Controlling Your Blood Pressure Archive

Experts are divided on optimal blood pressure targets but agree that an individual approach is the best strategy.

There's no debate about the dangers of high blood pressure. Dubbed the "silent killer," high blood pressure usually has no symptoms. Yet this common condition damages blood vessels throughout the body, raising the risk of heart attack, stroke, kidney disease, and other problems.

But exactly when to start drug therapy for high blood pressure and how aggressive that treatment should be — especially in older people — has been a matter of some dispute in recent years. Some studies suggest that aiming for a stricter (that is, lower) blood pressure target than the current guidelines recommend can substantially reduce a person's risk of cardiovascular complications (see: "Blood pressure research and guidelines: A moving target?"). Other studies offer evidence that a more relaxed (that is, higher) target makes more sense for most people, given the potential harms of drug side effects such as fatigue and coughing, as well as low blood pressure, which can cause lightheadedness and fainting.

Research we're watching

Following a Nordic diet — which features fish, whole grains, plus fruits and vegetables popular in Scandinavian countries — may help lower the risk of stroke, a new study suggests.

The study, published in the February 2017 issue of Stroke, included more than 55,000 Danish people from a national health registry, all of whom filled out questionnaires about their diets and other lifestyle habits. Researchers looked at how closely the participants followed the Healthy Nordic Food Index, which includes six food categories: fish, apples and pears, root vegetables (such as carrots and celery root), cabbages (which also include broccoli, cauliflower, kale, and Brussels sprouts), rye bread, and oatmeal.

Lifestyle changes may reduce your need for pills.

For most of us, as the years increase, so does our blood pressure. By age 60, almost 65% of Americans will have high blood pressure. Although men are more likely to develop high blood pressure between ages 45 and 55, women are at greater risk after 65. Yet high blood pressure isn't an inevitable fact of later life. It's possible to slow the processes that drive blood pressure up. By doing so, you'll also reduce your risk of heart attack, stroke, and dementia.

Blood pressure reflects the amount of blood flowing through the vessels and the pressure exerted by the vessel walls against the blood. In a blood pressure reading, the top number represents the systolic pressure, recorded when the vessel contracts to push blood through. The bottom number represents the diastolic pressure, recorded when the vessels are relaxed. Over time, our blood vessels lose elasticity, and atherosclerotic plaque may build up in artery walls. Both of these trends make vessels stiffer. As vessels become less flexible, blood pressure is higher at any level of blood flow.

A powdered form of whey protein from milk may modestly lower blood pressure.

When it comes to fighting high blood pressure, the average American diet delivers too much sodium and too little potassium. Eating to reverse this imbalance could prevent or control high blood pressure and translate into fewer heart attacks, strokes, and deaths from heart disease.

Normal body levels of potassium are important for muscle function. Potassium relaxes the walls of the blood vessels, lowering blood pressure and protecting against muscle cramping. A number of studies have shown an association between low potassium intake and increased blood pressure and higher risk of stroke. On the flip side, people who already have high blood pressure can significantly lower their systolic (top number) blood pressure by increasing their potassium intake when they choose to eat healthy foods.

Thiazide diuretics like hydrochlorothiazide (Esidrix, HydroDIURIL, other brands) continue to be a very effective way to lower blood pressure for people with hypertension. They're inexpensive, and results from large studies have shown them to be at least as effective as other types of blood pressure drugs for most patients.

But if you're taking a diuretic, your potassium levels need to be watched. These drugs direct the kidneys to pump water and sodium into the urine. Unfortunately, potassium also slips through the open floodgates. A low potassium level can cause muscle weakness, cramping, or an abnormal heartbeat, which is especially dangerous for people with heart problems.

Reduce your dependence on medications with these strategies.

More than a third of all adults in the United States have high blood pressure—a systolic pressure (the top number in a reading) of at least 140 millimeters of mercury (mm Hg), or a diastolic pressure (the bottom number) of at least 90 mm Hg, or both. The condition injures blood vessel walls and forces the heart to work harder, increasing the risk for heart disease and stroke.

Taking medication to treat high blood pressure is just part of the solution.

New research has linked heart tissue damage to blood pressure treatments that drive diastolic pressure (the bottom number in a reading) too low. 

Millions of older adults aren’t taking their blood pressure drugs as directed. Ways to combat adherence problems include asking a doctor for less expensive drugs, understanding what a medication is for, and reporting side effects. 

New findings focus on diastolic blood pressure—the second number in your blood pressure reading.

 Image: mangostock/Thinkstock

Of the two numbers that make up your blood pressure reading, the first one (systolic blood pressure) typically gets more attention. That's because as people age, their arteries lose their elasticity, and the inner walls are more likely to accumulate cholesterol-laden plaque. These factors tend to raise systolic blood pressure, a measure of the pressure inside the arteries when the heart contracts to pump blood throughout the body.

Current guidelines suggest that most people should aim for a systolic blood pressure reading of 140 millimeters of mercury (mm Hg) or lower. But last year, a widely publicized clinical trial suggested that a target of 120 mm Hg could further reduce the dangers associated with high blood pressure (namely, heart attack, stroke, heart failure, and death).