Choosing blood pressure medications

Choosing the right high blood pressure medication can be tricky. Find out which of the various drug options is appropriate for you.

Dozens of high blood pressure medications (antihypertensives) are available, each with pros and cons. Depending on how high your blood pressure is, your doctor may prescribe one or more high blood pressure medications to treat your condition. For everyone who has high blood pressure or is at risk of developing high blood pressure, lifestyle changes can help keep your numbers under control. Before beginning blood pressure treatment, it's a good idea to understand the options available to you.

Lifestyle changes

Whether you're on the road to developing high blood pressure (prehypertension) or you already have high blood pressure (hypertension), you can benefit from lifestyle changes that can lower your blood pressure. People who have prehypertension have a systolic pressure (top number) ranging from 120 to 139 millimeters of mercury (mm Hg) or a diastolic pressure (bottom number) ranging from 80 to 89 mm Hg.
Even if your doctor prescribes medications to control your blood pressure, he or she will likely recommend you make lifestyle changes as well. Lifestyle changes can reduce or eliminate your need for medications to control your blood pressure. To make these changes:

• Don't smoke
• Eat a healthy diet, focusing on fruits, vegetables and low-fat dairy products, and especially, control the salt in your diet
• Maintain a healthy weight
• Exercise by getting 30 minutes of moderate activity — even if you need to break up your activity into three 10-minute sessions — on most days of the week
• Limit the amount of alcohol you drink — one drink a day for women and two a day for men

You probably won't need to take high blood pressure medications if you have prehypertension and are otherwise healthy. However, if you have prehypertension and diabetes, kidney disease or heart disease, your doctor might prescribe medications to lower your blood pressure to a more desirable level.

Medication options for stage 1 high blood pressure (140/90 to 159/99)

If you have stage 1 high blood pressure, you have a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg. If both numbers are in this range, you also have stage 1 high blood pressure. The first change you can make is to adopt healthy lifestyle changes to help decrease your numbers. Your doctor will likely prescribe medications, as well.
Diuretics (water pills)Your doctor may first suggest diuretics — also called water pills. Diuretics work by flushing excess water and sodium from the body, thus lowering blood pressure, which may be enough along with lifestyle changes to control your blood pressure.
Although three types of diuretics are available, the first choice is usually a thiazide diuretic. Thiazide diuretics typically have fewer side effects than do other types of diuretics. They also offer strong protection against conditions that high blood pressure can cause, such as stroke and heart failure.
Other medicationsA diuretic may be the only high blood pressure medication you need. But under some circumstances, your doctor may also recommend another medication or may add another medication. Those choices include:

• Angiotensin-converting enzyme (ACE) inhibitors. These allow blood vessels to widen by preventing a hormone called angiotensin from affecting blood vessels. Frequently prescribed ACE inhibitors include captopril (Capoten), lisinopril (Prinivil, Zestril) and ramipril (Altace).
• Angiotensin II receptor blockers. These help blood vessels relax by blocking the action of angiotensin. Frequently prescribed angiotensin II receptor blockers include losartan (Cozaar), olmesartan (Benicar) and valsartan (Diovan).
• Beta blockers. These work by blocking certain nerve and hormonal signals to the heart and blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and penbutolol (Levatol).
• Calcium channel blockers. These prevent calcium from going into heart and blood vessel muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR) and nifedipine (Adalat, Procardia).
• Renin inhibitors.  Renin is an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren (Tekturna) slows down the production of renin, reducing its ability to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren with ACE inhibitors or ARBs.

Adding one of these medications can lower your blood pressure more quickly than can taking only a diuretic. This may reduce the risk of developing complications from high blood pressure. Combining two medications of different classes may allow you to take a smaller dose of each, which can reduce side effects and perhaps be less expensive. The choice of medications in combination depends on your individual circumstances.

Medication options for stage 2 high blood pressure (higher than 160/100)

If you have stage 2 high blood pressure, you have a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher or both. In this case, you'll likely need to take at least two high blood pressure medications when you start treatment.
As with stage 1 hypertension, your doctor will likely prescribe a thiazide diuretic. Diuretics work by flushing excess water and sodium from the body, thus lowering your blood pressure. Along with a diuretic, your doctor may recommend that you also take:

• ACE inhibitors. This medication helps blood vessels relax by blocking the production of a hormone that causes blood vessels to narrow. Frequently prescribed ACE inhibitors include captopril (Capoten), lisinopril (Prinivil, Zestril) and ramipril (Altace).
• Angiotensin II receptor blockers. This medication allows blood vessels to widen by preventing a hormone called angiotensin from affecting vessels. Frequently prescribed angiotensin II receptor blockers include losartan (Cozaar), olmesartan (Benicar) and valsartan (Diovan).
• Beta blockers. This class of drugs works by blocking certain nerve and hormonal signals to the heart and blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and penbutolol (Levatol).
• Calcium channel blockers. This medication prevents calcium from going into heart and blood vessel muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently prescribed calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR) and nifedipine (Adalat, Procardia).
• Renin inhibitors.  Renin is an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren (Tekturna) slows down the production of renin, reducing its ability to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren with ACE inhibitors or ARBs.

If none of these medications is effective in lowering your blood pressure, your doctor may recommend another medication, such as an alpha blocker, central-acting agent or vasodilator. These medications are strong and may cause more side effects than may other blood pressure medications.
When your blood pressure is very high, it's important to reduce it quickly to prevent or delay complications, such as damage to your arteries, heart failure or kidney damage. A two-drug combination generally works faster than does a single drug to get your blood pressure under control. Sometimes a third medication, or more, may be needed to achieve your blood pressure goal.

High blood pressure and other health problems

High blood pressure often goes hand in hand with other health problems. If you have a serious health condition in addition to high blood pressure, it's likely you'll need aggressive treatment. Those conditions include:

• Heart failure
• Previous heart attack
• High risk of coronary artery disease
• Enlarged or thickened left chamber of the heart (left ventricular hypertrophy)
• Diabetes
• Chronic kidney disease
• Previous stroke

High blood pressure itself puts you at higher risk of having one of these conditions. If you already have one or more of these conditions plus high blood pressure, your chance of developing a life-threatening complication increases. A more aggressive treatment approach may reduce your risk of these complications.
Your doctor may recommend specific high blood pressure medications to treat these conditions, as well as additional medications for your high blood pressure. For example, if you have chest pain (angina), your doctor may recommend a beta blocker, which can lower your blood pressure and also prevent your chest pain, reduce your heart rate and decrease your risk of death. If you have diabetes and high blood pressure, taking a diuretic plus an ACE inhibitor can decrease your risk of heart attack and stroke. If you have diabetes, high blood pressure and kidney disease, you may need to add additional medications to the mix, such as an angiotensin II receptor blocker.

Keep trying to reach your blood pressure goal

Sometimes high blood pressure can be difficult to treat. If your high blood pressure doesn't decrease despite taking at least three different types of high blood pressure drugs, one of which should be a diuretic, you may have resistant hypertension. Resistant hypertension is blood pressure that's resistant to treatment. People who have controlled high blood pressure and are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension.
It's not unusual to try several different medications or doses before finding what works best for you. In fact, if you and your doctor can identify what's behind your persistently high blood pressure, there's a good chance you can meet your goal with the help of treatment that's more effective. Home monitoring of your blood pressure can help your doctor decide if your blood pressure treatment is working, or if a different dose or medication is necessary.
In most cases, a combination of lifestyle changes and medication can help you successfully control your blood pressure. Once that's done, your doctor may recommend a gradual decrease in medications while monitoring the effect on your blood pressure; however, don't attempt to do this on your own.
Keeping your blood pressure under control may take some time, but in the long run it may mean a longer life, with fewer health problems

Add chlorella to your diet - 4 reasons why

Chlorella is a green algae that is considered to be one of the most powerful superfoods known to man. Chlorella contains vasts amount of chlorophyll within its cell walls. The cell walls of chlorella are tough and indigestible, so many chlorella producers break the cell walls before selling the product. Broken cell chlorella releases the nutrients inside the cell walls so the human body can use them. Besides being possibly the richest source of chlorophyll on Earth, chlorella is also very high in plant protein. Chlorella contains fifty-eight grams of protein per one hundred grams of weight. By comparison, beef and chicken have twenty-four to twenty-eight grams of protein per one hundred grams of weight. Chlorella is a pain reliever, reduces hypertension, enhances the immune system in some cases, and chelates heavy metals.

Chlorella has been found to reduce pain

In 2000, a pilot study was conducted in which fibromyalgia patients consumed 10g of a commercially available chlorella tablet and 100mL of chlorella in liquid form. Symptoms were measured at the beginning of the trial, and again after one and two months of treatment with chlorella. After two months on chlorella, the fibromyalgia patients reported a significant 22% reduction in pain and tenderness. One-third of the patients believed their health was better after taking chlorella. Scientists involved with this study stated that a full double-blind, placebo-controlled clinical trial was warranted.

Chlorella reduces or stabilizes blood pressure, even when medication is stopped

In another clinical study, patients with hypertension were given 10g chlorella tablets and 100 mL chlorella extract for two months. Patients were taken off all blood pressure medications, then treated with chlorella. One-fourth of the patients saw a decrease in blood pressure after taking chlorella for two months. The other three-fourths did not see a rise in blood pressure, despite being taken off their blood pressure medication.

Chlorella enhances the immune system after flu shots in some adults

In a clinical trial performed in 2003, patients who had received flu shots were given chlorella to see if the algae improved immune system function. The subjects, all over the age of fifty, took either a placebo or chlorella for three weeks before being injected with a flu vaccine. At one week and three weeks after receiving the flu shots, patients between the ages of fifty and fifty-five who had been taking chlorella had two to four times more antibodies than the placebo group. Results were insignificant for older adults in the study.

Chlorella has potential as a heavy metal chelator

A study involving rats showed the potential chlorella has for counteracting heavy metal poisoning in humans. Male rats were given cadmium chloride, a toxic metal compound used in yellow dye and photocopying. Some rats were also fed chlorella powder, while other rats were used as the control group. Cadmium was found in the bloodstream, liver, kidneys, and small intestines of the rats. However, there was a remarkable increase in cadmium in the urine and feces of the chlorella-fed rats. In addition, tissue damage was less in the chlorella group. The research group concluded that chlorella can be considered an appropriate counteragent for heavy metal poisoning.

chiropractic treatment prevents heart attacks and lowers blood pressure

The popularity of chiropractic care has grown dramatically since the middle of the 20th century. Although most people seek chiropractic treatment to relieve musculoskeletal pain, certain types of pain may be indicative of the patient experiencing a heart attack just before or during treatment.

Chiropractors should expect to have at least one presentation of a myocardial infarction, or heart attack, during their careers, according to chiropractor Dr. Dwain M. Daniel. Research indicates that regular chiropractic adjustments may prevent heart attacks, lower blood pressure, reduce heart rate, relieve chest pain and support the cardiovascular system, according to the Palmer Chiropractic College.

Studies at the College investigated the effects of chiropractic treatment on the sympathetic and parasympathetic nervous systems in reference to an analysis of heart rate variability. Findings indicated that chiropractic adjustments do reduce pain and lower participant's mean heart rate.

Additionally, anecdotal evidence indicates that adjustments of the atlas, or first cervical vertebra, may stop some heart attacks while they are occurring, according to chiropractor, Dr. Christopher Clarke of the Vibrance Family Chiropractic Center in Nashville. If a patient experiences a heart attack during an adjustment, gentle manipulation of the atlas may be appropriate and may alter the outcome; however, other emergency measures must be performed in an attempt to save a patient's life, including transport to the nearest medical facility. There are few studies on this fascinating aspect of chiropractic and additional research is necessary.

Reducing blood pressure

Chiropractic treatment also has a significant effect on blood pressure and anxiety levels, according to a study reported in the Journal of Manipulative and Physiological Therapeutics. The study examined systolic and diastolic blood pressure levels and patients' anxiety levels before and after an adjustment. In all cases, those subjects who received active treatment experienced a distinct drop in blood pressure and a decrease of their anxiety levels. Results of this study provide evidence that chiropractic treatment offers support to the cardiovascular system.

Recognizing signs and symptoms

Women are just as likely to have heart attacks as are men; however, women are less likely to seek medical treatment or attend rehabilitation during or after a heart attack, according to the Journal of Canadian Chiropractic Association. Because women are more than twice as likely to seek chiropractic care, according to Clarke, it's important to recognize the specific symptoms they may exhibit. Men tend to experience extreme pain and heaviness in the chest and left arm during a heart attack. Although women may also experience these effects, they may exhibit very different symptoms, making a heart attack more difficult to diagnose. Women often complain of neck and upper back pain, which is mild and annoying and often mistaken as a structural problem. They are more likely to be misdiagnosed because of the vagaries of their symptoms.

Other symptoms reported by women during a heart attack can range from chest pain brought on during exercise or other strenuous activity that then feels better during rest. There may be crushing chest pain accompanied by other wandering pains to the rest of the body, vague wandering pains extending down one or both arms, and difficulty breathing with shortness of breath, fatigue or weakness. They may also be fearful, anxious and in denial.

Chiropractic treatment can increase vitality, boost immunity, relieve a variety of musculoskeletal ailments and strengthen the heart and cardiovascular system for both men and women. Patients should always check credentials for any chiropractic doctor before undergoing treatment, especially if they have a history of heart disease or other related disorders. Look for an experienced doctor who performs a thorough exam before attempting any adjustments.

Fight high blood pressure with Yoga

When you think of yoga flexibility, relaxation and maybe meditation come to mind. The application of yoga as a system of healing rarely enters the Western mind. Despite today's widespread reliance on Western medicine (drugs), yoga has been used for thousands of years for concerns like high blood pressure (HBP), a condition the University of Maryland Medical Center (UMMC) calls "The Silent Killer".

One in three Americans have high blood pressure, according to the National Heart Lung and Blood Institute. High blood pressure (hypertension) is frequently a precursor to heart disease, the number one killer of Americans. Specific yoga poses are known to be beneficial exercises for high blood pressure.

Lower the numbers

Someone in the United States dies approximately every 33 seconds from heart disease, according to UMMC. The American Heart Association (AHA) recommends exercise, stress management and weight management to prevent high blood pressure, thereby lowering the risk of heart disease. Yoga can help with all three recommendations.

Yoga is known to lower blood pressure, especially the diastolic score, according to the American Yoga Association (AYA). Blood pressure is measured as two numbers, a systolic score written above a diastolic score. The systolic number is a measurement of blood pressure while the heart pumps blood. Diastolic refers to blood pressure between beats. The AYA states that the diastolic number is the most important. Additionally, people with high diastolic blood pressure frequently develop a high systolic blood pressure too, according to the Mayo Clinic.

Yoga benefits high blood pressure through promoting relaxation of the mind and body. Practicing yoga helps decrease the negative impacts of stress, including tension, shallow breathing and elevated heart rate. It also improves physical strength and flexibility, plus may assist with weight loss, according to Prevention magazine.

Beneficial high blood pressure exercises

Certain yoga poses are therapeutic for high blood pressure, according to Yoga Journal. Well-known poses like downward facing dog and easy pose are beneficial, but so are lesser known exercises like the big toe pose and seated forward bend:

Big toe pose

Stand with feet together. Inhale through the nose. Exhale through the nose and bend forward at the waist, keeping the back straight. Grab the big toes and gently pull down.

Seated forward bend

Sit with legs straight and pressed together. Exhale through the nose and bend forward at the hips. Keep the back straight and reach for the toes.

Additionally, MedIndia.net, a website managed by the Medindia Health Network, recommends camel pose and the knee squeeze as high blood pressure exercises:

Camel pose

Kneel on the floor. Exhale and arch the back, reaching back for the ankles. Tilt the head and look at the ceiling. Hips remain in line with the knees.

Knee squeeze

Lie face up on the floor with the legs straight. Exhale, bend one knee and hug it into the chest. Keep the other leg straight. Switch legs.

Potentially dangerous yoga exercises

People with high blood pressure need to be careful with inversion poses, according to Yoga Journal. Inverted poses are where the head is below the heart. This position increases pressure inside the blood vessels of the neck and head. However, starting with mild inversions and gradually increasing the degree of inversion overtime may strengthen the blood vessels and could be beneficial in the long run.

Additional recommendations

To prevent high blood pressure, the AHA advises limiting alcohol intake and refraining from smoking. Eating a healthy diet rich in fruits, vegetables and whole grains, but low in salt, is also recommended.

Diabetics should monitor blood pressure as well as their blood sugar

Amid worrying statistics showing that half of those with diabetes in the UK also have high blood pressure, the Blood Pressure Association is encouraging people with diabetes to monitor their blood pressure along with their blood sugar.
The complications associated with high blood pressure such as heart disease, stroke and kidney disease are even more of a risk if a person has diabetes, so it is vital that diabetics are helped to maintain a healthy blood pressure.
Diabetes charity, Diabetes UK, has warned that people with diabetes need to be aware of the hugely damaging effect that high blood pressure can have on their health and urged that reducing it should be a top priority.
Paul Newman, Chief Executive of the Blood Pressure Association agrees. He says,
“As the leading UK charity dedicated to blood pressure, the Blood Pressure Association exists to support all sufferers of high blood pressure and help them to lower and maintain a healthy blood pressure.
“We are always trying to raise awareness about the dangers of unchecked and untreated high blood pressure and encourage all adults to know their blood pressure numbers as they do their height and weight. Anyone who doesn’t know their blood pressure can easily get a quick and accurate test from their GP surgery or one of many high street pharmacies offering them.
“Diabetics are at increased risk of the effects of high blood pressure and need to be aware of their blood pressure numbers in case it is raised.”
He continues,
“Knowledge really is power where health is concerned. Taking control and managing chronic conditions such as diabetes and high blood pressure puts the patient in charge rather then being dominated by their condition.
“Home blood pressure monitoring is increasingly being used by patients to keep an eye on their blood pressure in between GP appointments and the BPA can advise on which home monitors have been clinically validated.”
Anyone diagnosed with diabetes that isn’t aware of their blood pressure numbers should ask for a test if they are not offered one. If high blood pressure is diagnosed, help and support to lower and manage it is available from the BPA.

British adults eat over 155 billion grams of salt a year!

UK Charity the Blood Pressure Association today released figures which show that UK adults eat over 425 million grams of salt a day adding up to more than 155 billion grams a year.
That’s the weight of 36,000 African elephants.
Fig.1 shows number of grams of salt eaten each year and each day in UK and home nations

	Number of adults (aged 16+)	Total grams of salt a year	Total grams of salt a day
United Kingdom	49,465,700	155,272,832,300	425,405,020
England	41,436,400	130,068,859,600	356,353,040
Wales	2,423,400	7,607,052,600	20,841,240
Scotland	4,227,100	13,268,866,900	36,353,060
Northern Ireland	1,379,000	4,328,681,000	11,859,400

To help lower this huge figure, UK Charity the Blood Pressure Association has today launched a new campaign urging:
• the government to continue its support for lowering salt intake in the UK by setting new salt reduction targets beyond 2012
• supermarkets and food retailers to stock more low salt products to help the 8 million people in the UK currently being treated for high blood pressure and for them to create a ‘no salt’/ ‘salt trace’ category within their ‘free from’ range
• supermarkets to introduce traffic light labeling for online shopping.
By each reducing our salt intake from the current 8.6 grams per day (Ref 2) to 6 grams an estimated 18,000- 21,000 lives a year could be saved (Ref 3); lives currently lost to the effects of high blood pressure such as stroke, heart attack and heart disease.
Professor Graham MacGregor, Chairman of the Blood Pressure Association said “This new analysis shows the huge and unnecessary amount of salt we are all eating- 425 million grams of salt a day! This puts up our blood pressure causing strokes, heart attacks and heart failure as well as increasing the risk of kidney disease, stomach cancer and osteoporosis.
“The Government and in particular the Department of Health needs to be much more proactive and set new salt targets for the industry to achieve so that the recommend level of 6 grams or less per day for all adults is achieved by 2015.
The Department of Health also needs to do much more to ensure that patients with high blood pressure- 16 million in the UK, with 8 million on treatment have a much greater choice of foods with far less salt so that they can reduce their salt intake now, to well below the 6 grams a day target for the general population.
“At the same time it is essential that sign post labeling is made compulsory so that the 16 million patients with high blood pressure can easily choose foods with less salt and thereby help to control their own blood pressure.”
We currently each consume around 8.6g of salt every day which adds up to over a massive 3Kg every year, mostly without even realising it.
75% of the salt we eat is already hidden in the foods we buy. Foods like bread, cakes, ready meals and processed meats such as ham are high in salt.
Mark Hooley, Head of Communications of the Blood Pressure Association said “By launching this campaign we hope to help make every day food choices easier for the 8 million adults in the UK being treated for high blood pressure.
“Everyone has a friend or family member with high blood pressure, so it’s important we get the nation behind the campaign to ensure these changes happen.
“By adding a ‘salt trace’/ ‘no salt’ category to their ‘free from’ range, supermarkets will be making it easier for their 8 million customers currently being treated for high blood pressure to find and buy products that will help them to lower their blood pressure.”
The National Institute for Health & Clinical Excellence (NICE) recommends that adults should reduce their sale intake to a maximum amount of 6g each day.
The Department of Health was planning to continue implementing reduced salt targets for food manufacturers beyond 2012, but concerns are now being raised that this is no longer the case despite NICE calling for a maximum daily salt intake of 6 grams for each adult by 2015 and 3g by 2025.
Ends
Ref 1- Population figures from: Key Population and Vital Statistics, 2007, Office for National Statistics, Series VS No 34, PPI No 30
Ref 2- Salt consumption (8.6 grams) from: “An assessment of dietary sodium levels among adults (aged 16-64) in the UK general population in 2008, based on analysis of dietary sodium in 24 hour urine samples”, National Centre for Social Research, June 2008
Ref 3- How far should salt intake be reduced? Feng J. He and Graham A. Macgregor, Hypertension, November 2003
Ref 4- Weight of African elephants: 2,268 to 6,350 kg= average 4309kg-