Your blood pressure treatment goals depend on your age and chronic conditions and this should be discussed specifically with your doctor.

What can you do to prevent or reverse hypertension without taking medications?

For both the prevention and treatment of hypertension lifestyle modification is the cornerstone of treatment. Medications are often needed but if these lifestyle changes are not implemented, controlling blood pressure will be almost impossible. If medications are initially needed to treat blood pressure, it is possible that  adhering to lifestyle changes may eventually eliminate the need for the medications.

Here’s what you can do:

1. Eat a balanced diet. Emphasize a diet rich in fruits, vegetables, whole grains, poultry and fish and limit your intake of excess calories, saturated and trans fats and sugar.
2. Cut back on salt. There is a direct correlation between salt intake and blood pressure. Aim for a low-sodium diet of less than 1,500 mg/day and avoid adding extra salt to your meals. Throw away your salt shakers!
3. Maintain a healthy weight. It is important to maintain a healthy weight or lose weight if you are obese. By losing as little as 10 pounds your blood pressure can be reduced by 8-10 mmHg.
4. Be active. Regular physical activity is important and it is most important to be consistent. Exercise for at least 30 minutes a day has been shown to have a significant effect on blood pressure.
5. Limit Alcohol. Drinking more than moderate amounts of alcohol (more than one drink per day) can actually raise the blood pressure and reduce the effectiveness of certain blood pressure medications.
6. Reduce Stress. Stress stimulates the nervous system to produce large amounts of vasoconstricting hormones that increase blood pressure and repeated blood pressure elevations can lead to hypertension. It is important to take time to relax, practice healthy coping techniques and get plenty of sleep.

What are the common medications used to treat blood pressure?

Although changing your lifestyle is key for blood pressure management, medications are often needed to lower blood pressure. Your blood pressure treatment goals depend on your age and chronic conditions and this should be discussed specifically with your doctor. The category of medications that your doctor prescribes depends on your medical history and other medical problems. It is important to know that multiple medications may needed in some difficult to control cases of hypertension. Also, there is growing evidence that gender should play a major role in which medications to begin as these drugs are metabolized and tolerated much differently in men and women. The following are the most commonly prescribed medications to treat blood pressure:

1. Diuretics (hydrochlorothiazide and chlorthalidone) are medications that remove excess water and sodium from the body. The Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure recommends that diuretics be a first-line agent.
2. Beta Blockers (atenolol, metoprolol, carvedilol) Cause the heart to beat slower and with less force. When prescribed in African-Americans and older patients this medication does not work as well alone and is much better in combination.
3. Angiotensin-converting enzyme (ACE) inhibitor (enalapril, lisinopril and ramipril) prevents the formation of a hormone angiotensin, which is a substance in the body that causes vasoconstriction of blood vessels. By inhibiting this enzyme, blood vessels relax and as a result lower pressure. This is a common medication to prescribe in patients with diabetes or chronic kidney disease.
4. Angiotensin II receptor blockage (ARBs) (losartan, valsartan, and candesartan) relax blood vessels by blocking the action, not the formation of angiotensin.
5. Calcium Channel Blockers (amlodipine, diltazem, and nifedipine) prevent calcium from entering the heart and as a result the blood vessels relax.

The above are the first-line medications for pharmacological treatment of blood pressure. There are various other categories of medications to use if it is difficult to reach your treatment goal or you are unable to tolerate these medications.

What is resistant hypertension?

Resistant hypertension is defined as blood pressure that is not controlled despite the use of three antihypertensive agents of different classes, one of which should be a diuretic. It is important in these circumstances to review medications  or supplements that you are taking for other conditions with your doctor. Additional medications can interact with blood pressure medications and decrease their effectiveness. A thorough evaluation of a secondary cause of hypertension should be reconsidered.

What are the gender differences pertaining to blood pressure?

It is commonly thought that hypertension occurs often in men and less frequently affects women. But this is a misconception as nearly half of adults with high blood pressure are women. Premenopausal women have a low risk and incidence of hypertension,compared with age-matched men, but this advantage for women gradually disappears after menopause. After age 65, a higher percentage of women than men have hypertension and the gap will likely increase with the continued aging of the female population. In women between the ages of 65 and 74 years, the prevalence of hypertension is as high as 58 percent. Hypertension is often underestimated and undiagnosed in women.

Throughout a woman’s life, health issues, like pregnancy, can increase the risk of developing hypertension. In some women, birth control pills have been found to increase blood pressure. This is more common in obese women, those with a family history of hypertension and mild kidney dysfunction. Young women on birth control pills should have their blood pressure checked at least once a year but ideally every six months.

Gestational hypertension is a form of secondary hypertension that develops during pregnancy, typically after the 20th week of pregnancy and usually resolves after delivery. Blood pressure needs to be closely monitored at all prenatal visits because high blood pressure can be dangerous to both the mother and fetus. Preeclampsia, also known as toxemia of pregnancy, is a condition similar to gestational hypertension but much more severe and is characterized by hypertension and protein in the urine. Immediate delivery of the fetus is the only treatment for this condition. Both gestational hypertension and preeclampsia have been associated with increased risk for hypertension later in life and discussing these issues with your healthcare provider can offer the opportunity for screening, prevention and treatment strategies.