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High Blood Pressure: Should I Take Medicine?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
High Blood Pressure: Should I Take Medicine?
Get the facts
- Start taking medicine for high blood pressure.
- Try lifestyle changes first.
If your blood pressure is very high—higher than 160/100, or when either number is higher—you don't have a decision to make. You definitely need medicine to lower your blood pressure.
Key points to remember
- 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 all of the following are true:
- No one in your immediate family (parent, sister, or brother) has had heart disease.
- You don't have diabetes.
- You aren't overweight.
- You don't smoke.
- You haven't had heart or blood vessel problems.
- Your cholesterol levels are normal.
- 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, and getting more exercise can work as well as or better than taking pills.
- 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.
Blood pressure is a measure of how hard the blood pushes against the walls of your arteries as it moves through your body. It’s normal for blood pressure to go up and down during the day. But if it stays up when you are resting, you have high blood pressure.
Adult blood pressure is sorted into four types:
- Normal blood pressure—less than 120/80 (say "120 over 80")
- Prehypertension—120/80 or higher, but less than 140/90
- Stage 1 high blood pressure—140/90 to 159/99
- Stage 2 high blood pressure—160/100 or higher
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.
Anything that increases your risk for a disease or problem is called a risk factor. 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 change. Others you can't.
Risk factors for heart attack and stroke that you can change include:
- Having high blood pressure that isn't under control.
- Smoking cigarettes.
- Having high total cholesterol, high LDL ("bad") cholesterol, or low HDL ("good") cholesterol.
- Being overweight.
- Not exercising.
- Having diabetes that isn't under control.
Things you can't change include:
- 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.
- Having an enlarged left ventricle (the lower left chamber in the heart).
Your treatment will depend on several things:
- Whether you have a health problem that is causing your high blood pressure
- How high your blood pressure is
- Whether you have other health problems, such as heart failure, coronary artery disease, chronic kidney disease, or diabetes.
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 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. For example:
- Losing as little as 10 lb (4.5 kg) 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, nonfat 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 to reduce the risk of heart attack and stroke. Nicotine in tobacco briefly increases blood pressure and heart rate with each use.
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.
Your doctor may advise you to take medicine for high blood pressure if:
- Your blood pressure is 160/100 or higher.
- Your blood pressure is 130/80 or higher and you have diabetes, heart failure, coronary artery disease, or kidney disease.
- There is heart disease or stroke in your immediate family (parent, brother, or sister).
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You take medicine every day.
- You may have to take more than one medicine to find the right mix to lower your blood pressure.
- You will still need to make lifestyle changes to lower your risk of heart attack and stroke.
- Medicines help control your blood pressure and lower your risk of heart attack and stroke.
- Some pills cause dry mouth, weakness or dizziness, a cough, or erection problems.
- Blood pressure medicine may be expensive if your insurance doesn't pay for it.
- You make lifestyle changes such as eating better, exercising, drinking less alcohol, and quitting smoking to lower your high blood pressure.
- You may be able to control your blood pressure.
- You avoid the side effects of blood pressure pills.
- You avoid the cost of blood pressure pills.
- If these changes don't lower your blood pressure enough, you may still need medicine to reduce your risk of heart attack and stroke.
Personal stories about taking medicine for high blood pressure
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
After my doctor told me my blood pressure was too high, she suggested I try to bring it down by changing some of my habits. I quit smoking, went on a diet, and started a walking program. That made me feel healthier, but it didn't bring my blood pressure down very much. Now I take two kinds of blood pressure medicine as well as keeping up with my lifestyle changes. Everything is under control.
Terrence, age 59
I just found out I have high blood pressure. I want to try to make some lifestyle changes before I start taking medicine. I know I need to start out by making small changes and sticking with them. I'm going to start by walking 15 minutes 5 days a week and cutting down on salt by looking for other ways to season my food. After 2 weeks of that, I'll add some more goals and walk a little longer. I really think I can do this.
Magda, age 45
I just started taking medicine for my high blood pressure. My doctor thinks I might be able to control my blood pressure by losing weight and getting more exercise. But I just don't feel ready to make those changes. So I'm going to take medicine for 6 months and then talk to my doctor again about diet and exercise. Maybe I'll be ready then.
Paolo, age 51
About 6 years ago I found out my blood pressure was a little too high. I was a little overweight and I didn't get much exercise. So I went on a diet and started going to the gym regularly. I was very motivated, because I did not want to have to take medicine if I could avoid it. It worked. My blood pressure came down and has stayed down.
Hanh, age 64
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take medicines for high blood pressure
Reasons to try lifestyle changes first
I've tried being more active and making other lifestyle changes, but it has not lowered my blood pressure enough.
I feel confident that I can succeed at making lifestyle changes.
I'm not concerned about the side effects of blood pressure medicine.
I'm worried about the side effects of pills.
I want to do everything I can to prevent a heart attack or stroke.
I don't want to take medicine, even if it might lower my risk of heart attack and stroke.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Trying lifestyle changes first
What else do you need to make your decision?
Check the facts
If your blood pressure is very high, is medicine the only way to get it low enough?
- YesYou're right. If your high blood pressure is very high—higher than 160/100, or when either number is higher—medicine is probably the only way to lower it. Lifestyle changes will probably not be enough.
- NoSorry, that's not right. If your high blood pressure is very high—higher than 160/100, or when either number is higher—medicine is probably the only way to lower it. Lifestyle changes will probably not be enough.
- I'm not sureIt may help to go back and read "What are the risks of not lowering your blood pressure?" If your high blood pressure is very high— higher than 160/100—medicine is probably the only way to lower it.
Do you still need to make lifestyle changes if you are taking pills for high blood pressure?
- YesYou're right. Even with pills, you will need healthy habits for the rest of your life to lower your risk for heart attack and stroke.
- NoSorry, that's not right. Even with pills, you will need healthy habits for the rest of your life to lower your risk for heart attack and stroke.
- I'm not sureIt may help to go back and read "Why are lifestyle changes so important?" Even with pills, you will need healthy habits for the rest of your life to lower your risk for heart attack and stroke.
If your risk of heart disease is low, can you lower your blood pressure without pills?
- YesYou are right. If your risk of heart disease is low, you may be able to lower your blood pressure without taking pills. But you will need to adopt healthy habits.
- NoSorry, that's not right. If your risk of heart disease is low, you may be able to lower your blood pressure without taking pills. But you will need to adopt healthy habits.
- I'm not sureIt may help to go back and read "Why are lifestyle changes so important?" If your risk of heart disease is low, you may be able to lower your blood pressure without taking pills. But you will need to adopt healthy habits.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Robert A. Kloner, MD, PhD - Cardiology|