1. High Blood Pressure? 8 To-Do’s When Your Medication Isn’t Enough

    If your blood pressure has crept up over the years, you likely take one or more drugs to help bring it down. But what happens when medication isn’t enough to control your hypertension, or high blood pressure?

    Although hypertension is often treated successfully with medication and lifestyle changes, resistant hypertension is not so easy to address.

    What is resistant hypertension?


    “Resistant hypertension is the failure to reach goal blood pressure in patients who are adhering to maximally tolerated doses of an appropriate three-drug regimen that includes a diuretic,” explains hypertension specialist George Thomas, MD.

    In other words, if you’re taking the maximum dose of three blood pressure medications, and one of those is a diuretic (water pill), and your blood pressure still isn’t at safe levels, you may have resistant hypertension. And you’ll need to do more to control it.

    High blood pressure is sometimes known as “the silent killer” — so named because it increases the risk of heart disease and stroke, but often goes unnoticed due its lack of obvious symptoms.

    Confirming this diagnosis


    Diagnosing resistant hypertension isn’t always simple, though. “Proper measurement of blood pressure and confirmation is key,” Dr. Thomas says.

    That means you’ll first need to make sure you’re getting accurate readings.

    There are several reasons why you might get an inaccurate reading. This can happen if:

    • The blood pressure cuff is too small.
    • You haven’t rested long enough before checking blood pressure.
    • You experience “white coat hypertension,” or elevated blood pressure due to anxiety in the doctor’s office.
    • You smoke or have caffeine right before having your blood pressure taken. (This can artificially inflate the numbers.)

    If you rule out all of those factors, and your blood pressure is still elevated, your may have resistant hypertension.

    What’s causing it?


    In many cases, it’s a matter of lifestyle, Dr. Thomas says. Medication can only do so much to control your blood pressure.

    Your doctor likely will explore four possibilities:

    1. If you’re eating a diet that’s high in sodium, smoking, consuming a lot of alcohol, or are overweight and skimping on exercise, your medication may not overcome those behaviors.

    2. Medications you take for other things can contribute to the problem. NSAIDS (non-steroidal anti-inflammatory drugs, such as ibuprofen), oral contraceptives and nasal decongestants can all boost your blood pressure, Dr. Thomas says.

    “Be sure to bring all of your pill bottles, including over-the-counter medications or herbal supplements or vitamins, to your medical appointments,” he says.

    3. There’s also evidence that obstructive sleep apnea can contribute to resistant hypertension. Your doctor may order a sleep study if this is a concern.

    4. If your doctor rules out lifestyle factors and medications, he or she may look for other causes related to hormones or vascular problems.

    Steps you can take to overcome resistant hypertension


    Dr. Thomas offers eight tips for managing hypertension. If you do these things, you’ll know you’re doing all you can to help:

    1. Make sure you’re taking your hypertension medication correctly and at the scheduled time.
    2. If your medication is causing unpleasant side effects, talk to your doctor about alternatives — don’t just stop taking it.
    3. Follow a low-sodium diet (less than 2.3 grams per day).
    4. Follow the DASH diet, which includes lots of fruits, vegetables, whole grains and lean protein.
    5. Exercise regularly. (Talk to your doctor first if it’s been awhile since you were physically active.)
    6. Limit the amount of processed foods you eat — they’re usually high in sodium.
    7. Limit your alcohol intake.
    8. Learn to check your blood pressure at home. Ask your doctor to help you create a monitoring schedule. Log the results and bring them to your doctor’s appointments. Have your blood pressure machine checked for accuracy at least once a year.

    Managing hypertension isn’t always easy, but making these changes is worth the effort. They will go a long way toward reducing your risk of heart disease and stroke.

    High Blood Pressure? 8 To-Do’s When Your Medication Isn’t Enough
    Author: Urinary and Kidney Team
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