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Home : Your Physical Health : High Blood Pressure: Treat it for Life

High Blood Pressure: Treat it for Life
From the National Institutes of Health

Section 1: Your High Blood Pressure

What is blood pressure?

Testing for high BP

How do you rate?

Section 2: Taking Action to Control High Blood Pressure

Lose weight if you need to

Be physically active

Foods low in sodium

Limit your alcohol intake

Take your high BP pills

Types of Medications

Possible side effects

Section 3: Special Concerns

Women & birth control pills

Older persons

African Americans

People with diabetes

People with high cholesterol

Special Concerns

Certain people need to pay special attention to their blood pressure. Finding out about their high blood pressure and taking care of it is doubly important for them.

Women taking birth control pills.

If you are a woman taking birth control pills, you may find your blood pressure goes up slightly. Studies have shown that women taking birth control pills for more than 5 years have higher blood pressures than those who do not take them. However, for most women, the increase does not go above normal.

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American Heart Association: Fitting in Fitness

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Women whose blood pressure increases too much should switch to another form of birth control. Once off birth control pills, they should find their blood pressure returns to normal within a few months.

Women over age 35 who take birth control pills and smoke cigarettes run an increased risk of developing high blood pressure—and other cardiovascular problems. Of course, all smokers should quit. If you are taking birth control pills and continue to smoke, you should change your method of birth control.

Older persons.

Studies have shown that older people, like younger people, who are treated for high blood pressure live longer, healthier lives. They benefit even if their blood pressure is only slightly above normal before they start treatment. Treatments for the elderly with high blood pressure are the same as those for younger adults: lifestyle changes, medicine, or a combination of both.

African Americans.

High blood pressure occurs more often among African Americans than whites. It begins at an earlier age and usually is more severe. Further, African Americans have a higher death rate from stroke and kidney problems than whites.

Yet, treatment can control high blood pressure. The key is to control the risk factors for high blood pressure, which are widespread among African Americans. These include being overweight, diabetes, lack of enough physical activity, and eating foods high in sodium or low in potassium. Lifestyle changes often are enough to control these factors and prevent the condition altogether.

Eric Tucker
Playing to Win

ERIC TUCKER returned every Saturday to his first love: basketball. He and his friends played fast games on the court at a nearby park, sometimes drawing onlookers, even teenagers.

One Saturday, Eric and his friends were deep in the second half when he fell. His ankle hurt so badly he though it was broken. His friends hurried him to the local hospital’s emergency room, where the doctor found that the ankle was just sprained.

But that wasn’t all she found—Eric had high blood pressure. Eric was only 40 years old and rarely sick, and he hadn’t been to a doctor since his military days. Now, in the emergency room, as part of the routine checkup, the doctor had taken Eric’s blood pressure and found it was 150/96 mm Hg.

The doctor cautioned Eric that high blood pressure could not be left untended. "You’ll have to see your regular physician for a more complete physical," the doctor said.

As an African American, Eric knew that high blood pressure was no game. He made an appointment with his regular doctor for the first day possible. His blood pressure readings were high at that visit and again when he returned a week later.

The doctor pulled no punches. He told Eric, "High blood pressure is dangerous, especially for African Americans. You have Stage 2 diastolic high blood pressure, and that increases your risk of having a stroke."

He outlined the reasons why: Eric’s family has a history of high blood pressure and stroke; and Eric ate foods high in salt and sodium, and usually had more than two alcoholic drinks a day.

"That’s not a good prescription," the doctor noted. He told Eric to take two steps to lower his blood pressure. First, the doctor explained, Eric had to eat foods lower in salt and sodium and higher in potassium. He with lots of potassium. The booklet also listed herbs and spices that could be used instead of salt. The doctor also set a limit of no more than one or two alcoholic drinks a day.

Second, he said, Eric should begin a program of regular physical activity.

"Wait right there," Eric said. "How do you think I got this swollen ankle?"

"Basketball is fine," the doctor said. "But you only play once a week. Isn’t that what you said?"

"Well, I’m only free once a week. And so are my friends."

"What about the evenings? Mornings? Noontime? You don’t have to round up a basketball team to get some physical activity."

Eric agreed. He asked if a walk in the evenings after work—once his ankle had healed—would count as a physical activity.

"That’s great exercise. And since you’re in pretty good shape, you can start right away to walk at least 30 minutes, three to four times a week. That’s all it takes."

The doctor told Eric to return for a checkup. "Those changes may bring your blood pressure down to the normal range," he said. "If not, we’ll have to consider putting you on a medicine. The important thing is to get your blood pressure under control."

Eric left the doctor’s office a little worried. His grandfather had died of a stroke a few years before. Eric secretly feared the same would happen to him.

He knew he could make some of the doctor’s suggested changes. But he wasn’t sure about the others. He talked it over with his wife. They decided to get some regular activity together. Once Eric’s ankle was healed, they started walking together after dinner. They began looking forward to the walks, enjoying the time together, away from children and job pressures.

They also joined forces to improve what the family ate. They knew that the changes could help prevent their children from getting high blood pressure.

It wasn’t easy but after 2 months, the Tucker’s were on their way to a new lifestyle. They took 30-minute walks several times a week. They ate far less sodium and Eric drank only one beer a day, after work.

At the next checkup, Eric’s blood pressure was 156/94 mm Hg. Eric had kept a record of what he ate and the doctor looked it over and suggested some additional changes.

"Don’t get discouraged, your doing well. Sometimes your blood pressure will go up and down slightly," the doctor said.

Two month’s later, Eric’s blood pressure was down to 150/92 mm Hg, but still not at his goal.

"Let’s try a medicine," the doctor said. "It’s a diuretic. But taking this medicine doesn’t mean you can go back to your old habits. The medicine is in addition to, not instead of. You still have to eat right and be physically active. Then you’ll need as little medication as possible to manage your blood pressure."

In a month, Eric’s blood pressure had dropped to his goal of 134/84 mm Hg. With proper eating and physical activity, and the aid of the medication, Eric is maintaining his blood pressure goal. He feels confident that he’ll be able to keep his high blood pressure under control. And he’s looking forward to someday watching his grandchildren grow up—and seeing if they can shoot the hoops against him.

People with diabetes.

There are two types of diabetes: noninsulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM). NIDDM is the most common form, it can often be controlled by following a specific meal plan and increasing physical activity. In some cases insulin or a pill may also be needed. IDDM is controlled by injecting insulin as well as following a specific eating and activity plan.

People who have high blood pressure and either form of diabetes also have an increased risk of heart and kidney problems and stroke. They usually have high blood cholesterol too.

To treat both your high blood pressure and your diabetes, you’ll probably be asked to make some changes in what you eat: You’ll have to eat foods low in salt and sodium, saturated fat, and cholesterol. Your specific meal plan will include eating small portions of poultry, fish, and lean meats, more fruits and vegetables, as well as low fat or nonfat diary products and whole grain breads and cereals. If you are overweight, you’ll need to watch your calories as well.

If your blood pressure doesn’t lower to 130/85 mm Hg, you probably also will need to take some medicine.

Ann Carrillo
Fifty-Five and Feeling Great

ANN CARRILLO went to the doctor for her yearly checkup. She told the doctor that she’d been feeling a little more tired than normal.

The doctor did a medical exam, including asking about Ann’s family medical history and lifestyle. She also took blood and urine test.

Ann is 55 years old. She weighs too much and does not exercise. But when the doctor said she’d developed diabetes and high blood pressure, she felt shocked. It sounded very serious.

The doctor explained that the problems were serious, and Ann would need to make some changes. The doctor said that, by having both conditions, Ann had to be especially careful to take action to lose weight, eat foods lower in sodium, calories, fat (especially saturated fat), and simple sugars, and higher in starch and fiber, be more active, and take the medicine that would be prescribed.

Since Ann’s blood pressure was high—160/110 mm Hg—the doctor put her at once on a medicine for the high blood pressure. The drug was an ACE inhibitor. The doctor told her that the drug was not the whole treatment. In fact, if Ann did her part, she might one day be able to take less of the drug.

That surprised Ann.

"You have the type of diabetes that develops in adults—non-insulin dependent," the doctor explained. "Let’s see how you do on the drug and with the other changes."

"Other changes?"

"Nothing bad. In fact, you’ll wind up feeling better than you have in years."

The doctor said the first change would be in what Ann ate. That would help bring her diabetes and blood pressure under control. And she had to lose weight. So she had to start a program of regular physical activity.

"Even if you weren’t overweight," the doctor added, "the activity would help your diabetes. In fact, activity is one of the bet medicines ever discovered."

"And hard to take?"

"Not a bit." The doctor gave Ann a simple walking program to get her started. "And as part of this prescription," the doctor said, "I’m sending you straight to the shopping mall. Go buy yourself a pair of good walking shoes."

But Ann did not feel like smiling. "How am I supposed to figure out all of these changes?" she asked. "I’ve always heard you have to be so careful with diabetes and can’t eat much of anything."

"Your diabetes is a mild form. Right now you do not need to take any medicine for the diabetes. But without treatment, it would worsen." To help her understand the changes she needed to make in her diet, the doctor gave her the name of a Registered Dietitian. "Don’t worry. This only sounds confusing because you haven’t gotten started. You’ll be surprised at how easy it becomes and how good you’ll feel."

Ann went to the dietitian, who outlined the changes she needed to make to manage both her diabetes and her high blood pressure. The dietitian reassured Ann that the new diet was not hard to follow. All Ann had to do was: eat fewer calories, less fat, less sodium, and less simple sugars, but more starch and fiber.

Ann soon found that the dietitian was right: The changes were not hard to make. She ate more fresh fruits and vegetables, and dry beans and peas. For breads and crackers, she chose the whole grain kinds. She ate her food in small meals throughout the day. She ate an occasional sugary food as part of a regular meal, instead of by itself. And she also ate smaller portions. She stopped putting salt on and in her food. Instead, she seasoned her food with herbs and spices. She even began to prefer her food cooked with the new flavors. And she changed how she cooked, baking and steaming more, while frying far less. She also was careful to eat foods low in fat and checked product labels to be sure she chose items low in saturated fats and sodium. And she became a whiz at knowing which foods were high in calories and sodium and which low.

She tried to be more active too. At first, she did little things, using the stairs at work and taking short walks a few times a week, just around her block at home. But she found the walking soon got easier and, before long, she went farther. She followed the doctor’s walking program, going three or four times a week. On weekends, she joined the early morning walkers at the local mall.

She was surprised by the results. The weight came off slowly but surely. After only 1 month, she had lost about 5 pounds. Her blood glucose (sugar) improved, improving her diabetes, and her blood pressure dropped. She had not reached her blood pressure goal, but she felt like a success. And the improvements encouraged her to keep going.

Her doctor was pleased too. "You’re doing well," the doctor said. "I think we can keep going with your lifestyle changes. We’ll decrease the amount of medicine you’re taking."

Ann continued to talk with the dietitian. She went once a month and always got new suggestions on how to improve her food habits. The dietitian also gave her tips on how to eat at restaurants and parties.

After another 3 months, Ann had lost 10 more pounds. Her blood sugars and blood pressure were normal. She bought an exercise bicycle to use, especially in bad weather, when she could not get outside or to the mall. She sometimes rode the bicycle even on sunny days—it was the best excuse she’d found for watching TV game shows.

She was doing so well the doctor took her off her medicine saying that she could stay off of it if she kept the weight off, watched what she ate, and kept up her activity habits.

After a while, Ann missed certain foods or just being able to eat whatever she wanted whenever she wanted it and skipped her walks a few times a week. She started gaining a pound or two a week and, when she went back to the doctor for a checkup, her blood sugar was up and her blood pressure was 146/90 mm Hg.

The doctor put her back on her blood pressure medicine and started her on a medicine for her diabetes. He emphasized how important it was to lose weight and keep it off, rather than going up and down. Ann made another appointment with dietitian to help her get back on track. She’s beginning to lose weight again, and plans to stick to her changed habits this time.

Sometimes, it amazes her: She has diabetes and high blood pressure, and she’s healthy. Once, the words "diabetes" and "high blood pressure" scared her. She thought her life was closing in. Now, she feels like fifty-five is just the start—it’s the best age ever.

People with high blood cholesterol.

Having both high blood pressure and high blood cholesterol is common, and the first line of treatment for both conditions is to change your lifestyle. This includes losing weight if you are overweight (cut back on calories), eating less saturated fat and cholesterol, and cutting back on sodium. It also means becoming more physically active.

If these changes do not lower your blood pressure and cholesterol enough, then you may need to take medicine.

. . . . . . So Remember . . . . . .

High blood pressure does not simply go away. It needs to be controlled. Take charge. Help yourself and your family stay healthy. Start now to lower your high blood pressure: Treat it for life!

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