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Dr. Antony Pham is a pharmacy practice resident at University of California, Los Angeles Medical Center. Dr. David Pham is an assistant professor of pharmacy practice at Western University College of Pharmacy and Health Sciences in Pomona, California.

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High blood pressure (also known as hypertension) affects about 50 million Americans and almost 1 billion people worldwide. People who have normal blood pressure at 55 years of age have a 90% risk of developing high blood pressure in their lifetime. Therefore, it is likely that high blood pressure will affect you or someone closely related to you.

High blood pressure usually is found by measuring the pressure in the blood vessels during a heartbeat and when the heart is at rest. The reading during a heartbeat is known as systolic blood pressure. The reading when the heart is at rest is known as diastolic blood pressure. These readings usually are written with the systolic blood pressure number over the diastolic blood pressure number. An example would be 138/93 mm Hg (milligrams of mercury).

In patients who are older than 50 years of age, controlling systolic blood pressure is more important than controlling diastolic blood pressure, because systolic blood pressure is directly linked to the risk of heart disease. If your systolic blood pressure is more than 140 mm Hg or your diastolic blood pressure is more than 90 mm Hg on 2 separate occasions, your health care provider may diagnose you as having hypertension.

Lowering your high blood pressure to a specific goal, as set by your health care provider, will reduce your risk of stroke, heart failure, heart attack, kidney failure, and even death. If you are diagnosed with high blood pressure and also have either diabetes or kidney disease, your blood pressure should be less than 130/80 mm Hg. If you are diagnosed with high blood pressure and have other disease states, your blood pressure should be less than 140/90 mm Hg (see the Table).

Monitoring Your Blood Pressure

To achieve your blood pressure goal, it is recommended that you obtain a blood pressure self-monitoring device. This device will allow you to check your blood pressure in the convenience of your own home at any time of the day. You may bring your monitoring device as well as a log of your blood pressure readings to every health care visit to ensure that your readings are consistent with those of your health care provider.

To obtain an accurate blood pressure reading, you should sit quietly for at least 5 minutes with your feet uncrossed on the floor and your arm supported at the level of your heart. Make sure that you have an appropriately sized cuff that wraps around at least 80% of your arm. Cuffs that are too big or too small will give incorrect readings.

Although some digital devices can measure blood pressure on your fingers and your wrist, only those that are used on the upper arm are recommended. When selecting a self-monitoring device, talk to your pharmacist about the differences between each product. If you have trouble reading small numbers, ask for a device that shows larger numbers. Some devices can record your blood pressure readings and give you a printout that you may bring to your health care provider.

Lifestyle Changes

Several healthy lifestyle changes can improve blood pressure in patients with prehypertension (see the Table) and/or hypertension. Patients with high blood pressure are urged to adopt the Dietary Approaches to Stop Hypertension (DASH) plan. This plan encourages patients to eat foods rich in fruits and vegetables, as well as lowfat dairy products. Foods containing a high fiber content and potassium also are suggested. Fish and poultry are recommended, in comparison to red meats. In addition, the DASH plan emphasizes a diet low in saturated and total fat. It is recommended that patients with high blood pressure reduce their daily intake of sodium to less than 2.4 grams. Do not add salt when cooking, and remove all salt from the table.

Physical activity such as aerobic exercise—for at least 30 minutes a day for most days of the week—also can reduce blood pressure. This type of exercise includes walking, swimming, jogging, running, and bicycling.

Healthy weight loss means a 7% to 10% reduction in weight over 1 year. This reduction may be achieved by lowering your total daily intake by 500 calories. A weight loss of 1 to 2 pounds per week is considered healthy. Any greater weight loss is discouraged.

Men with high blood pressure should limit their alcohol consumption to 2 drinks a day (for example, two 12- ounce beers or 10 ounces of wine). Women should limit their alcohol consumption to 1 drink per day. Lastly, it is recommended that patients with high blood pressure not smoke, because smoking may increase the risk of heart disease.

Patients are strongly encouraged to adopt these changes, because they can lower blood pressure, enhance the work of blood pressure medicines, and lower the risk for heart problems.

Drug Therapy

Medicines can be used in addition to lifestyle changes to lower blood pressure. Several classes of drugs are available to lower blood pressure.

Many patients with high blood pressure will require 2 or more medications along with lifestyle modifications to achieve blood pressure goals. Follow-up visits with your health care provider, with careful monitoring of your blood pressure, are important to determine the best medicines to control your high blood pressure. Your health care provider will decide which drug or combination is best for you.

Summary

Controlling blood pressure can reduce the risk of stroke, heart failure, heart attack, and kidney failure. Patients with high blood pressure are encouraged to monitor their own blood pressure with a self-monitoring device. Patients should adopt healthy lifestyle changes, and they should discuss medication options with their health care provider.

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