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High blood pressure, and how it is treated

Diuretics are usually used as first-line agents in hypertension treatment

As stated in my most recent column, hypertension is the medical term for a high blood pressure, namely a BP reading of at least 130 mmHg systolic or at least 80 mmHg diastolic, or both.

By increasing the tension on the arteries and the strain on the heart muscle, multilevel organ damage ensues including heart attack (myocardial infarction), heart failure, stroke, blockages in leg vessels, dilation of big arteries and kidney insufficiency.

Fortunately, treatments to lower BP are well tolerated and can help prevent health problems.

How big is lifestyle impact on blood pressure control?

While this part of high BP treatment was largely covered in last week’s article, it is quite critical and bears a quick restating.

It includes lowering sodium (to less than 5 to 6 grams of table salt) and alcohol intake (less than 2 drinks), maintaining a healthy weight, engaging in regular aerobic exercise (at least 2 hours a week), and stopping the cigarettes.

Studies have shown that each measure could lower blood pressure by a magnitude of 2 to 5 points or mmHg.

Combined, these actions could, in some motivated patients, bring BP down to normal ranges without a need for medications.

In other patients requiring multiple drugs, the same positive lifestyle choices could bring down the treatment need to just one antihypertensive agent.


Most people would still require one or more drugs to lower their blood pressure. It may take time and trials to determine the right medication(s) and proper dosing to effectively lower BP with minimum side effects.

For that purpose, healthcare providers take several factors into account. In addition to the meds’ effectiveness and potential side effects, they consider one’s general health, sex and age, hypertension severity and any additional underlying medical conditions that could favour or preclude some drug choices.

What are the most commonly used BP meds?


They are usually used as first-line agents in hypertension treatment. They lower BP mainly by causing the kidneys to excrete more sodium and water, but also potassium. So in some instances, a concomitant potassium supplement or a potassium-sparing diuretic is also given.

Their side effects include dizziness, weakness, muscle cramps, erectile dysfunction, increase in sugar level and gout attacks.

Calcium channel blockers

Calcium is needed for contraction of the tiny muscles inside the vessel’s wall. Blocking calcium relaxes the arteries and brings down the blood pressure.

Their side effects include headache, flushing, constipation and leg swelling.

ACE inhibitors and angiotensin II receptor blockers

They block angiotensin II, a hormone that causes narrowing of blood vessels and BP increase.

Their side effects include a dry cough, elevated blood potassium level (opposite to diuretics); angioedema occurs rarely – in 0.2 per cent of people. Angioedema is a serious condition characterised by a swelling of the lips, tongue, and throat, which can impede breathing.

Beta blockers

As their name implies, these agents block some of the effects of the sympathetic nervous system responsible for increasing blood pressure and heart rate. They are very safe.

However, in some cases, they may worsen asthma, mask symptoms of low blood sugar (hypoglycaemia) in people with diabetes, and precipitate fatigue, nightmares and weight gain.

When do I need more than one BP drug?

If a person has a BP above 160/100 mmHg, then combination therapy with two drugs at the same time rather than monotherapy (treatment with a single medication), may be the initial step in blood pressure treatment.

Adding a second drug may be more effective than increasing the dose of the first drug and is usually associated with fewer side effects.

Is there a role for alternative medicine on hypertension treatment?

Alternative medicine refers to medical practices that are not part of mainstream Western medicine. It includes acupuncture, chiropractic, herbal medicine, homeopathy, and naturopathy among others.

There is a limited scientific evidence to support the effectiveness of many alternative treatments for hypertension.

In addition, it is important to be cautious when considering alternative therapies because some may have side effects or may adversely interact with conventional BP drugs.

Some alternative medicine approaches that have been studied for the treatment of hypertension include yoga/meditation/progressive muscle relaxation (PMR). Some studies have found that regular yoga practise may help to lower blood pressure.

A review of studies also found that acupuncture may be effective at modestly reducing BP in some patients.

Below are some of the supplements and herbs that studies have found may be helpful:

Potassium, magnesium, folic acid and omega-3 folic acid have the most data behind their use in treating BP – a mild, positive effect.

Products such as dark cocoa, coenzyme q10, hibiscus and garlic could boost production by the vessels of a natural relaxant called nitric oxid, which could help with lowering BP.

Hawthorne, cardamom and celery seed have also been considered although the evidence to support them isn't clear.

Joseph Yammine is a consultant cardiologist at the Bermuda Hospitals Board. He is also the director of the outpatient multi-speciality clinics and director of the Cardiac Computed Tomography programme. He received his post graduate training at the Brigham and Women's hospital, Brown University and the State University of New York. Dr Yammine holds five active American board certifications.

The information herein is not intended as medical advice nor as a substitute for professional medical opinion. Always seek the advice of your physician. You should never delay seeking medical advice, disregard medical advice or discontinue treatment because of any information in this article.

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Published January 10, 2023 at 7:59 am (Updated January 10, 2023 at 8:07 am)

High blood pressure, and how it is treated

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