How can I lower my blood pressure (BP)?
Definition of high blood pressure
Hypertension, or high blood pressure, is defined as persistently elevated arterial blood pressure.
It is almost always silent. There are no symptoms.
But what is normal? Who to Treat?
There is no such thing as normal blood pressure. There is a normal range = 100/70 – 135/85.
Persistent levels of 135/85 or above (in you are under 70 years) warrants medical assessment – not necessarily treatment. These are the levels at which treatment is considered.
- Healthy range: Clinic/home BP <135/85
- Stage 1 Hypertension: Clinic BP ≥140/90 mmHg – repeat 2 weeks later – treat some
- Stage 2 Hypertension: Clinic BP ≥160/100 mmHg – treat soon
- Severe Hypertension: Clinic BP ≥180/120 mmHg
- Needs medical attention
- Treat now
- Investigate for secondary cause.
How to lower your blood pressure – 5 principles
There are 5 main principles of treatment to reduce blood pressure.
1. Lifestyle modification
First-line for all patients:
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- Reduce your salt intake
- Adopt a balanced diet: Rich in fruits, vegetables, whole grains, and low in saturated fats
- Regular physical activity: At least 180 minutes of moderate exercise per week
- Limit alcohol consumption: No more than 14 units per week
- Smoking: Stop smoking
- Weight reduction: Lose weight if you are overweight. Aim for a BMI of under 30 kg/m².
2. Treat secondary cause
If there is an underlying cause, you need to see the relevant specialist – e.g. nephrologist (kidney doctor) if you have Stage 3B CKD (chronic kidney disease) or worse. There may be a treatable underlying cause of your CKD.
Another example is high BP secondary to pregnancy (pre-eclampsia). Deliver your baby.
3. Pharmacological therapy
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- Stage 1 Hypertension: Consider treatment if your 10-year cardiovascular risk is ≥10% (using the QRISK3 score), or you have diabetes
- Stage 2 Hypertension: Medication is recommended for all patients
- First-line therapy
- ACE inhibitors (e.g. ramipril) or ARBs (e.g. losartan): Preferred in patients under 55 years or those with diabetes
- Calcium channel blockers (e.g. amlodipine): Preferred in patients over 55 years or those of Afro-Caribbean descent (often require three drugs or more to control their BP)
- Thiazide-like diuretics (e.g. indapamide): Consider if calcium channel blockers are not suitable
- Alpha-blockers (e.g. doxazosin).
- Second-line therapy
- Beta-blockers (e.g. bisoprolol): Not first-line but may be used in specific cases (e.g. patients with heart failure, angina, or tachyarrhythmias). Labetolol is often used in pregnancy. Anxiolytic effects are helpful
- Other vasodilators: e.g. hydralazine and/or minoxidil can be used by specialists for severe BP
- Centrally acting drugs: e.g. methyldopa (also used in pregnancy)
- Combination therapy: Often required for effective control, involving drugs from different classes.
4. Role of loop diuretics (and/or fluid restriction)
This is especially useful in you also have chronic heart failure (CHF), CKD or another kidney disease called nephrotic syndrome. In patients with advanced CKD (CKD4/5), uncontrolled hypertension can be one of the indications to start dialysis.
You need regular follow-up to monitor BP control (and U&Es) and potential side effects. Many GP surgeries have a practice nurse or clinical pharmacist that run clinics to monitor BP treatment – book in!
Target blood pressure
130/80 is a good average target for most patients, and 120/70 if you have diabetes.
If your BP cannot be controlled on 3 drugs
You should be referred to see a hospital consultant. These can be in various departments including cardiology, endocrinology or nephrology (depending on local practice).
Summary
We have described how to lower your blood pressure. We hope it has been helpful.
