Your Doctor Can Help You Make An Informed Decision About Treatment
Exercising, losing weight, eating healthy, and quitting smoking can help you control high blood pressure and improve your overall health. Some people find that after making these lifestyle changes, they no longer need medication to control their blood pressure.
However, before you stop taking blood pressure medication, you’ll need to work with your doctor to assess the risks and benefits.
Hypertension Doctor Discussion Guide
More Than Half Of Younger Patients Skip Or Quit Blood Pressure Meds
THURSDAY, Aug. 15, 2019 — High blood pressure can be a killer. But a new study finds that more than half of younger patients — those under 65 — who are prescribed high blood pressure meds either stop taking them within a few months or don’t take them as prescribed.
But stopping treatment can prove dangerous, even for the relatively young, the study’s lead author warned.
“Blood flow is a physical action. Your vessels are being slammed by waves of blood every time your heart pumps,” explained Gabriel Tajeu. He’s assistant professor of health services administration and policy at Temple University in Philadelphia.
“That’s why the younger population is important,” he said in a Temple news release. “Somebody may have blood pressure that is a bit high, but they have been exposed to it for 10, 20 years, causing a lot of damage to their vascular system.”
About 100 million U.S. adults have high blood pressure, and the number is rising.
In the new study, Tajeu’s group tracked the rate of prescription refills for blood pressure medications issued to more than 370,000 patients younger than 65. All of the patients had private insurance.
The researchers found that 23.5% of the patients stopped taking the drugs within the first nine months. And of those who kept using the medications, 40% had “low adherence” — taking the prescribed amount less than 80% of the time.
So, patients may be fooled into thinking that the treatment is somehow worse than the disease.
Getting Off Blood Pressure Meds
Health Tips / Getting Off Blood Pressure Meds
If youre currently taking a blood pressure medication OR your doctor has remarked that shell be keeping an eye on your borderline high blood pressure OR high blood pressure runs in your family and you have concerns about it, please read this Health Tip closely. The issues surrounding blood pressure are far more complicated than you might guess.
Importantly, your doctor, who we can safely assume intends the best for your health, may be basing her recommendations and prescribing your medication on what she may not know is actually some very controversial information. She simply may not be aware that shes starting you on what could be decades of inappropriate medication for a condition you dont really haveand one that isnt even dangerous to your health.
In fact, based on new government guidelines in which your doc is paid less by insurance companies for failing to reach certain clinical goals , she may be encouraged to prescribe more meds for your potentially non-existent elevated blood pressure. Read that sentence a couple of times and let it sink in. It means if your blood pressure is not at a particular normal level AND your doctor has failed to give you medication to reach that level, she can be financially penalized, even if your actual blood pressure level is totally harmless to your health. Tell me thats not just a little bit spooky.
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Changing Guidelines On Blood Pressure
Physicians have put increased scrutiny on blood pressure since the American College of Cardiology and the American Heart Association changed their blood pressure guidelines in 2017.
Under the new guidelines, high blood pressure is defined as 130/80 mm Hg, down from 140/90. A reading of 120129 systolic, a previously healthy range, is now considered elevated.
As a consequence of these changes, about half of all adults in the United States meet the criteria for hypertension around 103 million people.
These dramatic changes underscore the importance of lifestyle choices when it comes to staying healthy.
The study does have its limitations.
Since the infrastructure of the trial including a diet plan, monitored exercise periods three times a week, and weight management counseling was robust, the results are likely more impressive than would be observed for someone trying to make these changes on their own.
The reality is insurance companies do not cover visits with nutritionists or dietitians, or provide supervised exercise programs, Dr. Guy L. Mintz, director of cardiovascular health and lipidology of cardiology at North Shore University Hospital in Manhasset, New York, told Healthline.
Without active intervention and management, physicians just providing patients with literature on a diet, and encouraging them to exercise is less than ideal and would not achieve these results, said Mintz, who wasnt involved in the study.
Exercise Behaviors Change On Medications
It is not just ourfood choicesthat changewithstatins. We tend to stop moving as well.
In a recently published studyof 5,994 older men, once they were prescribed a statin their exercise efforts plummeted and their sitting timeskyrocketed. Despite controlling for other factors, theseresearchers concluded that statins changed exercise behavior. In other words, once people went on a statin they somehow feltthat exercise was no longer as critical.
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What Can I Do About Dizziness That Comes With My Blood Pressure Medications
Dr. Domenic Sica answers the question: ‘Dizziness And Blood Pressure Meds?’
— Question: I have well-controlled blood pressure on several medications but recently began feeling dizzy when I stand up. What can I do about this?
Answer: Well, when you take blood pressure medicines, there are important facets or features of the therapy that can give you too much of an effect. So if your pressure — the phrase we use oftentimes is ‘bottoms out,’ then you’re going to be symptomatic or you’re going to get — dizziness is a very common symptom when you stand up. So that will be a first thing to think about, is, could you get your blood pressured measured at the time of the symptom; if the blood pressure is too low, then adjustments have to be made.
The second issue is: there’s a phenomenon of postural, or standing up, blood pressure drop, which kind of sneaks its way in to what happens with us as we age or if we are a diabetic. So oftentimes it’s very useful, particularly if a patient is taking their blood pressure readings at home, to every so often, every several months or so, obtain a blood pressure when lying down and obtain a blood pressure after you stand up for about three to five minutes. That will show you if there’s a postural element — standing up, your blood pressure falls. Doctors oftentimes need that information in order to adjust medications accordingly.
Other Medicines For High Blood Pressure
Apart from the five main classes of medicines listed above, sometimes other medicines are used to lower blood pressure. For example:
Methyldopa or alpha-blockers are sometimes used if there are problems with the more commonly used medicines. Doxazosin is an alpha-blocker commonly added when blood pressure is high despite the treated person being on other medicines.
Spironolactone is another stronger ‘water’ tablet sometimes used as an add-on option for blood pressure which is difficult to control. Spironolactone is not usually given alongside ACE inhibitors or ARBs because the combination can cause potassium levels in the body to become dangerously high. Regular blood tests to check for this are needed if you are on this medication or medicine combination.
Also Check: What Gives You High Blood Pressure
Sometimes It Is Not Possible To Get Off Medications
Unfortunately, there are some conditions that may require life-long medications. For example, this could be due to a genetic abnormality or damage that has already been done.
In these cases, dont despair. Rather, work with your physician to get to as few medications as possible by adoptinghealthy behaviors.
What Happens If You Suddenly Stop High Blood Pressure Medication
If your blood pressure remains higher than 140/100 mmHg then you are suffering from high blood pressure. Most patients are urged to control their blood pressure with diet and exercise. However, if you are one of those patients whose blood pressure can not be normalized with changes in the lifestyle, then you will be prescribed high blood pressure medicines.
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Wrong Medication Or Wrong Dose
For each person theres an ideal combination of medications and dosages that would best control their hypertension. Some people havent yet received that ideal combination. Its important to work with a doctor who is familiar with the range of medications and who knows what works best for each individual.
Evolving Treatment For High Blood Pressure
The findings presented today reflect a growing trend in U.S. healthcare that emphasizes greater importance on maintaining a healthy blood pressure range.
New scientific guidelines presented last year identified high blood pressure readings as 130/80. High blood pressure was previously defined as 140/90.
That announcement made waves, as it suddenly put 46 percent of U.S. adults in the high blood pressure category.
The treatment of hypertension, or high blood pressure, has evolved, Yancy said. New evidence makes clear that we can reduce the risk of stroke and death due to heart disease by carefully controlling blood pressure in those at higher heart disease risk.
For people with high blood pressure, theres a range of other approved medications available that may be safer and more effective than alpha-blockers and alpha-2 agonists.
Both Yancy and Clements point out that those medications include:
- thiazide diuretics
- ACE inhibitors
- calcium channel blockers
- angiotensin II receptor blockers
These therapies are all safe and effective, said Yancy.
Everyone should know their blood pressure. If it is 130/80 mm Hg, see a healthcare provider to determine your risk for heart disease and the best approach to address your blood pressure, he said.
But medications arent the only answer for people with high blood pressure.
Also Check: How To Get Rid Of Low Blood Pressure
Tracking And Managing Your Blood Pressure
Daily monitoring of your blood pressure is one of the most effective ways to track and manage your high blood pressure. This has been shown to lower your blood pressure naturally, by 9 points or more.Properly monitoring your blood pressure each day will provide essential feedback for yourself as you implement changes in your diet and lifestyle. It will also allow your doctor to better track your progress and reactions to medications. You can see how you are doing, and your doctor can provide the best care possible â as a team. This is an essential step in taking control of your health and reducing heart health risks.To track your blood pressure, follow this pain-free process:
- Choose a good blood pressure measuring device.
- Check your blood pressure twice daily.
- Track your results. This task is made easy with a phone app .
Start Slow And Watch For These Signs
- If youre exercising and getting lightheaded you need to stop what youre doing. Lie down and put your feet over your head to get blood flow to your brain.
- If you get lightheaded, dizzy or feel fatigued, call your doctor and share your symptoms and home blood pressure readings. You may need to adjust your medication dosage, the time you take your medication, or your diet.
- If youre very lightheaded, salt and water will bring your blood pressure back up. Have a friend bring you water and something salty like pretzels and water, or a Gatorade.
- If you faint during exercise, call emergency services.
Stop For The Right Reason
According to a report from CVS Caremark, half of patients taking maintenance medications for chronic conditions will stop taking them within the first year of starting therapy. This non-adherence results in roughly a $300 million charge to health care costs per year. Non-adherence can lead to worsening of chronic conditions, increased hospitalizations, and overall worsened outcomes.
If you feel better after taking a medication, say an antidepressant or arthritis medication, your symptoms can return when you stop taking the medication. In addition, some conditions, like hypertension and high cholesterol, have no real symptoms at all, lessening the chance youll stick with your meds. Many people think they can stop their treatment when they feel better, but this is usually not the case. Not only will your condition worsen, you may experience side effects from abrupt medication withdrawal.
If you read or hear news from the media about your medication that is concerning to you, do not stop your medication before you speak to your healthcare provider. The news reports, including those from social media, may be unfounded, or the particular concern may not be relevant to your condition.
Medicines For High Blood Pressure
Several types of medicine can be used to help control high blood pressure.
Many people need to take a combination of different medicines.
- if you’re;under 55 years of age you’ll usually be offered an ACE inhibitor or an;angiotensin-2 receptor blocker
- if you’re aged 55 or older, or you’re any age and of African or Caribbean origin you’ll usually be offered a calcium channel blocker
You may need to take blood pressure medicine for the rest of your life. But;your doctor might be able to reduce or stop your treatment if your blood pressure stays under control for several years.
It’s really important;to take your medicine as directed. If you miss doses, it will not work as well.
The medicine will not necessarily make you feel any different, but this does not mean it’s not working.
Medicines used to treat high blood pressure can have side effects, but most people do not get any.
If;you do get side effects, do not stop taking your medicine. Talk to your doctor, who may advise changing your medicine.
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Reason: It Could Be Your Diet
Dr. Thomas recommends the low sodium DASH diet for patients with hypertension lots of fruits, veggies, whole grains and lean protein, with an ideal goal of no more than 1.5 grams of sodium each day. You should check with your doctor if the DASH diet is appropriate for you.
You may not use the salt shaker,but perhaps youre eating processed foods or using canned foods that containhigh levels of sodium. Registered dietitians can show you how to spot sodium innutrition labels to better manage your intake.
Many people tell me they dont add salt to their foods, and thats great, says Dr. Thomas. But they often dont realize how much sodium is already in the foods they eat.
Medications For Blood Pressure
Q1. Can a person taking medication for high blood pressure ever be taken off the meds, or is it a lifelong prescription?
That’s a good question, and the answer is heartening too: Just because your physician prescribes blood pressure medication doesn’t mean you have to take it forever. Although most people find that taking antihypertensive medication helps to control their blood pressure with relatively few serious side effects, once your blood pressure is under control you may be able to lower the dosage or stop taking the medication altogether by adopting and maintaining a healthy lifestyle. However, many people do require lifelong medication therapy because despite a healthy lifestyle, they still may have high blood pressure due to other intrinsic factors.
The good news is that even if you require medications for blood pressure, you can keep the dose down by eating a diet rich in fruits and vegetables, getting regular exercise, maintaining a healthy weight, and not smoking. One word of warning: Often people stop taking their pills once their blood pressure reaches a healthy level, only to find it shoots right back up after a period of time. This fluctuation could be dangerous, so never stop taking your medication without first consulting your physician. And if you are concerned about taking medication for the long term, ask your doctor about alternative ways to control your blood pressure. Good luck.
Here are some heart-smart strategies to incorporate into your life:
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What Are The Risks Of Resistant Hypertension
Over time, uncontrolled hypertension damages the arteries, contributing to their stiffening. As the arteries become narrower and less flexible, the heart has to work harder to move blood through the body. Uncontrolled high blood pressure can lead to stroke, heart attack, heart failure and other heart conditions; cause damage to your kidneys, memory and vision; and contribute to erectile dysfunction.
Why Im Ditching The Blood Pressure Pills Ive Taken For 40 Years
Of all my recent health issues, my biggest concern has been whether I should keep taking blood pressure medication. Ditching the pills would be a big deal, since I’ve taken various hypertension meds for at least 40 years.
A week ago, I summarized my blood pressure history and concerns in a letter to a doctor regarded as a top specialist in this area. It was very detailed, and I’ve included it at the end of this post.
Here are the keys issues I raised:
Read Also: How Accurate Are Blood Pressure Apps
Reason: You Or Your Doctors Office Could Be Making Mistakes In Testing
Sometimes, people makemistakes in testing at home. Bring your home unit to your appointment and showit to your doctor to make sure its operating correctly. Make sure your armcuff is the right size for you. When you take readings at home, start bysitting quietly for five minutes. Then, be sure your back is supported, yourfeet are on the ground, and your arm is at heart level to get an accurate bloodpressure reading.
Misreadings can also happenat your doctors office, says Dr. Thomas. The cuff might be the wrong size, orthey might be taking a reading before youre fully at rest.
To get a more accuratereading, Dr. Thomas takes six blood pressure readings in a row, each one minuteapart, using an automated blood pressure machine. He or his staff observes thefirst reading but then youre alone in the room for the remaining fivereadings. They use the average of the last five readings to get the result.