Blood Pressure Medication: What You Should Know

A brief overview of how it works, side effects, guidelines and what to ask your doctor.

Contributor

Toni J. Brayer, M.D.

Sutter Pacific Medical Foundation

High blood pressure, or hypertension, is one of the main causes of heart attack, kidney failure and stroke. It can occur at any age, and may worsen as people get older. Hypertension is called the "silent killer" because patients may not know they have it.

"If your blood pressure is only mildly high, making lifestyle changes can bring blood pressure down to normal levels," says internal medicine physician Toni Brayer, M.D., of Sutter Pacific Medical Foundation. Maintaining a healthy weight, exercising and avoiding excessive alcohol are all important in blood pressure control.

Many patients may need to use medication to help control high blood pressure. Thanks in part to medications that safely lower blood pressure, there has been a dramatic reduction in the number of people dying from heart attack and stroke over the last 40 years.

Doctor holding prescription pill bottle

"If lifestyle changes alone don't work, people shouldn't be afraid to take medication to get their blood pressure to a normal range," Dr. Brayer says.

Here's what you need to know if you've been prescribed blood pressure medication.

How Blood Pressure Medication Works

The heart, kidneys, hormones, blood vessels and central nervous system each play a role in maintaining healthy blood pressure. There are many different kinds of blood pressure medication that can affect each of these systems.

"Blood pressure is controlled by many systems in our bodies, so different drugs work in different ways," Dr. Brayer says. "Some are calcium channel blockers, beta blockers, diuretics, ACE inhibitors, ARB inhibitors or adrenergic blockers. That is why some people need two or even three medications to work together for optimal control."

Side Effects

"There are few – if any – health risks from taking hypertension medications, and most of them are well-tolerated by patients," Dr. Brayer says. "However, each and every medication may cause side effects for some people. ACE inhibitors, for example, can cause a cough. Diuretics can cause weakness or potassium problems in certain patients."

The good news is there are dozens of blood pressure medications on the market. Work with your doctor to find a medication that works for you.

"No one should accept a side effect when there are so many choices," she says.

Blood Pressure Guidelines

Current guidelines advise the systolic (top) number should be under 140 and the diastolic (bottom) number under 90. "However, a new study with an average patient age of 68 shows greatly improved outcomes with even lower blood pressure," Dr. Brayer says.

In the past, guidelines allowed older adults to have readings as high as 150/90. But the initial results of a new study, sponsored by the National Heart, Lung and Blood Institute, showed managing blood pressure to a lower reading may save lives.

Study participants age 50 and older lowered their risk of cardiac death by 25 percent when their target blood pressure was 120/80, and participants over age 75 also did much better at 120/80 without any side effects.

"I advise patients to get a home blood pressure monitor and keep a record of their readings over time," Dr. Brayer says. "We adjust their medication upward or downward as needed to keep them in a normal range."

Talk to Your Doctor

It's natural to have questions and concerns when you're prescribed blood pressure medication. Before you start taking any new medication, be sure to ask your doctor:

What is it prescribed for?
How is it taken?
How long will I take it?
What side effects should I watch for?
Does it come in generic?