The Ups And Downs of Controlling Blood Pressure

blood-pressure-1HYANNIS – Blood pressure has long been called “the silent killer” because it typically has no symptoms until after it has done significant damage to the heart and arteries. The Centers for Disease Control and Prevention estimate that one-third of the adults living in the United States have high blood pressure. Only half of them actually have it under control and many more don’t even know they suffer from hypertension.

Cardiologist Lawrence McAuliffe, MD, of Cape Cod Healthcare Cardiovascular Center in Hyannis said that blood pressure is a particularly insidious problem that is hard to treat if people aren’t willing to change their lifestyles. The new American Heart Association guidelines that suggest maintaining a blood pressure of 120/80 have made this even more difficult, he said.

“Sometimes the amount of drug, and often drugs, plural, that you have to administer to achieve those goals is daunting,” Dr. McAuliffe said. “If someone is taking two and not uncommonly three medications for their blood pressure, they’re popping 10, 12, 15 pills and if they have other medical conditions 20 pills a day. They become a slave to their medications.”

As important as it is to take the medication, patients are often not compliant because of issues of medication side effects, the inconvenience of taking multiple pills and the high costs of prescriptions, he said.

Side effects, in particular, are a very common reason for non-compliance in patients, said Dr. McAuliffe. The side effects of most blood pressure medications are a function of what the medicine is supposed to be doing, such as diuretics, which can cause a dry mouth or increased frequency of urination.

“It’s like the commercials you see on television; drug A is great for this condition and now we’re are going to spend 55 seconds of our minute telling you about all the contraindications and side effects this medicine can cause,” he said. “The rule of thumb is that the treatment shouldn’t be worse than the condition, but sometimes as we attempt to control blood pressure, the side effects from the treatment becomes our biggest enemy.”

Minimizing Side Effects

One of the ways that doctors try to minimize side effects from blood pressure medicines is to prescribe low doses of several different blood pressure medications that each work in a slightly different way. Dr. McAuliffe said the process is a little like Prince Charming finding Cinderella.

“You have to find the right shoe for the right fit,” he said. “You have to find the right medicine or combination of medicines to treat blood pressure. There are nuances in treating blood pressure where you’ll choose one or another agent. Since each medicine works at a different site, sometimes you can get a very good result and lack of side effects using lower doses of two or three medicines rather than mega-doses of one.”

Adopting a heart-healthy lifestyle of eating less salt and more fruits and vegetables, exercising daily and not smoking helps keep blood pressure under control, but some people will still need to take medication or they risk developing heart disease or having a stroke. High blood pressure is the number one cause of strokes and needs to be taken seriously, warned Dr. McAuliffe.

Reducing stress also plays a part in reducing blood pressure. When our bodies are under constant physical or emotional stress, it triggers the fight or flight response of the sympathetic nervous system. That releases adrenaline which causes a constriction of blood vessels which then makes our heart rate go up and causes our blood pressure to rise.

“If you go for a job interview or have to give a speech, those are short-term expected sorts of things,” Dr. McAuliffe said. “But if you have a cranky boss or you’re in a difficult relationship or you have to meet deadlines regularly, the constant stress and the constant barrage of that adrenaline can have a deleterious effect.”

Compliance with medication is very important, but other factors can help keep the numbers down too, said Dr. McAuliffe. One of the easiest ways to relieve stress and control blood pressure is to exercise at least 30 minutes a day. It not only is healthy for your heart, but also your brain.

“In exercise you can measure the endorphins, which make you feel better, more content, and put you in your happy place.”

By LAURIE HIGGINS, OneCape Health News

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