Treatment for high blood pressure will depend on your blood pressure levels and your associated risk (after taking account of several factors) of developing a cardiovascular disease, such as a heart attack or stroke.
There are seven main risk factors for developing a cardiovascular disease. These are:
- high blood pressure
- smoking (or a previous history of smoking)
- lack of exercise
- having a high level of cholesterol in your blood
- having a family history of cardiovascular disease (conditions of the heart or blood vessels).
If your blood pressure is slightly high
If your blood pressure is slightly higher than the ideal level (120/80mmHg), and your GP feels that the risks of cardiovascular disease are low, then you should be able to lower your blood pressure by making simple lifestyle changes (see more below).
If your blood pressure is moderately high
If your blood pressure is moderately high (140/90mmHg or higher), or your GP feels that your risk of developing cardiovascular disease in the next 10 years is more than one in five, then you will be advised about changing your lifestyle and may also be prescribed medication.
If your blood pressure is very high
If your blood pressure is very high (180/110 mmHg or above) you should be referred to a hypertension specialist (a doctor who specialises in treating high blood pressure).
The following lifestyle changes are known to reduce high blood pressure:
- regular exercise of at least 30 minutes a day, a minimum of five times a week (e.g. walking, cycling or swimming)
- cutting your alcohol intake to recommended levels (less than 21 units a week for men, and less than 14 units a week for women)
- eating a healthy, low-fat, balanced diet, and restricting your salt intake to less than 6g (0.2oz) a day
- losing weight if you are overweight or obese
- restricting your caffeine consumption to less than five cups of coffee or tea a day
- relaxation therapies, such as yoga and meditation
Even if you achieve a relatively low decrease in your blood pressure, it can still have significant health benefits.
More about preventing high blood pressure
A number of medications can be used to treat high blood pressure. You may need to take more than one type of medication to lower your blood pressure because a combination of treatments is sometimes needed to successfully treat the condition.
If you have high blood pressure, you may need to take blood pressure-lowering medication for the rest of your life. However, if your blood pressure levels stay under control for several years, you should ask your GP if you could come off your treatment and have your blood pressure monitored.
Most medications that are used to treat high blood pressure have some side effects (see below for details of the specific side effects of each type of medication). Consult your GP immediately if you have any of the following common side effects while taking medication for high blood pressure:
- feeling drowsy
- pain around your kidney area (on the side of your lower back)
- a dry cough
- dizziness, faintness or light-headedness
- a skin rash
Research has shown that different blood pressure lowering medications work better for different ethnic groups. For example, ACE inhibitors are more effective as a first-choice medication for treating high blood pressure in white people, whereas calcium channel blockers, or thiazide diuretics, tend to work better for black people.
It is thought that this is because black people tend to have a lower level of renin in their blood. Renin is an enzyme that helps to regulate blood pressure. ACE inhibitors are most effective when there is a high amount of renin in the blood, so they are not as effective in treating black people with high blood pressure.
Therefore, your GP will consider your ethnic background when making a treatment plan.
The most widely used medications for treating high blood pressure are described below:
- Angiotensin-converting enzyme (ACE) inhibitors
- Calcium channel blockers
- Thiazide diuretics
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-converting enzyme (ACE) inhibitors work by blocking the actions of some of the hormones that help to regulate blood pressure.
By stopping these hormones from working, the medication helps to reduce the amount of water in your blood, and it widens your arteries, decreasing your blood pressure.
ACE inhibitors are not suitable for:
- pregnant or breastfeeding women
- people with conditions that affect the blood supply to their kidneys
ACE inhibitors have been known to reduce the blood supply to the kidneys, which can reduce their efficiency. Therefore, blood and urine tests may be carried out before you start taking ACE inhibitors to make sure that there are no pre-existing problems with your kidneys.
You may need to have annual blood and urine tests if you continue to use ACE inhibitors.
Side effects of ACE inhibitors include:
- tiredness or weakness
- a persistent dry cough
Most of these side effects should pass in a few days, although some people find that they continue to have a dry cough.
If side effects become particularly troublesome, a medication that works in a similar way to ACE inhibitors, known as an angiotensin-2 receptor antagonist, may be recommended.
ACE inhibitors can cause unpredictable effects if taken with other medications, including some over-the-counter (OTC) ones. Therefore, as with any prescribed medication always check with your GP or pharmacist before taking any 'over the counter' medication in combination with those prescribed for you.
Calcium channel blockers
Calcium channel blockers work by relaxing the muscles that make up the walls of your arteries. This widens your arteries and reduces your blood pressure.
Examples of calcium channel blockers include:
Every calcium channel blocker acts differently. Common side effects of calcium channel blockers should pass within a few days once your body gets used to the medication, these include:
- flushed face
- swollen ankles
- skin rashes
- abnormally fast, slow or uneven heart rate
Certain brands of calcium channel blocker may also cause constipation in some people.
Do not drink grapefruit juice if you are taking calcium channel blockers because it can lower your blood pressure.
Thiazide diuretics, work by reducing the amount of water in your blood and widening the walls of your arteries. They are not recommended for pregnant women, or people who have gout (a type of arthritis where crystals develop inside the joints).
Thiazide diuretics have been known to reduce the level of potassium in your blood, which can interfere with your heart and kidney functions. They can also raise the level of sugar in your blood, which could lead to diabetes.
Therefore, you will probably be recommended to have blood and urine tests every six months so that your potassium and blood sugar levels can be monitored.
Example of thazide diuretics include:
The side effects of thiazide diuretics include:
- muscle cramps
- going to the toilet more during the day and possibly night
A few people have reported that they could not get or maintain an erection while taking thiazide diuretics. However, this particular side effect was resolved once the medication was withdrawn.
There are two other types of diuretic available which you may be prescribed these are:
- Loop Diuretics
- Potassium-sparing diuretics
Alpha-blockers are effective in reducing high blood pressure. However, they are not usually prescribed unless you are already taking other medication and your blood pressure is still high.
Alpha-blockers, work by preventing the muscles that line your blood vessels (alpha receptors) from being activated and tightening the muscles in the walls of your blood vessels. This enables the blood vessels to relax and open, making it much easier for blood to flow through them and lower your blood pressure.
Examples of alpha-blockers include:
Common side effects of alpha-blockers include:
- fainting spells when you first start the treatment
- swollen ankles
Beta-blockers used to be a popular treatment for high blood pressure, but now they only tend to be used when other treatments have not proved successful. This is because beta-blockers have more potential side effects than the other medications that are used to treat high blood pressure.
Beta-blockers, work by slowing down your heart rate and the force of your heart. This reduces the pressure at which the blood is pumped out of your heart and around your body.
Examples of beta-blockers include:
Common side effects of beta-blockers include:
- cold hands and feet
- slow heartbeat
Less common side effects of beta-blockers include:
- sleep disturbances
Although beta-blockers are not the preferred method of treatment for high blood pressure, they may be considered for younger people if:
- other treatments, such as ACE inhibitors, have not been effective
- a woman is fertile (can become pregnant)
Beta-blockers can also interact with other medications, causing possible adverse side effects. Therefore, as with any prescribed medication always check with your GP or pharmacist before taking any 'over the counter' medication in combination with those prescribed for you
Do not suddenly stop taking beta-blockers without first consulting your GP. Stopping this medication suddenly will lead to serious side effects, such as a rise in blood pressure or chest pain caused by reduction in oxygen to your heart muscle (angina).