Diuretics for High Blood Pressure

What is High Blood Pressure? A blood pressure of 140/90 mmHg or higher is considered high blood pressure. [A blood pressure of 130/80 mmHg or higher is considered high blood pressure in people with diabetes and chronic kidney disease.] Both numbers are important. If one or both numbers are usually high, you have high blood pressure. Nearly 1 in 3 American adults has high blood pressure. Once high blood pressure develops, it usually lasts a lifetime. The good news is that it can be treated and controlled. High blood pressure is called the silent killer because it usually has no symptoms. Some people may not find out they have it until they have trouble with their heart, brain, or kidneys. When high blood pressure is not found and treated, it can cause: The heart to get larger, which may lead to heart failure. Small bulges (aneurysms) to form in blood vessels. Common locations are the main artery from the heart (aorta); arteries in the brain, legs, and intestines; and the artery leading to the spleen. Blood vessels in the kidney to narrow, which may cause kidney failure. Arteries throughout the body to “harden” faster, especially those in the heart, brain, kidneys, and legs. This can cause a heart attack, stroke, kidney failure, or amputation of part of the leg. Blood vessels in the eyes to burst or bleed, which may cause vision changes and can result in blindness. Blood pressure changes during the day. It is lowest as you sleep and rises when you get up. It also can rise when you are excited, nervous, or active. Still, for most of your waking hours, your blood pressure stays pretty much the same when you are sitting or standing still. That level should be lower than 120/80 mmHg. When the level stays high, 140/90 mmHg or higher, you have high blood pressure. With high blood pressure, the heart works harder, your arteries take a beating, and your chances of a stroke, heart attack, and kidney problems are greater. Blood pressure should be controlled to less than 140/90 mm Hg--even lower if you have certain conditions, such as diabetes or heart failure. If you are being treated for high blood pressure and have repeated readings in the normal range, you still have high blood pressure. Every drug has multiple effects, and the benefits of its use must be weighed against the risks to find the best treatment for each person. Treatment includes lifestyle measures, such as becoming physically active, losing weight, if overweight, following a low-saturated fat, low-cholesterol eating plan, limiting dietary salt, and not smoking. Drug therapy may not be needed. New Findings about Drugs to Lower High Blood Pressure Many drugs have been developed in recent years to treat high blood pressure, a major risk factor for heart disease. Recent findings from a major clinical study supported by the National Heart, Lung, and Blood Institute (NHLBI) offer new information about treatment. The “Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial” (ALLHAT) was a large study that began in 1994 and lasted 8 years. It had two parts: one compared effects of a diuretic (sometimes referred to as a “water pill”) with three newer, more costly blood pressure-lowering drugs; the other compared the effects of a cholesterol-lowering statin drug and diet with those of “usual care.” The blood pressure trial involved more than 40,000 persons, aged 55 and older, who had high blood pressure. If you are being treated for high blood pressure and/or high cholesterol, do not make any changes without first talking with your doctor. All four of the drugs studied in ALLHAT are effective in lowering blood pressure. The study tried to find which was the best choice for starting treatment. Results show that diuretics work best to both lower blood pressure and prevent stroke and some forms of heart disease, including heart attack and heart failure. The advice given here also includes another type of blood pressure drug called beta blockers. This drug was not studied in ALLHAT but prior trials found it effectively lowers blood pressure, and prevents heart problems and strokes. Results to Guide You: If you need to begin drug treatment, you should definitely try a diuretic first. [The most commonly prescribed diuretic used for hypertension in the VA system is hydrochlorothiazide (HCTZ)] Beta blockers are another option to begin treatment, especially if you’re younger than age 60 and do not have diabetes or peripheral artery disease (in which blood flow becomes reduced, especially to the hands and feet). Beta blockers also may be needed if you’re taking the drug for another condition, such as heart attack or heart failure. If you’re now taking a beta blocker, talk with your doctor about your total health needs. If you need multiple drugs to control your blood pressure- which is common-make sure one is a diuretic. If you already take more than one drug but your blood pressure is not yet under control, talk with your doctor about adding a diuretic to your treatment. If you take more than one drug and your blood pressure is controlled, ask about switching one to a diuretic. Your doctor may consider giving you a calcium channel blocker or ACE inhibitor if you cannot take a diuretic. If you have angina (chest pain from heart disease), you may need to take a beta-blocker, a calcium channel blocker, or both. These medications are often used in combination with a diuretic for associated heart conditions. Check with your doctor. Your doctor may consider prescribing an alpha-blocker if you take more than one drug to control blood pressure and you also have Benign Prostatic Hyperplasia. Talk with your doctor about your total health needs. To Learn More Ask your primary care provider if you have questions about your blood pressure or the drugs that you are taking to treat high blood pressure. If you have questions, an appointment can be made for you.

VISN 2 Home | Sitemap | Alphabetical Site Index | What's New | Contact Us | Plug-ins