Meds might not be the first prescription.
Measuring blood pressure may seem like a routine part of your doctor’s visit, but understanding its role in your heart health is critical. If left untreated, high blood pressure can have serious consequences on the rest of the body, including stroke, heart failure, vision loss, erectile dysfunction in men, decreased sex drive in women, and kidney disease.
Unfortunately, high blood pressure doesn’t typically present symptoms at first, according to Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center. “That’s the reason why we call it the ‘silent killer,’” says Dr. Bloom. In many cases, by the time high blood pressure is detected, a lot of damage—sometimes fatal—has already been done.
Your heart is like the engine for the rest of the body, pumping blood throughout the body and delivering oxygen to cells and organs. If your heart can’t do its job well, the rest of the body has to work extra hard to function with less oxygen.
“Blood pressure is simply a physical measurement of the tension or pressure of the blood in the arteries,” says Paul Knoepflmacher, MD, a clinical instructor in medicine at The Mount Sinai Hospital. The top number represents the pressure when your heart contracts (the systolic pressure), and the bottom shows the pressure when it relaxes (diastolic pressure).
Blood pressure readings fall into one of four categories, according to Dr. Knoepflmacher.
Normal blood pressure is less than 120 (systolic) over less than 80 (diastolic).
Elevated blood pressure is between 120 and 129 (systolic) over less than 80 (diastolic).
Hypertension stage 1 is between 130 and 139 (systolic) over 80 to 89 (diastolic).
Hypertension stage 2 is 140 or greater (systolic) over 90 or greater (diastolic).
In early stages of treatment for high blood pressure, medication may not be necessary. “I give [patients] either a few weeks or a few months to see if they can bring down their blood pressure naturally,” says Dr. Bloom.
Experts recommend a few key lifestyle changes for lowering blood pressure.
Exercise. Cardio exercises, such as running or biking, are your “first line of defense” against high blood pressure, says Joan Pagano, an exercise physiologist in New York City.
Limiting caffeine, alcohol, and sodium. “Sodium has a direct relationship with high blood pressure,” says Antonella Apicella, RDN, a dietitian with the Lenox Hill Hospital Outpatient Nutrition Program. “Limiting to 1,500 mg for the day is very effective in lowering that blood pressure.” (Here are ways to eat less salt for a healthier heart.)
Eating a heart-healthy diet. One simple way to improve your diet is including more color, suggests Frances Largeman-Roth, RDN, a nutritionist in New York City. Adding more colorful fruits and veggies can help nourish your body with crucial micronutrients, including potassium. A potassium-rich diet can counteract some of sodium’s negative effects on the body. (Here are the best food sources of potassium to add to your diet.) Learn more about the diet recommended to lower high blood pressure here.
If medication for blood pressure is needed, the most common choices are diuretics, angiotension II receptors, ACE inhibitors, calcium channel blockers, beta blockers, alpha agonists, or vasodiolators.
“Once you start a medication [for blood pressure], it doesn’t necessarily mean you’re going to be on that for the rest of you life,” says Rachel Bond, MD, a cardiologist at Lenox Hill Hospital. The deciding factor? Committing to lifestyle changes. Here are smart lifestyle tweaks for a healthier heart.
Dr. Bloom is an associate professor of medicine at Stony Brook University Medical Center, a fellow of the American College of Cardiology, and a fellow of the Heart Failure Society of America.Paul Knoepflmacher
Dr. Knoepflmacher is a clinical instructor of medicine at The Mount Sinai Hospital in New York City, where he also maintains a private practice.Joan Pagano
Joan Pagano is an exercise physiologist in New York City.Antonella Apicella
Antonella Apicella is a registered dietitian at the Lenox Hill Hospital Outpatient Nutrition Program.Frances Largeman-Roth
Frances Largeman-Roth is a nutritionist and cookbook author in New York City.Rachel Bond
Dr. Bond is a cardiologist and associate director of the Women's Heart Health Program at Northwell Health, Lenox Hill Hospital and an assistant professor of cardiology at Hofstra Northwell School of Medicine.
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So high blood pressure can give
you symptoms, but, unfortunately,
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often it doesn't.
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And actually that's the reason
why we call it the silent killer.
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Blood pressure is simply a physical
measurement of the tension or
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the pressure of the blood in
the arteries when your heart contracts,
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that's the top number or systolic.
00:00:25,740 --> 00:00:28,440
And when your heart relaxes,
that's the bottom number,
00:00:28,440 --> 00:00:31,510
Because high blood pressure
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leads to a lot of bad stuff like
heart attacks, pain in the chest.
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But the problem is that patients
don't always know that they have high
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And if you don't know you have it, you
haven't had it treated, and then you're at
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an increased risk of developing a problem.
When we're talking about normal
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blood pressure, we're talking about
less than 120 over less than 80.
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When we're discussing elevated blood
pressure, we're talking about a systolic
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blood pressure of 120 to 129 on the top
and less than 80 on the bottom.
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And within hypertension, there's what
we call Stage 1 which would be 130
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to 139 on the top or
80 to 89 on the bottom.
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If you have Stage 2 Hypertension,
that's considered a systolic of 140 or
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greater or a diastolic of 90 or greater.
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in my practice, what I try to do is I try
to give patients the benefit of the doubt.
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If they seem like they're
a motivated patient and
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they really are either borderline or in
the first stages of high blood pressure,
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I like to give them the opportunity to
lower their risks without medication.
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I give them either a few weeks or
a few months to see if they can
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bring down their blood pressure naturally.
If you've been told that you
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have high blood pressure,
one of the easiest things that you can do
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is start exercising in
order to bring it down.
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Cardio exercise being your
first line of defense.
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Along with exercise,
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focusing on your caffeine intake,
your alcohol intake, and
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your overall sodium intake as well.
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We also know that sodium has a direct
relationship with high blood pressure, and
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limiting to 1500 milligrams for
the day is very effective in lowering that
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when I talk to people about
eating a heart-healthy diet and
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a diet that's going to help to lower their
blood pressure, I really talk about color.
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So we wanna be getting more fruits and
vegetables, which are really rich in
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potassium, and potassium helps
to balance out sodium levels.
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And then also to be cutting back
on the amount of added sugars and
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also dietary fat that we're getting.
If they come back to the office and
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either they haven't been able
to accomplish those goals, or
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even if they have
accomplished those goals,
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I still find their blood pressure to be
above what we're comfortable with, that's
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the point where I'll introduce medication.
We have a series of medications out
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there that the doctor will likely
prescribe to treat your blood pressure and
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these medications include most commonly
a diuretic, which is a water pill.
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The way it works is ultimately it releases
fluid and sodium from the body and
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lowers the blood pressure that way.
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Another agent is an angiotensin II
receptor, or an ACE inhibitor, which both
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those agents work in the kidneys and by
doing that it lowers your blood pressure.
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Other medications that
your doctor may prescribe
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include a calcium channel blocker or
a beta blocker or an alpha agonist.
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And lastly a medication
which we also tend to
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use depending on the medical
condition are vasodilators.
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Once you start a medication, it doesn't
necessarily mean that you're gonna be
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on that for the rest of your life.
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If you have lifestyle changes and
you commit to these lifestyle changes,
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it's a conversation with the doctor.
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Changes you can make to manage high blood pressure. Dallas, TX: American Heart Association. (Accessed on January 9. 2021 at http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/MakeChangesThatMatter/Changes-You-Can-Make-to-Manage-High-Blood-Pressure_UCM_002054_Article.jsp#.Wm9SDKinEdU.)Dietary guidelines for Americans 2005: Chapter 8 sodium and potassium. Washington, DC: U.S. Department of Agriculture, 2008. (Accessed on January 29, 2018 at https://health.gov/dietaryguidelines/dga2005/document/html/chapter8.htm.) Health threats from high blood pressure. Dallas, TX: American Heart Association. (Accessed on January 9. 2021 at http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/LearnHowHBPHarmsYourHealth/Health-Threats-From-High-Blood-Pressure_UCM_002051_Article.jsp#.Wm9EhqinEdU.) Understanding blood pressure readings. Dallas, TX: American Heart Association. (Accessed on January 9. 2021 at http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#.Wm9R6KinEdU.)