High blood pressure is a very big deal. According to the American Heart Association, it affects up to 65 million Americans (nearly one in three adults). The majority (more than 70 percent) are not controlling it adequately. For the most part, the experts are still trying to figure out what causes this common condition and why it becomes so widespread as people age.

If you were to reduce traditional medical wisdom on hypertension to its essence, it would probably come to these four points:

  1. High blood pressure is bad! It contributes to atherosclerosis and leads to strokes, heart attacks, kidney damage, and dementia.
  2. Low blood pressure is good.
  3. Eat less salt.
  4. Take your pills.

Wouldn’t it be wonderful if it were that simple? Like so many things, though, blood pressure (BP) is complicated. For one thing, your blood pressure is not a single, solitary number that remains stable day in and day out. If you were to monitor your BP every few minutes throughout the day and night you would likely discover enormous variability. Over the course of 24 hours, readings could change by as much as 50 points.

Some people may have relatively low blood pressure in the morning when they first get up. After drinking coffee and dealing with rush hour traffic, however, their BP may go up by 10 or more points. A stressful interaction with a co-worker or family member can jack it up even higher. Exercise (including sex) pushes up blood pressure dramatically, but after a strenuous workout, pressure often comes down below where it started. And blood pressure can vary while you are asleep, depending upon whether you are dreaming, sleeping peacefully, or snoring (with sleep apnea).
Even the day of the week can affect your blood pressure. One study revealed that readings are substantially higher on Monday and Tuesday compared to Saturday and Sunday. That’s presumably because people relax on the weekends and are under a lot less stress at home than at work.

Then there’s the whole issue of “white coat hypertension,” so named because it is triggered by the presence of a health professional wearing a white coat. Some years ago Italian researchers demonstrated that when a doctor walked into a patient’s room, systolic blood pressure (the first, or top, number of a blood pressure reading) went up an average of 27 points within 2 minutes. This increase occurred in 47 out of 48 subjects regardless of whether they started with normal blood pressure or had a history of hypertension. Sitting in a doctor’s exam room in a goofy gown with your butt hanging out while you wait forever to see the doctor is not designed to put you at ease. The minute he knocks on the door and comes rushing in, you are likely to feel even more stressed out.

The point is that blood pressure is a constantly moving target. Relying on a single measurement in a doctor’s office would be like looking at a still shot from a 90-minute movie and trying to decipher the plot. If you happened to catch a love scene, you might think the movie was romantic. If the actors were laughing, you might assume it was a comedy. In reality, though, you could not predict how the movie would play out based on a couple of quick snapshots. Likewise, trying to draw conclusions about someone’s blood pressure based on a few readings in a doctor’s office is virtually impossible.

  • High blood pressure is common. The chances are very good that you or someone you love has this condition. It increases the risk of serious health problems like stroke, heart attack, dementia, and kidney disease.
  • Measure your blood pressure properly. Purchase at least one digital device and plot your numbers in a diary or on a computer.
  • Monitor your stress level. Purchase a mood ring or a Bio-Q Thermal Biofeedback and Stress Monitoring Ring. Take time-outs, exercise, and breathe deeply whenever you notice that you’re stressing out.
  • Never forget to make new friends but keep the old; one is silver and the other gold. Social support is crucial to good health!
  • Lose weight and exercise. If you can do these two things, you may not need medication. Losing the belly and the love handles will do more to keep you healthy than almost anything else we can think of. The DASH diet, which is heavy on vegetables and fruits, can lower blood pressure by as much as some medications.
  • Drink tea and avoid coffee and soft drinks. Drink some pomegranate or purple grape juice daily. Indulge in a little dark chocolate.
  • Maximize your minerals: calcium, magnesium, and potassium. Get them from your diet if you can. You may need a magnesium supplement (300 to 500 milligrams daily) if you are taking a diuretic.
  • Beware of the beta-blocker blues. Do not let your medicine cause fatigue, depression, or forgetfulness. Discuss the latest findings about beta-blockers for hypertension with your physician. Do not stop taking a beta-blocker suddenly! Check with your physician before stopping any medication.
  • Diuretics are the first choice for most blood pressure regimens. Chlorthalidone is at the top of our list. It works well and is affordable. Potassium-sparing diuretics such as triamterene and hydrochlorothiazide (found in Dyazide and Maxzide) or spironolactone (Aldactone) may offer similar benefits without risking potassium depletion.
  • The best ace up your sleeve is an ACE inhibitor. These drugs represent some of the best treatments modern medicine has to offer for high blood pressure.
  • If you need additional antihypertensive treatment, work closely with your health-care professionals to find the approach that will best control your blood pressure without causing unacceptable side effects.

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  1. rms

    Female age 77
    I have been on Amlodipine 5mg for 8 weeks. I always had low blood pressure until the last few years when my BP was usually in the normal range. My BP spiked up to 185/90 due to a family crisis and fortunately I had a regular check up within 2 weeks and it was caught and the Dr prescribed the Amlodipine 5mg. After a month it came down to around 140/70 and is now from 125 to 140 and sometimes as low as 114. But the side effect is that I have swollen feet and ankles. When I showed it to the Dr she asked if that was a problem for me. It wasn’t at the time but now they are so swollen that my feet ache and the skin feels so tight it could crack.

  2. BJR

    Female, age 83, in top physical shape in the past. Taking 25 mg metoprolol a.m. and same p.m. following ablation for a-fib six years ago (successfully treated). B.P. has been in normal range since successful ablation.
    Within the last two weeks, have been to the instacare, ER same evening, then ER again two days later with BP at 223 and 220 each, and vertigo prior to each ER visit. Given every test know to man, including nuclear chamber showing blood flow to the heart. Passed all tests with flying colors… (I had also had low sodium level for 6-9 months previous (134, down to 124, but is now within normal range.)
    I was released from ER a week ago with an additional Rx for Losartan 50 mg. (to take in addition to the twice daily metoprolol).
    Have been incredibly off-balance (especially when I get up at night in the dark) since starting the new drug. Reading the side effects for Losartan were quite “scary”…but the doctor reassured me that none of his patients had reported any problems taking the drug, and I should feel safe taking it.
    I continue to be off-balance and want to get off the Losartan. Since I had vertigo symptoms in the beginning, I can’t tell if the Losartan is making it worse, or if there is still an underlying problem we have not yet discovered.
    Blood pressure remains in the high range now that I’m on full meds…145-150 plus.
    I keep trying to find internet answers on how to lower BP naturally. Someone reported celery and celery seeds in one of your news articles, so I am going to try that today. Any suggestions you might have would be GREATLY APPRECIATED.
    Thank you in advance for any assistance or ideas you can provide.

  3. SKB

    My insurance no longer covers Benicar. I am not willing to pay so much for a medication if I can find an alternative. Any suggestions?
    PEOPLE’S PHARMACY RESPONSE: Benicar (olmesartan) is an “ARB.” The earliest ARBs, such as losartan, are now available as generic drugs. Ask your doctor if one would be appropriate for you. Then monitor your own blood pressure to make sure you are responding well.

  4. jean

    My doctor prescribed AMLODIPINE 2.5mg about 6 weeks ago. I took them as proscribed however, the doctor wasn’t happy with the results, so she upped the dosage to 5mg , which I began taking at bedtime, as she indicated. A week ago, today, I developed bloody urine (maroon in color). Naturally this got my attention, I have had a urine test taken (no results, yet), consequentially, I have stopped taking this med since it was the only new wrinkle in my medical horizon.
    Anyone else have this symptom??

  5. RK

    For many years, my BP was the bane of my doctors’ life. Seems it never went below about 155/85, or thereabouts. He put me on Verapamil ER (bedtime) and Benicar (AM). Ok, this got it down somewhat, but only about five to six points, and the Benicar gave me an annoying, long term cough.
    I read about a device called Respar@te (or spelling very close to this), recommended by the Mayo Clinic. Got one and used it consistently as directed. This did the trick, although I continued to take the prescribed meds, but substituted something else for Benicar. After a while, I realized I did not need the Respar@te, and did deep breathing exercises daily, for fifteen to twenty minutes.
    This has kept my bp below 140/75 for several years now. This deep breathing also raised my blood oxygen levels, opened up all the little air sacs in the lower half of my lungs, increasing my ability to do things, such as walking farther and faster. What I do is sit in a comfortable chair, breathe in through the lungs only, hold the breath for about two seconds, exhale, hold about two seconds, then inhale, repeating the process.
    Don’t take more than about six breaths per minute, or one cycle of inhale/exhale every ten seconds. Get yourself a low cost bp monitor and take your bp about a half hour before and after a deep breathing exercise, and write the results in a notebook.

  6. hk

    My b p is unusual. the lower number is usually about half of the upper number. Sunday it was 102/42. as a result, I felt my heart beating stronger and faster and I had to lie down. This lightheadedness happens almost every day. When I saw that the pressure was so low, I took a recommended licorice supplement (for the first time). within a half hour, my bp had jumped to 178/90! I have been to several doctors and worn a heart monitor twice. It showed nothing unusual. Stress test ok too. I am in my 60’s. any suggestions?

  7. D.G.

    What would cause my BP to rise suddenly? I am a 67 year old female and have had low BP all my life. Back in January I gave blood and my BP was about 120/70. A month later my BP was quite high–159/92. When I take my BP at home it is sometimes higher than this and sometimes lower but always high. I eat a healthy diet, am not overweight and take no medications. My Dr. wanted to put me on BP medication which I am reluctant to do. Could something in my diet raise my BP? I take a mulch-vitamin daily, also vitamin C, EFA and a mineral supplement which I have taken for years.
    Is it possible to develop high BP so suddenly?
    Peoples’ Pharmacy response: Since it is sudden, your doctor will need to do a workup to rule out something serious such as pheochromocytoma.

  8. c.h.

    How to tell if it’s sfx or me? Many of the Target effects of conditions I have are the same as listed side effects to immediately report to MD!
    How is it practical to regulate drug quality when response is so variable? what incentives not to cut corners in production? e.g.,psychmeds: only work well in about 30% of patients and only properly diagnosis in about 40% of cases and only, at best, slightly better than placebo, plus, prescribed on trial&error plan… when, rarely there’s any written treatment plan? Patients often go unaware of treatment plans/goals at all!
    Who’s kidding whom?

  9. B.S.T.

    I have High Blood Pressure and I am an older Lady. The doctor has had me taking some dangerous medicine, after I had lots of side effects I researched via Drugs on Web. I got off of Bystolic 5 mg. at night about a year ago and am now still taking Ramipril 10 mg. and Hydrochlorot 25 mg. 1 each morning. I have had lots of breathing problems since I have been on these drugs.
    Also am up every night about every 2 hours to urinate. Can you tell me what is the safest H.P. Drug today? Going to doctor in about 10 days and need to know to discuss my problems and what is safe. I always read your article in the paper and really do trust you both with an answer soon. Thanks for all of your information, you help many people

  10. Kathryn M.

    I have been taking 80 mg of Diovan a day for a year or so. I just had a stress test (I have 4 stents placed 3 years ago) and passed, however my blood pressure at the start was quite high. The cardiologist doubled my Diovan Rx. Afterwards I began to wonder if the Hibiscus tea that I’d been brewing quite strongly to use as a diuretic had been playing with my BP numbers.
    I read in an online post that BP meds and hibiscus should not be used concurrently. Without the BP med–hibiscus can lower BP– with meds especially after hibiscus is stopped the BP can rise. I haven’t used the hibiscus for the past few days and since this is not reported very widely I thought I’d send the experience I’ve had along.

  11. PRS

    Have you ever heard of going off Hormone Replacement Therapy increasing Blood Pressure? My BP was always normal. After stopping HRT my BP was elevated. Please respond to this. I just made an app’t for a physical.
    PEOPLE’S PHARMACY RESPONSE: MAYO CLINIC SAYS ELEVATED BLOOD PRESSURE OFTEN OCCURS WITH MENOPAUSE: http://www.mayoclinic.com/health/menopause-and-high-blood-pressure/AN01463

  12. dj

    What are the best blood pressure medications with the least side effects?

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