What are the medication treatment options for high blood pressure?
When is medication treatment started for high blood pressure (hypertension)?
Medication to lower blood pressure is usually advised for:
- All people who have a blood pressure that remains at 160/100 mm Hg or above after a trial of any relevant lifestyle changes.
- People with a blood pressure that remains at 140/90 mm Hg or above after a trial of any relevant lifestyle changes AND who have:
- Diabetes; or
- An existing cardiovascular disease; or
- A 2 in 10 risk or more of developing a cardiovascular disease within the following 10 years (as described above).
- People with a blood pressure of 130/80 mm Hg or more who have certain diseases. For example, people who have certain complications from diabetes, people who have had a recent heart attack, stroke or transient ischaemic attack (TIA) - sometimes called a mini-stroke. Also, some people with certain ongoing (chronic) kidney diseases.
What is the target blood pressure to aim for?
If you are taking medication to lower high blood pressure:
- For most people who are otherwise well, the target is to reduce blood pressure to below 140/90 mm Hg. If you are checking your blood pressure at home, the aim is for the average to be below 135/85 mm Hg.
- If you are aged 80 years or more, the target is usually to reduce blood pressure to below 150/90 mm Hg. If you are checking your blood pressure at home, the aim is for the average tobe below 145/85 mm Hg. However, there is now increasing focus on looking at your 'biological' age (whether you're in better shape than most people fo the same age) so if you're very healthy, your doctor may aim for a lower target
- In some people, the target is to get the blood pressure to an even lower level. This generally applies to people who have diseases where very good blood pressure control is important. This includes:
- People who have a cardiovascular disease.
- People with diabetes.
- People who have a chronic kidney disease.
You will be advised of your blood pressure target level by your GP or practice nurse.
What medicines are used to lower blood pressure?
There are several medicines that can lower blood pressure. The one chosen depends on such things as:
- Whether you have other medical problems.
- Whether you take other medication.
- Possible side-effects of the medicine.
- Your age.
- Your ethnic origin.
Some medicines work well in some people and not so well in others. One or two medicines may be tried before one is found to suit.
One medicine reduces high blood pressure to the target level in less than half of cases. It is common to need two or more different medicines to reduce high blood pressure to a target level. In about a third of cases, three medicines or more are needed to get blood pressure to the target level. In some cases, despite treatment, the target level is not reached. However, although to reach a target level is ideal, you will benefit from any reduction in blood pressure.
How long is medication needed for?
In most cases, medication is needed for life. However, in some people whose blood pressure has been well controlled for three years or more, medication may be able to be stopped. In particular, this may be possible for people who have made significant changes to lifestyle (such as having lost a lot of weight, or stopped heavy drinking, etc). Your doctor can advise you.
If you stop medication, you should have regular blood pressure checks. In some cases the blood pressure remains normal. However, in others it starts to rise again. If this happens, medication can then be started again.
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Further reading & references
- Hypertension: management of hypertension in adults in primary care; NICE Clinical Guideline (August 2011)
- Guidelines for the management of arterial hypertension; ESH/ESC Clinical Practice Guidelines, European Society of Cardiology (2013)
- He FJ, Li J, Macgregor GA; Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ. 2013 Apr 3 346:f1325. doi: 10.1136/bmj.f1325.
- Description of the DASH (Dietary Approaches to Stop Hypertension) Eating Plan; National Institutes of Health
- Lipid modification - cardiovascular risk assessment and the modification of blood lipids for the prevention of primary and secondary cardiovascular disease; NICE Clinical Guideline (July 2014)
- Ettehad D, Emdin CA, Kiran A, et al; Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016 Mar 5 387(10022):957-67. doi: 10.1016/S0140-6736(15)01225-8. Epub 2015 Dec 24.
- Alcohol Guidelines Review – Report from the Guidelines development group to the UK Chief Medical Officers; Department of Health, January 2016
- 2016 European Guidelines on cardiovascular disease prevention in clinical practice; European Society of Cardiology (2016)
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