Let’s say your doctor wants you to lower your blood pressure. You fill a prescription. You remove the salt shaker from your table. You try to exercise more, and if you’re too heavy, cut some calories. You show up faithfully in your physician’s office three months later–and your pressure, like a mountain blocking your path to health, hasn’t budged. You’re at risk. High blood pressure is high on most doctors’ lists of the biggest threats to your heart and vessels.
High numbers? you’re not alone
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Donald G. Vidt, M.D., is seeing more difficult-to-control hypertension than ever before. Partly, that’s the result of changing standards as research over the past 20 years has shown that lower blood pressure is safer. “Fifteen or 20 years ago, pressures of 160 over 95 millimeters of mercury [mm Hg] were considered okay,” says Dr. Vidt, a consultant in the Department of Nephrology and Hypertension at Cleveland Clinic. No longer (see “Why Heart Patients Should Aim for Lower Pressures,” page 5).
“Guidelines have evolved. And as we’ve learned that we can further reduce cardiovascular risk by treating to reduce blood pressure, we’ve seen more patients referred to the Clinic” with stubborn hypertension.
According to one recent expert analysis, as many as 40 percent of patients may have difficulty achieving blood pressure goals (July 27 2006 New England Journal of Medicine).
If you’re among them, it may be time to buy yourself a home blood pressure monitoring unit, take a fresh look at how you’re dealing with the menace, and work more closely with your doctor on these five ways to beat “resistant hypertension.”
1. Ensure adherence to prescription medications. Not taking prescribed hypertension drugs is a major reason why patients can’t tame hypertension, Dr. Vidt says. “Up to 75 percent of prescriptions are no longer being refilled after six to 12 months. Most patients don’t stay on their medications.” Failure to refill is a major contributor to non-adherence and uncontrolled blood pressure.
Keep yourself on track by monitoring progress at home. One of the best ways to maintain continued compliance is to buy your own blood pressure monitor (see “Tips for Monitoring Blood Pressure at Home,” page 5). “Patients can see the effects of taking ‘drug holidays,’” Dr. Vidt says, “or stopping medications entirely, for example if they think they’re cured.” In fact most patients need to remain on at least one drug for a lifetime.
Taking daily readings can also spur you to call your physician if your best efforts aren’t paying off. And it can help you and your physician rule out “white coat hypertension”–abnormally high readings caused by nervousness in the presence of your doctor.
Remind your physician to set up regular office appointments. How often? If you’ve just been diagnosed with hypertension, you should be seen at least once every three months. If you have Stage 2 hypertension (with readings greater than or equal to 160/100 mm Hg), request more-frequent appointments. Once your blood pressure is under control, you won’t need to see your doctor as often.
2. Find out if the regimen you’re on might be inappropriate. Your prescription may not be ideal. It’s up to your doctor to determine what’s right for you. But here’s a quick way you can evaluate whether your regimen is in line with current practice guidelines:
If you’re taking just one medication and it controls your pressure, it doesn’t matter what the drug is. But if you take multiple pills and they don’t seem to be working, check with your doctor or pharmacist to see if one of your drugs is a diuretic. If you’re not taking one, you should be, Dr. Vidt says. If you are, check your dosage. It should be 25 milligrams. If the diuretic dose is lower–say 12.5 milligrams–you’re probably not taking enough.
The kind of diuretic you’re given can also make a difference. acyclovir. “Some patients get a loop diuretic, like furosemide” (trade name: Lasix) Dr. Vidt says. “It’s very potent–but short-acting. So a patient on 50 milligrams of Lasix a day will not do as well as someone on 25 milligrams of a long-acting thiazide diuretic.” You don’t have to know what all the terms mean to raise questions about your medications.
3. Ensure that your physician knows what other medications you’re taking. You and your doctor will need to rule out unhealthy interactions between your anti-hypertensive medications and other drugs. Non-steroidal anti-inflammatory pills, commonly taken for arthritis, can raise blood pressure. So can many decongestants. They relieve stuffiness by restricting blood flow into nasal tissues and throughout your system–kicking hypertension into higher gear.
4. Optimize your lifestyle. Weight reduction, if your doctor prescribes it, can reduce your systolic (high) pressure by four to 10 mm Hg for each four or five pounds you lose.
Regularly walking briskly every day for 30 minutes can cut systolic pressure by up to nine mm Hg. Eating a diet rich in fruits, vegetables and low-fat dairy products while reducing saturated and total fat can take down systolic readings by as much as 14 mm Hg. Systolic pressure, the pressure in your vessels when your heart beats, has a greater effect on your heart health than diastolic, the pressure between beats.