One of every two North American adults has high blood pressure, and only 40 percent of those taking medications have their hypertension well-controlled (Int J Cardiol Hypertens, July 31, 2020;6:100044). It is established that high blood pressure markedly increases a person’s chances for heart attacks, strokes, kidney damage, dementia and premature death. Ideally, blood pressure should be below 120/80 (JAMA, 2019;321(6):553-561). However, high blood pressure treatment often requires more than three drugs and significant side effects can come from getting high systolic blood pressure down to 120 mg Hg, so at this time most doctors treat high systolic blood pressure down only to below 140 or 130 mm Hg.
This month, a study reported on 11,255 patients, average age 65, with high blood pressure and at high risk for heart attacks from 116 hospitals in China (Lancet, July 20, 2024;404(10449):245-255). The goal was to find out whether intensive treatment aimed at a systolic blood pressure below 120 mg Hg was more effective than a target of 140 mg Hg in preventing heart attacks.
, revascularization surgery or hospitalization for heart failure, stroke, or death from cardiovascular causes. After 3.4 years, the authors found that:
• The intensive blood pressure control group had fewer serious life-threatening complications of high blood pressure. They had a 12 percent lower incidence of heart attacks and a 39 percent lower incidence of deaths from heart attacks.
• Both groups had the same rate of serious side effects of treatment with the drugs used to treat high blood pressure: dizziness, electrolyte abnormalities, injurious falls, or acute kidney injuries.
Controversy Over Treating to 120 Rather Than 140 mm Hg
The American Academy of Family Physicians (AAFP) recommends that you get your systolic blood pressure below 140/90 mm Hg (Am Fam Physician, Nov 10, 2022;106(6):721-722). They cite literature showing that taking medication to reduce blood pressure below 140 mm Hg did not further reduce your chances of dying overall or from heart disease, even though it did lead to a 16 percent reduction in heart attacks. The AAFP guidelines apply to adults with high blood pressure with and without heart disease. To reduce high blood pressure from 140/90 to 120/80, a person often has to take at least three medications. See Aggressive Treatment of High Blood Pressure
Side Effects of Blood Pressure Drugs
Common side effects of blood pressure medications include:
Diuretics: frequent urination, weakness, leg cramps, fatigue, foot pain
Beta-Blockers: asthma, cold hands and feet, depression, erection problems, insomnia
Angiotensin Converting Enzyme Inhibitors (ACIs): cough, skin rash, loss of taste
Angiotensin II Receptor Blockers (ARBs): dizziness
Calcium Channel Blockers (CCBs): constipation, dizziness, headache, irregular or rapid heartbeat, swollen ankles
Alpha-Blockers: dizziness, lightheadedness, or weakness when standing up, rapid heart rate
Alpha-2 Receptor Agonists: sleepiness, dizziness
Alpha-Beta-Blockers: dizziness, weakness
Central Agonists: anemia, constipation, dizziness, drowsiness, dry mouth, impotence, fever
Peripheral Adrenergic Inhibitors: dizziness, erection problems, stomach burning, stuffy nose, nightmares
Vasodilators: excessive hair growth, swollen ankles, headaches, irregular heartbeat, joint pains
Renin Inhibitors: cough, diarrhea, stomach pain, skin rash
Lifestyle Changes to Lower Blood Pressure
You cannot cure high blood pressure with drugs, you can only control it as long as you continue to take the drugs (Hypertension, 2002;40(5):612-618). Most of the time, your blood pressure cannot be controlled with just one drug and most people end up with three or more drugs to treat their high blood pressure. However, some people are able to cure their high blood pressure just by making lifestyle changes. You should treat high blood pressure with lifestyle changes, whether or not you are taking any of the blood pressure drugs.
• Eating a plant-based diet with lots of vegetables, whole grains, beans, nuts and fruits.
• Restricting mammal meat, processed meats, sugar-added foods and drinks, and fried foods.
• Limiting salt. Avoid the salt shaker and restrict processed foods because they often have added salt.
• Trying to get 7-8 hours of sleep every night.
• Trying to avoid habits and exposure to everything that increases cell damage such a smoke, alcohol, recreational drugs, herbicides, insecticides, air pollution and so forth.
• Exercising. Try to do aerobic and resistance exercise for at least 30 minutes daily. If you have heart-attack risk factors, check with your doctor first.
• Avoiding being overweight. If overweight, lose excess weight and try to restrict refined carbohydrates.
• Keeping blood levels of hydroxy vitamin D above 30 ng/mL
My Recommendations
If your average systolic blood pressure is over 130 or your average diastolic pressure is over 85, you should immediately make all of the lifestyle changes that will help to lower it. Your doctor may feel that you need medications to lower high blood pressure, but everyone can help to prevent and control high blood pressure with lifestyle changes, whether or not they are taking blood pressure medications.
