If you are the 1 in 2 adults with high blood pressure (hypertension), there are ways to approach it without medications. Occasionally, the blood pressure may be too high, and medications are sometimes necessary. Nevertheless, it is important to remember that there are things that you can still do to improve the control. The following information is intended to supplement the evaluation of a clinician. You can use it to prepare for a visit, to screen yourself for possible risk factors for high blood pressure, or after a visit.

Always follow the direct guidance of your primary care provider for treatment options.

High Blood Pressure: Overview and Risk Factors   

 1. Underlying Causes

In medicine, whenever we do not know clearly the nature of the disorder, we give it the term “essential.” Sure, you are more likely to have it when you get older, but there are still potentially reversible causes. Below are a few areas that often go overlooked.

• Obesity and Overweight Conditions. If your Body Mass Index is >25, your blood pressure may directly result from your weight. The increase in adipose tissue (fat) elevates the systemic pressure. Obesity is associated with 2/3 of the patients with high blood pressure.

• Obstructive Sleep Apnea. Do you have trouble sleeping through the night? Do you wake up to urinate more than once nightly? Do you suffer from fatigue or find yourself drinking high doses of caffeinated drinks, like coffee and energy drinks. Patients classically overestimate sleep. If your sleep is disrupted and you have high blood pressure, it is important to get a sleep study to clarify if you have significant apnea. Sleeping pills do not treat sleep apnea. Get checked.

• Medications. Certain medications antagonize blood pressure. The most common are non-steroidal anti-inflammatory drugs (NSAIDs), including Ibuprofen,  Motrin, Advil, Naproxen, and Alleve, cough medications with pseudoephedrine can increase blood pressure. Triptan (Sumatriptan, Frovatriptan, etc.), used to treat migraines, can increase pressure. Remember that migraines are usually telling you something related to self-care. Prednisone, and triamcinolone injections used in joints, have been known to exacerbate blood pressure by leading to salt and water retention. Abruptly stopping a class of medications for blood pressure known as beta-blockers can result in rebound hypertension.

• Coffee, Alcohol, and Drugs. To raise the blood pressure by 8 mmHg systolic usually requires about 200mg of caffeine or about 1.5 to 2 cups of coffee. Alcohol, usually more than 1 or 2 beers, induces high blood pressure in several ways. Like methamphetamines (and to lesser extent amphetamines for ADHD) and cocaine, stimulant drugs stimulate the heart, increasing the heart rate and blood pressure, possibly with dangerous results.

• Hormone, Vascular, and Kidney Problems. Only about 5% of the causes of hypertension are related to hormones (cortisol, hyperaldosteronism (Conn’s syndrome), hyper/hypothyroidism), and congenital conditions of the kidneys and vascular system. Outside of the usual screening for the other conditions, your doctor may order additional testing, including ultrasound of the kidneys, vascular studies of the kidneys, cortisol, thyroid (TSH, T4), aldosterone, and renin levels, catecholamine levels, and other bloodwork.

     2.  A Sign of Systemic Decompensation.

• If you have high blood pressure, you are statistically more likely to have obesity, diabetes, and sleep apnea. The same holds for the reverse. If you have any of these conditions, a preventive approach can often improve ALL of the conditions.

     3. Most people are without Signs or Symptoms. 

• The take-home message here is that screening is necessary to ensure that you are not in the category. If you consistently get blood pressures over 130 systolic or 90 diastolic, refer to #1 and inform your doctor.

• “White coat hypertension” benefits from ambulatory monitoring and regular monitoring. Although studies support no difference in outcome compared to those with normal pressure, it has been felt to be potentially a harbinger of future sustained high blood pressure for some. Untreated blood pressure can lead to kidney damage, risk of hemorrhagic stroke, and other cardiovascular complications.

     4. Stress and Sleep Deprivation Can Antagonize It. 

• Daily exercise is recommended. Getting at least 7 to 9 hours of consistent sleep nightly helps to manage stress.

• Lifestyle significantly impacts high blood pressure, occasionally enough for people to forego medications after improving it. Although studies have not shown a direct link to stress and blood pressure, plausibility exists that it may contribute to its lability. Heart disease has been clearly linked to increased stress.

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5 Ways to Treat It 

While pharmacologic treatment may sometimes be necessary, it is an important point that only one in four patients on BP medications has it under control. Although medicating blood pressure can assist in preventing complications, there is an increased likelihood of side effects with escalating therapy. Multiple measures can mitigate the severity. Remember that your body systems function in concert with each other. The heart responds by increasing pressure because of neurologic, hormonal, chemical, physiologic, and structural reasons.

1. Counseling, Mindset, and Exercise 

• Exercise is an essential part of hypertension treatment and recovery. Exercise improves the vascular walls, helps improve insulin resistance, and can help manage pro-inflammatory cytokines. Regular, daily moderate exercise for 30 to 60 minutes is recommended.

• Maintaining sleep duration and timing of sleep can protect you from the risk of high blood pressure. Sleep deprivation is associated with increased inflammation, diabetes risk, obesity risk, and hypertension.

• Be aware of stress triggers. Practice mindfulness and seek care for any addiction to drugs, cigarettes, and alcohol.

2. Diet Optimization 

• An elevated weight, particularly abdominal fat, is directly tied to pressure. Optimizing weight will optimize pressure.

• Try the DASH diet offered by The National Heart Lung and Blood Institute is useful.

• Intermittent fasting can help decrease pressure and improve overall cardiovascular health, such as diabetes and obesity.

• A natural diet with low processed foods can be effective in weight optimization.

3. Monitor Your Blood Pressure

• The only way to know if you have high blood pressure is to check it. You can check your blood pressure readings at home with an automatic blood pressure cuff. Ensure it is the correct size, as cuffs too small will measure higher blood pressure. Plan to check them at the same time each day. Record your blood pressure and pulse to discuss with your doctor.

• Recommend regular screening if your BMI is in the overweight and obese range. 

• A screening blood pressure check with a physician is recommended at 40 (or sooner if risk factors).

4. Screen for Sleep Apnea

• At least 50% of patients with sleep apnea also have hypertension, while about 30% of hypertensives suffer from sleep apnea. All those with high blood pressure should consider screening, particularly if they are on two or more medications for it.

• Find out if you may be at risk of obstructive sleep apnea. Newer technologies in pulse oximeter measurements and smartwatches may be an ice breaker to check your oxygen levels and determine if further testing needs to be done.

• Sleep questionnaires such as the STOP-BANG questionnaire or the Epworth Sleepiness Scale can be useful screening tools. See attached.

• The most sensitive measurement of sleep is a formal sleep study in a sleep lab. Discuss with your PCP about Sleep Apnea Screening if you are over the age of 50, have elevated pressure, are experiencing frequent waking up at night, need to wake up to urinate, feel fatigued, or have any swelling in your legs.

5. Certain Medications and Substance Abuse 

• Avoid medications such as ibuprofen, Advil, and high-dosed aspirin, which can worsen blood pressure.

• Get help if you have alcohol dependence. If you more than one drink of alcohol daily, you may have dependence. Discuss this with your primary care doctor.

Further Reading

Patient

CDC

American Heart Association