Been told that your blood pressure is too high? Already on meds to lower your pressure?
You should know that you might not have to reduce it as much as you thought. Many experts say that millions of Americans don’t have to aim quite as low when trying to manage their blood pressure. That means you might be able to delay or even avoid taking a blood pressure medication, thereby reducing the risk of side effects and lowering your costs.
The not-so-great news is that it has been more than a year since the advice, from experts convened by the National Heart, Lung, and Blood Institute, came out, but many doctors have not yet adopted the new blood pressure targets. Here’s why Consumer Reports thinks they should, and what it means for you.
High blood pressure continues to be a serious health problem; it’s still a leading cause of heart attacks and strokes. The ideal levels remain the same: a systolic pressure of 120 millimeters of mercury or less (the top number) and a diastolic reading (the bottom number) of 80 or less.
Until recently, most experts agreed that medication was needed if a person’s systolic level (which reflects the pressure in arteries when the heart contracts) hit 140 or if the diastolic level (the pressure between heartbeats) reached 90. The goal was even lower — 130/80 — for people with diabetes or chronic kidney disease because they’re vulnerable to heart attacks and strokes.
But the independent group of experts suggested changing those cutoffs based on a review of the medical research. Contrary to long-held assumptions, they concluded that most people age 60 or older don’t need drugs until their levels hit 150/90 and that drugs aren’t necessary for most people with diabetes or chronic kidney disease until their systolic pressure reaches 140/90.
Consumer Reports’ medical experts think that the goal of 150/90 for most people age 60 or older and 140/90 for most people with diabetes or chronic kidney disease is reasonable. They point out that getting levels below 140/90 can require high doses of blood pressure drugs or multiple medications. That increases the risk of side effects, which can include persistent coughing, erectile dysfunction and frequent urination, depending on the medication. The drugs can also cause dizziness, which can lead to falls.
Even if your blood pressure is moderately elevated, Consumer Reports’ experts say that you might not need to start taking medications, at least not right away. Instead, do these two things first:
● Confirm the diagnosis. Blood pressure levels fluctuate depending on factors such as how you’re sitting and whether you’re feeling anxiety in a doctor’s office. If your levels are high in your doctor’s office, ask him or her to confirm the readings. The gold standard for that is 24-to-48-hour monitoring. But that kind of monitoring isn’t widely available, and insurance might not cover the cost. In that case, schedule several follow-up visits. It’s also wise to invest in a home monitor so that you can check levels on your own.
● Try lifestyle changes. There are a number of measures — including losing weight, exercising more, cutting back on sodium and drinking less alcohol — that can sometimes reduce or even eliminate your need for drugs. If your systolic level is moderately elevated (150 to 160 for people 60 and older, 140 to 150 for others), consider drugs only if your blood pressure hasn’t dropped enough after six months of serious attempts at diet and lifestyle changes.
If you do need a drug, choose carefully. Until recently, the standard advice for most people was to start with a “water pill,” a thiazide diuretic such as hydrochlorothiazide, either alone or with another drug. Diuretics are still a good choice for many people. But several other classes of drugs usually work just as well. And like diuretics, they’re available as low-cost generics, most of them costing less than $1 per day.
In some cases, other drugs are actually better choices than diuretics. For example, people with kidney disease may fare better on ACE inhibitors such as enalapril or lisinopril because those drugs can also help reduce complications of kidney disease.
Having a choice of blood pressure drugs can also help you minimize side effects. The medications are relatively safe, but some trigger side effects that can be severe enough to warrant switching to another drug.
If your doctor says that you need drugs, ask what numbers he or she is hoping to reach. Whether it’s with lifestyle changes alone or combined with drugs, the aim for most people is to keep blood pressure below 140/90 if they’re younger than age 60 or have diabetes or kidney disease, and below 150/90 if they’re older. The ideal remains below 120/80, but you don’t have to get your levels that low to substantially cut your risk of heart attack and stroke.
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.