Treating High Blood Pressure
Jun 15, 2016
Last week I had the chance to talk about blood pressure, and what the numbers mean. If you missed the talk, you can read it on our new website at www.dcp.ca, under health articles. This week we will review blood pressure treatments. Six million Canadian adults have hypertension. As a pharmacist, a very high percentage of medications we fill are used to treat hypertension.
While blood pressure pills are extremely common, they are in fact not the step toward controlling your hypertension. "Health behaviour modification" is listed as the first and most important things you should do to help lower your blood pressure. These practises are also considered first line in preventing hypertension.
In behavior modification, the first goal is to be more physically active. Moderate intensity workouts including walking, cycling, swimming for 30-60 minutes, at a minimum of four days per week are extremely important. Interestingly enough, higher intensity workouts have shown to be no more effective and weight training alone will not significantly affect blood pressure. Looking for an idea to increase your amount of physical activity? Head down to the Dauphin Clinic Pharmacy walking track for a brisk walk.
Weight reduction is also important. If you need help losing weight, talk to a registered dietician or your community pharmacist. If dieting and exercise seems like a losing battle you could try the Clinic Pharmacy's Ideal Protein Weight Loss Program. Moderation in alcohol intake has shown to reduce blood pressure levels. Men should consume no more than 2 drinks per day and women should aim to be consuming no more than 9 drinks per week. Eating healthier is another required modification, which can be extremely hard to succeed at. The name of the game here is to eat fresh fruits, vegetables, fibre rich foods, and low fat dairy and low fat proteins. While increasing potassium, you also need to decrease sodium, fat and cholesterol intake.
Hypertension Canada reports that 13% of cardiovascular events are attributed to excess dietary sodium. As Canadians, our sodium intake is through the roof, mainly due to processed foods being a large part of our regular diet. If you want to decrease your blood pressure significantly, try to reduce your sodium intake to around 2000 mg per day. It is not an easy task, but can keep you alive.
If you are a smoker, get help from your clinic pharmacist, and quit. Seek help with quitting smoking, because only 3% of people can quit on their own. If you are hypertensive your health is at risk and your pharmacist can help you find a way to butt out. Lastly, try to reduce your stress level and use relaxation techniques if possible. All of these behaviour modifications work to lower your blood pressure. Unfortunately, the majority of us cannot make these changes in lifestyle long term or the changes we make are not quite significant enough to get our blood pressure to a level of where it has to be.
One of the safest, effective and inexpensive treatments in blood pressure are thiazide diuretics. Hydrochlorothiazide as an example is a once a day treatment which assists the body in excreting fluid from the blood. Simply, they inhibit sodium reabsorption in the kidneys. If sodium leaves, body fluids want to go with it. If fluid leaves the blood, there is less pressure.
Ace inhibitors and Angiotensin receptor blockers classes have many drugs in this class and most have been widely studied in blood pressure studies. Simply these medications have shown to save lives by lowering blood pressure. From ramipril to irbesartan their mechanism of action varies, but they all lower resistance in the arteries which reduces pressure. They too, promote fluid excretion in the kidney by very complex mechanisms. Bottom line they work great, especially in diabetics. However; some side effects can occur and kidney function has to be appropriate to use them.
Calcium channel blockers also act against vessel stiffness and alter heart rate, in their mechanism to reduce blood pressure. If you increase the size of the pipes and slow the pump, the pressure goes down. Examples in this class include amlodipine, diltiazem and verapamil. These medications do have side effects associated with them, so they are often used as add on agents and when other medications cannot be tolerated due to other health issues.
Beta Blockers are used to control heart rate and blood pressure. They are first line treatment in people under the age of 60, but are usually used as an add on agent to some of the examples I have mentioned above. Beta blockers slow heart rate and reduce the heart's oxygen demand. They also work in the vessels to reduce stimulation, thereby lowering the pressure.
A combination of medications is often used then blood pressure is running more than 20 points above the systolic normal or more than 10 points high on the diastolic pressure. We have also learned it is often more beneficial and safe to be on two low to moderate doses of blood pressure medication than to be on one medication at a high dose. Often treating blood pressure is a bit of an art and can take a while to find a treatment that produces maximal results. Remember, you cannot often feel blood pressure running high. So I cannot stress enough how important it is to take your medication regularly, while trying to make positive lifestyle changes. If you have blood pressure questions, talk to your clinic pharmacist.