I’ve Been Making Lifestyle Changes, But How Do I Know When It’s Time to Start Medication for High Blood Pressure?

Key takeaways:

Lifestyle changes are a vital part of keeping blood pressure healthy and controlled.
Sometimes, lifestyle changes may not be enough and medication might be the best next step.
There are multiple medication options for lowering blood pressure, each with their own risks and benefits.
Know the key questions to ask yourself and your healthcare provider to make sure you’re making the best decisions for your health.

Almost half of adults in the United States have high blood pressure, and only about 1 in 4 of these people have their blood pressure controlled. High blood pressure (hypertension) is often silent. But untreated high blood pressure increases the risk of a heart attack or stroke, which are leading causes of death worldwide.

Many people can lower their blood pressure with lifestyle changes such as dietary changes, exercise, and weight loss. But the fact is: Most people with high blood pressure do not have their blood pressure controlled, and they would benefit from either starting or adjusting blood pressure medication.

Read on to learn if it might be time to consider medication for your blood pressure, and how you can make the best treatment decision for your health.

What are the signs that lifestyle changes may not be enough to manage your blood pressure?

Unless you are checking your blood pressure regularly, you may not know that it is higher than it should be.

The first step is to know what your blood pressure should be and to monitor it regularly at home. Your target blood pressure will be based on guidelines from the 2017 American College of Cardiology and the American Heart Association. In general, a normal blood pressure is considered less than 120/80.

The most impactful lifestyle changes to lower blood pressure include:

DASH diet (DASH stands for “Dietary Approaches to Stop Hypertension”)
Alcohol reduction
Weight loss
Aerobic exercise
Not smoking
Reducing stress

It’s important to ask yourself if you are able to make long-term lifestyle changes. Do you have a plan? Have you set goals that are achievable? Do you have the support that you need?

How long can you keep trying to lower your blood pressure naturally?

How long you can try to make lifestyle changes really depends on how high your blood pressure is and your own personal risk, such as your age and other health conditions. Healthcare providers will often use a risk assessment tool to understand your personal 10-year risk of a heart attack or stroke.

What’s a slightly elevated blood pressure, and what to do about it?

Blood pressure that is slightly elevated is:

120 mmHg to 129 mmHg for the top number
80 mmHg or less for the bottom number

If your blood pressure is slightly elevated, it will likely be reasonable to try to lower your blood pressure with lifestyle changes. It’s usually safe to try to improve your blood pressure in this way for 3 to 6 months.

Beyond that, medication may be the best next step if:

You’ve tried unsuccessfully to lower your blood pressure with lifestyle changes for 3 to 6 months.
Your blood pressure is going into the Stage 1 category (top number 130 mmHg to 139 mmHg, or bottom number 80 mmHg to 89 mmHg) and you have other risk factors for a heart attack or stroke (such as increased age, smoking, or diabetes).
Your blood pressure is in the Stage 2 category (top number 140 mmHg and above, or bottom number 90 mmHg and up).

What’s a very high blood pressure, and what to do about it?

Readings that are very high are:

180 mmHg or higher for the top number
120 mmHg or higher for the bottom number

If your readings are very high, this is an emergency. You need blood pressure treatment immediately to prevent damage to your heart, brain, or kidneys.

What are some concerns about taking blood pressure medication?

If you find yourself resisting blood pressure medication, it’s important to think about why you might be reluctant to start medication. Make a list of your concerns and take them to your next appointment. It’s very normal to have questions and concerns about a chronic health condition like high blood pressure. Your healthcare providers can help to talk through these and make a treatment plan with you that fits your needs.

Some of your concerns may include:

Will I have to be on this medication for the rest of my life?
What are the side effects?
Will I get dependent on this?
Will I be able to afford this medication?

Are there risks to using medications to lower your blood pressure?

There are many different types of blood pressure medications. You and your healthcare provider can work together to make the best choice for you. Together, you can ensure that the benefits will outweigh potential risks and side effects.

Blood pressure medications fall into the following main categories, each with their own strengths as well as potential side effects.

Diuretics

These help your body get rid of extra salt and water to lower blood pressure. Examples include:

The main side effects may be:

Increased urination
Potassium abnormalities
Dizziness
Dehydration
Increased blood sugar

ACE inhibitors

These medications work by decreasing angiotensin (which narrows arteries), helping blood vessels relax to lower blood pressure. Examples include:

The main side effects may be:

A dry cough
Potassium abnormalities
Headaches
Dizziness

Importantly, these should not be used if there could be any chance of pregnancy.

Angiotensin II receptor blockers (ARBs)

These help block angiotensin and help keep the blood vessels relaxed to lower blood pressure. Examples include:

The main side effects can include dizziness or headaches. These also should not be used if there could be any chance of pregnancy.

Beta blockers

These reduce your heart rate and heart output, helping lower blood pressure. Examples include:

The main side effects can include:

Decreased heart rate
Fatigue
Cold hands or feet
Dizziness

Calcium channel blockers

These help lower blood pressure by helping your blood vessels relax. Examples include:

The most common side effects may include:

Dizziness
Headaches
Swelling in your ankles
Constipation

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