You’ve Been Diagnosed: Now What?

Your next steps after a hypertension diagnosis.
You’ve Been Diagnosed: Now What?

If you’ve been diagnosed with high blood pressure, you have plenty of effective treatment options and lifestyle changes you can make under the supervision of your doctor to manage the condition.

Medication
Physicians will generally consider using antihypertensive drugs if you have repeated blood pressure readings of higher than 140/90 mm/Hg.

Drugs called diuretics are often used to treat stage 1 hypertension. They help remove extra sodium and water from the blood through urination, lowering blood volume and the amount of force exerted on the artery walls. Doctors may also consider using angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), calcium channel blockers (CCB), or beta-blockers (BB), all of which help blood vessels to relax. Beta-blockers also allow the heart to beat slower and with reduced force.

For stage 2 hypertension, a two-drug combination of a diuretic and an ACEI, ARB, CCB, or BB is often the treatment of choice.

Lifestyle changes
While drugs can help lower your blood pressure, some people may be able to delay, forgo or come off medication once they start making healthier choices — for example, losing weight, exercising and eating right.

“People are often surprised at how little it takes to start lowing your blood pressure through lifestyle changes,” says Nieca Goldberg, MD, clinical associate professor of medicine and medical director of New York University Women’s Heart Program and a national spokesperson for the American Heart Association’s “Go Red” campaign.

Lose weight and exercise
Dr. Goldberg has seen blood pressure reductions in patients who have lost as little as 5 to 10 pounds or who start walking a half hour daily. Dropping weight and exercising can lower blood pressure by making “the arteries more flexible and better able to expand,” she says.

The AHA recommends 150 minutes weekly of moderate- to vigorous-intensity aerobic activity like walking or biking. This is equivalent to 30 minutes a day, 5 days a week, although physical activity can take place in 10-minute increments. The AHA also suggests incorporating muscle strengthening two days a week, as well as flexibility and stretching exercises into your routine.

People with hypertension or those at risk should get a check-up before starting an exercise program because individuals with untreated high blood pressure run the risk of it becoming “dangerously high” during physical activity, says Dr. Goldberg.

Eat a healthy diet
In people who are overweight or obese, adding weight loss and exercise to a healthy diet can have a significant impact on lowering blood pressure.

“Our research shows that initiating and maintaining lifestyle changes can help some individuals achieve similar blood pressure reductions as medications,” say lead study author James A. Blumenthal, PhD, professor of medical psychology in the department of psychiatry and behavioral sciences at Duke University Medical Center.

The eating plan used in the study was Dietary Approaches to Stop Hypertension (DASH), which is often recommended to patients with hypertension or prehypertension.

However, “a structured program like Weight Watchers could be very beneficial,” says Dr. Blumenthal. “It's important to find a program that works for you and that fits your lifestyle so you are able to maintain your weight loss.”

The DASH diet is similar to Weight Watchers in that it emphasizes eating plenty of fruits and vegetables, fat-free or low-fat dairy products, and high-fiber, whole grain foods.

“Fruits and vegetables contain potassium and magnesium, important nutrients that help regulate blood pressure,” says Jessica Shapiro, MS, RD, a clinical dietitian at Montefiore Medical Center in the Bronx, New York. Some research suggests that calcium may also help to you to lower blood pressure. “Whole grains are a good source of fiber, which can help with hypertension and losing weight,” she adds.

The DASH diet also encourages eating more nuts, beans and seeds, as well as more fish and poultry and less red meat. Reducing your intake of sweets and other added sugars is also important.

Reduce sodium intake
The DASH diet generally recommends limiting sodium consumption to 2,300 mg per day, about the amount in a teaspoon of table salt. This can help to lower blood pressure, but greater reductions can occur by consuming only 1,500 mg daily.

Current USDA Dietary Guidelines also recommend that Americans consume no more than 2,300 mg per day, but this number may soon be reduced to 1,500 mg. In contrast, the typical American consumes 3,500 mg to 5,000 mg of sodium each day.

While reducing the amount of salt in our diet may initially seem daunting, “people’s taste for sodium can be modified over time,” says Rachel K. Johnson, PhD, MPH, RD, an AHA national spokesperson and the associate provost and professor of nutrition at the University of Vermont in Burlington. "At first it may seem like food is missing something, but studies show you can retrain your palate to acquire a preference for a less salty taste.” For more information on reducing your sodium intake, see Salt: Why Less is More.

Limit alcohol
If you have hypertension, reducing the amount of alcohol you drink may help to lower your blood pressure. Be sure to drink in moderation, meaning one drink per day for men and two drinks per day for men.

Quit smoking
While smoking has not been proven to cause hypertension, the chemicals in cigarettes can temporarily elevate your blood pressure. Moreover, smoking injures blood vessel walls.

“If you’re a heavy smoker, you’ll have high blood pressure more often than you don’t,” notes Dr. Goldberg, adding that smoking also increases your risk of heart attack, stroke, lung disease, asthma, lung cancer and cancer of the mouth.

Reduce stress
While researchers have yet to confirm it as a risk factor for hypertension, stress can temporarily make your blood pressure rise. When you feel stressed your body releases the hormones adrenaline and cortisol, which can momentarily restrict blood vessels.

Monitor your condition
Talk to your doctor about how often you need to come in to measure your blood pressure or whether you need to check it at home with a monitor. Ongoing monitoring will help you and your physician know whether any medications your taking and lifestyle changes you’ve made are working.

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