety of lifestyle modifications to promote a healthy lifestyle and blood pressure medications.

Lifestyle interventions

When discussing a hypertension management plan, your doctor or healthcare provider may advise certain applicable lifestyle changes that could help lower your blood pressure.4 Education on the lifelong commitment for any lifestyle changes suggested by a doctor is important to successfully reduce the risk of developing diseases associated with uncontrolled hypertension.5

These non-pharmacological interventions have been found to help control blood pressure.4

Healthy Diet

An unhealthy diet is an important risk factor for developing hypertension.3 For example, a diet high in sodium is known to contribute to the development of hypertension.4

One diet plan that has been developed to lower blood pressure is the Dietary Approaches to Stop Hypertension (DASH).3 It promotes a diet rich in plant-based proteins, whole grains, fruits, vegetables, low-fat dairy products, and lean meat.3 Notably, DASH recommends reducing foods that are high in refined sugar, saturated fat, and cholesterol.3 This diet can help lower sodium intake and increase potassium intake – both changes are known to lower blood pressure.4

Regular Physical Activity

People with hypertension would likely benefit from regular physical activity, which has been found to control blood pressure.4 Aerobic exercises are thought to be more effective at lowering blood pressure than resistance (muscle-strengthening) exercises, although any type of exercise will be beneficial.3

Guidelines suggest people get 150 minutes of moderate-intensity aerobic activity each week and do muscle-strengthening exercises at least twice a week.6 If you are just starting to become physically active, gradually work your way up to the recommended intensity and amount of weekly exercise.6 Also, the American Heart Association suggests that you talk to your doctor or healthcare provider about the type, intensity, and duration of physical activity that they recommend for you.6 

Weight Loss

Losing weight to a healthy range is often advisable in people with hypertension and obesity.5 Losing excess weight has been shown to lower blood pressure.5 Other measures, such as adopting a healthy diet and increasing physical activity, may help with losing weight.4

Limit Alcohol Consumption

Reducing alcohol consumption is associated with lowering blood pressure.4 Guidelines suggest a maximum of two standard alcoholic drinks per day for men and one standard alcoholic drink per day for women.4

Stop Smoking

Stopping smoking may reduce the risk of developing diseases related to hypertension over time.5

Pharmacological treatment

Antihypertensive medications can help lower blood pressure. Typically, they are used for people with severe hypertension.5 Also, people considered high-risk – people with diabetes, chronic kidney disease, or at high-risk for cardiovascular disease – may be prescribed antihypertensive medications.5 Often, these patients will initially be prescribed one or more first-line antihypertensive medications.4

Depending on its effectiveness or side effects, your doctor may adjust the initial prescription. For many people, more than one antihypertensive medication is required to control their blood pressure, especially for people who have severe hypertension.4

Side effects of antihypertensive medications are usually mild.5 They are more frequent when a patient is first beginning their treatment. If side effects do occur, your doctor may change the dosage or stop the prescribed drug for a short period of time.5 For more severe side effects, your doctor may request a complete stop of the prescribed medicine. Mild symptoms may include hypotension or electrolyte imbalances.5 Severe symptoms may include symptomatic hyperkalemia or hyponatremia, or acute kidney injury.5

Secondary hypertension treatments

Treatment for secondary hypertension includes treating the underlying condition.2 It is possible that this will significantly decrease blood pressure, potentially back to a normal state.2

Treatment for this type of hypertension may also include an antihypertensive medication to help lower the blood pressure.2

Sticking with treatments

People often don’t make or stick with lifestyle changes suggested to them by a health care provider.3 Similarly, continuing to take antihypertensive medications as prescribed is not common in people with hypertension.3

Some barriers to sticking with prescribed medical treatments include having to take multiple pills a day, treatment side effects, and limited access to care.3

Overcoming these barriers may require better education for patients about the condition and its consequences if uncontrolled.3 Also, prescribing low-cost or single daily dose antihypertensives and maintaining communication between healthcare providers and patients are all strategies that may improve consistent medication taking.3

Technology-assisted management of hypertension

Recent advances in technology have allowed new tools for hypertension care to be developed. For example, it is possible to monitor blood pressure at home with new technology approaches, such as self-monitoring and tele-monitoring.7

There are a variety of technology-assisted methods to help manage blood pressure. Future research is needed to gather evidence for the effectiveness, safety, and feasibility of these technologies before they can be recommended for use in the general population.7

Self-Monitoring

Self-monitoring refers to doing blood pressure readings outside of your doctor’s office. There are many blood pressure monitoring apps available that can collect data from a blood pressure monitor to store your blood pressure measurements.7 This way, people can view their past or current blood pressure readings and communicate any significant changes to their doctor.7 Some apps even provide reminders for taking medication and education about the condition.3

Tele-Monitoring

Tele-monitoring is a similar process to self-monitoring, except the blood pressure readings stored on the device are automatically transferred to the doctor’s office or other healthcare setting.7 This way, doctors will be able to monitor their patients’ blood pressure remotely.

Virtual Clinics

Virtual clinics allow a patient and their doctor or a healthcare provider to meet remotely, potentially making it easier for blood pressure check-ups and adjustments to treatment plans.7 Virtual check-ups may provide additional support to the patient than otherwise received from the usual hypertension care.3

References:

  1. Centers for Disease Control and Prevention. (2020). High Blood Pressure Symptoms and Causes. Retrieved from https://www.cdc.gov/bloodpressure/about.htm
  2. Hedge, S., & Aeddula, N. R. (2020). Secondary Hypertension. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK544305/#_NBK544305_pubdet_
  3. Carey, R. M., Muntner, P., Bosworth, H. B., & Whelton, P. K. (2018). Prevention and Control of Hypertension: JACC Health Promotion Series. Journal of the American College of Cardiology72(11), 1278–1293. https://doi.org/10.1016/j.jacc.2018.07.008
  4. Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cífková, R., Dominiczak, A. F., Grassi, G., Jordan, J., Poulter, N. R., Rodgers, A., & Whelton, P. K. (2018). Hypertension. Nature reviews. Disease primers4, 18014. https://doi.org/10.1038/nrdp.2018.14
  5. Iqbal, A. M., & Syed, F. J. (2020). Essential Hypertension. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK539859/
  6. American Heart Association. (2018). American heart association: Recommendations for physical activity in adults and kids. Retrieved from https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults
  7. Kitt, J., Fox, R., Tucker, K. L., & McManus, R. J. (2019). New Approaches in Hypertension Management: A Review of Current and Developing Technologies and Their Potential Impact on Hypertension Care. Current hypertension reports21(6), 44. https://doi.org/10.1007/s11906-019-0949-4
  8. Image by mohamed Hassan from Pixabay 
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