How Should I Manage My High Blood Pressure?

Roughly 108 million American adults live with high blood pressure. Many don't even realize they have it because the condition often carries no symptoms. That's why hypertension is known as the "silent killer"—it can lead to heart attack or stroke if left untreated. Fortunately, blood pressure can be managed through lifestyle changes and/or medications.

Jim Liu, M.D., is a cardiologist with The Ohio State University Wexner Medical Center and a clinical assistant professor of internal medicine with The Ohio State University College of Medicine in Columbia. In this exclusive interview with Giddy, Liu discussed the treatment options for hypertension, lifestyle medications that can lower blood pressure, the importance of reducing salt intake and more.

Editor’s Note: This interview has been edited for length and clarity.

I understand that there is no cure for hypertension, but it can be managed.

Liu: Exactly, there's no cure for it once someone is diagnosed with it generally. It's a condition that they have to try to manage for the rest of their life.

At what point does someone need to be on medication for hypertension?

It depends on a couple of things. It depends on what their actual blood pressure is. In general, for most patients, based on the most recent guidelines that the American Heart Association has put out, the top number, the systolic, should be 130 or less. And the bottom, the diastolic number, should be less than 80. It depends on the person's other medical problems too.

For example, if someone has a history of heart attack, stroke, diabetes or kidney issues, they may need a more aggressive target for blood pressure. In someone who is fairly healthy and doesn't have any major medical problems, they might be able to get away with a slightly higher target for blood pressure. That goal of 130 over 80 or less is still an optional target.

Generally, we tell patients to try non-pharmacologic measures, meaning lifestyle modifications, to get it under control first. But if they can't achieve that, the medications are going to be useful.

What are the medication treatments for high blood pressure?

Generally, we have four first-line classic blood pressure medications. Those would be diuretics, ACE (angiotensin-converting-enzyme) inhibitors, calcium channel blockers and angiotensin receptor blockers (ARBs). For some people, diuretics can be very effective, but for other people, they might have issues with symptoms of dehydration. It can affect the electrolytes.

Calcium channel blockers are also very commonly used. Sometimes people complain about swelling in the feet or ankles. People can also have issues with constipation. ACE inhibitors and ARBs generally don't have a lot of side effects, although ACE inhibitors are known to cause a little bit of a cough.

Are patients usually on medications long-term?

Usually. If someone has a really reversible type of high blood pressure. For example, if they're eating a lot of sodium or they're overweight, and they make lifestyle changes, potentially they can lower their blood pressure enough by doing that.

In general, these medications are long-term, but the need to be on them can be eradicated over time.

Is taking a pill once daily the most common?

It just depends on what the medication is dosed. Certain medications are dosed once a day, and certain medications are dosed every 12 hours.

There are even some that are more frequent, like three or four times a day. Generally, we try to avoid those because it's harder for patients to take pills more than twice a day.

What lifestyle changes can people do to bring down high blood pressure?

There are a lot of things people can do. Obesity or being overweight contributes to high blood pressure. Ideally, if people can get down to their ideal body weight based on their gender and height, that would be perfect. Realistically, that's very difficult to do.

Losing any kind of weight for someone who is overweight or obese will be helpful. It's actually been shown that if you can reduce 1kg [2.2 pounds] in body weight, it can reduce your blood pressure by 1 point systolic. Over time, that can add up.

Diet also helps. Certain types of diets have been shown to improve blood pressure. Those would be diets that are high in fruits, vegetables and fiber. The Mediterranean diet has been shown to be helpful.

Exercising is important. The recommendation right now is to do 90 minutes of more intense aerobic exercise per week or 150 minutes of more moderate exercise a week. Moderate activity would be walking. More intense would be jogging.

Getting good sleep is important too. It's been shown if you sleep for six hours or less every night, that can increase your blood pressure.

Limiting alcoholic intake is important as well. For men, it's recommended to stick to less than two drinks per day, and one for women.

What are the guidelines for restricting salt intake?

Excessive salt or sodium intake can lead to high blood pressure. Right now, the American Heart Association recommends an optimal goal of less than 1.5 grams of sodium in a day. For most people, that's really hard to achieve. If you could cut down a thousand milligrams of dietary sodium in a day, that would be better than nothing.

A lot of people don't realize how much salt they're getting in their diet. It's not so much the salt you're adding to your food but the salt that's already in prepared foods.

I understand that the time of day can also have an impact on blood pressure.

There's a natural progression of blood pressure throughout the day. Your blood pressure is lowest theoretically overnight and in early mornings and your blood pressure rises throughout the day to the point that midafternoon to late afternoon is when it's highest. Then it comes back down at night.

Is hypertension a condition that can be handled by a primary care provider? At what point should a cardiologist or specialist be involved?

Certainly, most primary care physicians are well-trained and equipped to handle blood pressure. But if it's something that's difficult to manage, it may be a sign that they need to see a specialist.

How can someone with high blood pressure be a good partner to their medical team?

It's important to follow up on your visits and pay attention to what your doctor is telling you. If you're prescribed medication, make sure you take that medication regularly.

Typically, we tell patients to monitor their blood pressure at home because that can provide a lot better data in terms of how well the blood pressure is managed compared to just checking the blood pressure once every few months when we see them in the clinic.