Features March 2012 Issue

Managing Blood Pressure Now Pays Big Benefits Later

Recent studies show the long-term effects of controlling your blood pressure with medication and a healthy lifestyle.

It’s the condition that is often overlooked or taken less seriously because it doesn’t have obvious symptoms. But high blood pressure must be controlled as early as possible, according to two new studies.

The iHealth blood pressure monitoring system allows you to measure your blood pressure, keep track of changes in your BP, and easily send the information to physicians or family members using your iPod Touch, iPad or iPhone. It’s just one of many innovations in home health care.

One study published in the Dec. 19, 2011 online issue of Circulation found that preventing hypertension by age 55 significantly lowers the risk of cardiovascular disease later in life. A separate study, published in the Dec. 21 issue of the Journal of the American Medical Association, revealed that chlorthalidone-based therapy can prolong life. Chlorthalidone is a commonly prescribed diuretic.

Cleveland Clinic cardiologist Curtis Rimmerman, MD, notes that chlorthalidone is the recommended first option in treated elevated blood pressure by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), the latest consensus report from the National High Blood Pressure Education Program of the National Heart, Lung, and Blood Institute. He says the basic message from this and similar studies is that the earlier you start treating high blood pressure, the better. There is no reason to wait.

He says the risks are cumulative, and related to the extent of the high blood pressure and the duration of the time you are hypertensive. “Unabated, elevated blood pressure increases the risk for left ventricular wall thickening (hypertrophy) and congestive heart failure, coronary atherosclerosis and heart attacks, cerebral atherosclerosis and strokes, heart rhythm abnormalities, and aortic aneurysms,” Dr. Rimmerman explains. “Kidney disease incidence is also increased.”

He adds that over time, hypertension leads to an adverse remodeling of the arteries. They thicken, they stiffen and they are more prone to atherosclerosis development and progression, Dr. Rimmerman says. “The earlier that you develop high blood pressure, the greater likelihood that it will be present later in life.”  

Understanding Diuretics
Diuretics, such as chlorthalidone, help lower blood pressure by reducing fluid levels and helping  the kidneys filter out more water and sodium in urine.

Chlorthalidone is usually taken once a day with food, preferably after breakfast. But you should always check with your doctor about the timing of any medications you take. If you follow the prescription instructions closely, you should be able to avoid the medications side effects, such as low potassium, lightheadedness or dizziness due to dehydration from the diuretic effect. “These are all unlikely to occur if under the supervision of a physician,” Dr. Rimmerman adds.

While diuretics are often the first line of medications prescribed to treat hypertension, many patients will often require other drugs to get their blood pressure to their target levels. “It (chlorthalidone) works synergistically in lowering blood pressure, making the effect greater than the sum of the parts,” Dr. Rimmerman says.

Of course, to help ensure that effectiveness, patients need to follow their medication regimen closely. Remembering what to take and when can be difficult, especially if several pills are required each day.

Dr. Rimmerman suggests some easy-to-follow tips. “If you brush your teeth twice daily, keep your meds near your toothbrush and use the left-hand drawer for AM meds and right-hand drawer for PM meds,” he advises. “Or use some other drawer / placement system, but whatever you choose, make it foolproof.”

Other Self-Management Keys
It’s important to remember that heart health isn’t found in a pill only. The best medications can lose some of their effectiveness if you don’t follow other important steps.

Dr. Rimmerman advises everyone to get plenty of quality sleep and to talk with your doctor or a sleep specialist if you have trouble sleeping through the night. Obstructive sleep apnea is a known and largely undertreated cause of elevated blood pressure, but it’s one that can be treated, he adds.

Reduce the stress in your life as much as possible; consider counseling or therapy if you find yourself feeling anxious, depressed or unable to de-stress.

Other important steps include aerobic exercise for at least 30 minutes a day, a reduced sodium diet (especially in salt-sensitive blood pressure patients), and weight loss for anyone who is overweight or obese. Talk with your doctor about a good target weight for you and discuss strategies to help you reach that goal.