Features August 2014 Issue

5 Reasons Why Your Blood Pressure Still Isn’t Under Control

You may need to step up your efforts in terms of diet, exercise and medication adherence to help bring down your blood pressure.

You may think you’re doing all the right things to get your blood pressure down to a healthy range. But despite your efforts, you’re still not reaching your target blood pressure. If that’s the case, you’re not alone. A report by the National Center for Health Statistics noted that of the estimated 78 million Americans with high blood pressure, 80 percent were aware they had hypertension—yet only half of those people were able to control it.

Controlling your blood pressure usually requires strict medication adherence and other heart-healthy behaviors.

While some individuals suffer from resistant hypertension, a condition in which three or more anti-hypertensive medications still aren’t controlling blood pressure, for many people the problem is more a matter of commitment to the behaviors needed to bring down their blood pressure. “It often comes down to the motivation to institute and maintain lifestyle changes, such as low dietary sodium intake, following the DASH diet, limiting alcohol intake, exercising at least 30 minutes most days of the week, and weight loss if overweight,” explains Cleveland Clinic nephrologist George Thomas, MD.

“Patient education is so important.”

But there may be specific underlying causes, such as hormonal or vascular factors. In many of those cases, the conditions are treatable To better understand how and why ideal blood pressure control remains elusive, Heart Advisor explores five of the most common roadblocks to blood pressure control.

Medication Misuse
Taking prescription medications is a crucial part of blood pressure control for many people. Dr. Thomas makes it a point to explain to patients the importance of being compliant with medications. If you’re not taking your medications as instructed or you’re skipping doses, you’ll find it harder to maintain consistent control of your blood pressure.

“Side effects and/or cost may be a concern for patients,” Dr. Thomas acknowledges. “Patients should discuss any medication concerns with their physicians rather than just stopping medication. Medications take time to work. Some side effects may be mild and usually subside over time.”

Dr. Thomas also notes that you may simply be taking the incorrect dose or be taking an inappropriate combination of drugs to control your blood pressure. You need to work with your doctor to get the right dosage and right mix of medications.
But you should also be aware that other prescription medications, over-the-counter drugs and herbal supplements may interact with your blood pressure medications. You should bring all your medications and supplements to your doctor’s appointment to make sure you’re not taking something that may cause problems. For example, some non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), and cold medicines that contain decongestants may also increase your blood pressure.

Physical Inactivity
Exercising serves several purposes in improving heart health. Regular physical activity, for example, strengthens the heart muscle. That means it can pump more blood with less effort. The result is less force on the arteries and lower blood pressure.
Of course, the opposite is also true. A sedentary lifestyle weakens the heart over time, meaning more force is needed to pump blood throughout the body. This raises blood pressure.

Exercise also helps reduce stress, which can elevate blood pressure. And, importantly, exercise is key to losing weight. Obesity is a significant risk factor for high blood pressure.

The more you can get up and move, the more likely you can control your blood pressure.

Becoming more active can lower your systolic blood pressure (the top number) by an average of 4 to 9 mm Hg. The American Heart Association recommends 30 to 40 minutes of aerobic activity, such as brisk walking, at least five days a week.

Poor Diet
If your blood pressure is difficult to control, you may want to look closely at your sodium consumption. Some people are especially “salt sensitive,” meaning their blood pressure is particularly vulnerable to high sodium intake. You should consume no more than 2,400 mg of sodium per day, though bringing down your daily sodium consumption to 1,500 mg is recommended if you’re struggling with blood pressure control.

Dr. Thomas recommends the Dietary Approaches to Stop Hypertension (DASH) eating plan, which focuses on lower sodium intake and a diet rich in fruits, vegetables, whole grains and lean sources of protein.

Dr. Thomas also warns that excessive alcohol consumption can cause blood pressure increases.

Incorrect Readings
Your elevated blood pressure may actually be inaccurate measurements or a condition known as “white coat hypertension.” If you want to take regular blood pressure readings at home, which is a good idea, take your home monitor to your doctor’s office to make sure it’s calibrated and to learn how to use it correctly.

“Use a device with an arm cuff that is appropriately sized,” Dr. Thomas says. “That is, the cuff should fit properly. Blood pressures should be taken in a seated position, with legs on the ground and uncrossed, and back supported against chair. The arm used for the reading should be supported at heart level. Take blood pressures after sitting quietly for at least five minutes. Patients should not be talking during this time. Take at least two blood pressure readings each time.”

He adds that if you have smoked or exercised, wait at least 30 minutes before checking blood pressure. Keep a log and take it to your doctor at your next appointment for review.

You may also experience white coat hypertension, the name given to elevated blood pressure that exists only when you visit your doctor, Dr. Thomas says. If there is a difference between the readings taken at the doctor’s office and at home, talk with your physician about how to reconcile the disparity.

Underlying Causes
It can often be difficult to pinpoint the exact cause of high blood pressure. But in some individuals, the possible explanations may be more apparent. For example, if the arteries carrying blood to your kidneys become narrowed, you have a condition known as renovascular hypertension.

Narrowing of other arteries in the body due to the buildup of plaque can also contribute to high blood pressure. That’s why it’s critical to manage your LDL cholesterol levels.
Hormonal factors that lead to high blood pressure include thyroid disease and Cushing’s syndrome—a condition in which there is too much cortisol in your bloodstream. By treating these underlying causes, you may have greater success managing your blood pressure.

Don’t give up
If your blood pressure remains above goal, Dr. Thomas suggests a frank discussion with your physician about the possible reason or reasons.

“Talk with your physician about the choice of medications, and the rationale for choosing a particular medication or combination of medications,” Dr. Thomas says. “If your blood pressure remains above goal despite being on three medications including a diuretic (the definition of resistant hypertension), be sure to see a hypertension specialist.”

Dr. Thomas adds that it’s important to set achievable goals with your doctor, and get support at home, too.

“The involvement of family members or friends can help keep patients motivated,” he says. “The important thing is to stay motivated and continue to maintain lifestyle changes to get maximal benefit.”

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