I’ve Been Making Lifestyle Changes. But How Do I Know When It’s Time to Start Medication for High Blood Pressure

Almost half of adults in the U.S. have high blood pressure. But only about 1 in 4 of these people have their blood pressure treated and managed. Untreated high blood pressure is dangerous because it increases the risk of a heart attack or stroke - the leading causes of death worldwide.

Many people can lower their blood pressure with lifestyle changes, such as dietary changes, exercise, and weight loss. But this doesn't work for everyone, and medication is often needed to keep blood pressure in the normal range.

Let's take a closer look at when it might be time to consider medication for your blood pressure - and how you can make the best treatment decision for your health.

What lifestyle changes can help to lower blood pressure?

Lifestyle changes can be an effective way to lower blood pressure for many people. The most impactful lifestyle changes to lower blood pressure include:

• Reducing stress

• Following the DASH diet (DASH stands for "Dietary Approaches to Stop Hypertension.")

• Cutting down on alcohol

• Quitting smoking

• Weight loss

• Aerobic exercise

But it's not always easy to incorporate lifestyle changes. It's important to ask yourself if you're able to make long-term lifestyle changes. Do you have a plan? Have you set goals that are achievable? Do you have the support that you need?

What are the signs that lifestyle changes may not be enough to manage your blood pressure?

Unless you're checking your blood pressure regularly, you may not know that it's higher than it should be. So, the first step is to know what your blood pressure should be and to monitor it regularly at home. In general, a normal blood pressure is considered less than 120/80. If your blood pressure is consistently higher than this, despite lifestyle changes, it may be time to consider additional treatment.

How long can you keep trying to lower your blood pressure naturally?

How long you can try to make lifestyle changes really depends on how high your blood pressure is and your own personal risk, such as your age and other health conditions. Healthcare professionals will often use a risk assessment tool to understand your personal 10-year risk of a heart attack or stroke.

What should I do if my blood pressure is elevated?

If your blood pressure is slightly elevated, it will likely be reasonable to try to lower your blood pressure with lifestyle changes. It's usually safe to try to improve your blood pressure in this way for 3 to 6 months.

Blood pressure that's slightly elevated is:

• 120 mmHg to 129 mmHg for the top number

• 80 mmHg or less for the bottom number

Beyond that, medication may be the best next step if:

• You've tried unsuccessfully to lower your blood pressure with lifestyle changes for 3 to 6 months.

• Your blood pressure is in the Stage 1 category for hypertension (top number 130 mmHg to 139 mmHg, or bottom number 80 mmHg to 89 mmHg) and you have other risk factors for a heart attack or stroke (such as increased age, smoking, or diabetes).

• Your blood pressure is in the Stage 2 category for hypertension (top number 140 mmHg and above, or bottom number 90 mmHg and up).

If your blood pressure readings are very high, this is an emergency. You'll need blood pressure treatment immediately to prevent damage to your heart, brain, or kidneys.

Blood pressure readings that are very high are:

• 180 mmHg or higher for the top number

• 120 mmHg or higher for the bottom number

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Are there risks to using medications to lower your blood pressure?

There are many different types of blood pressure medications. They fall into the main categories below, each with their own strengths as well as potential side effects.

Diuretics

Diuretics help your body get rid of extra salt and water to lower blood pressure. Examples include:

• Hydrochlorothiazide

• Spironolactone

• Furosemide (Lasix)

The main side effects may be:

• Increased urination

• Potassium abnormalities

• Dizziness

• Dehydration

• Increased blood sugar

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors work by decreasing angiotensin (which narrows arteries), helping blood vessels relax to lower blood pressure. Examples include:

• Lisinopril

• Benazepril

Common side effects may include:

• A dry cough

• Potassium abnormalities

• Headaches

• Dizziness

Importantly, ACE inhibitors shouldn't be used if there's any chance you're pregnant.

Angiotensin II receptor blockers (ARBs)

ARBs help block angiotensin and help keep the blood vessels relaxed to lower blood pressure. Examples include:

• Losartan

• Valsartan

The main side effects can include dizziness or headaches. These also shouldn't be used if there's any chance you could be pregnant.

Beta blockers

Beta blockers reduce your heart rate and heart output, helping lower blood pressure. Examples include:

• Metoprolol

• Atenolol

The main side effects can include:

• Decreased heart rate

• Fatigue

• Cold hands or feet

• Dizziness

Calcium channel blockers

Calcium channel blockers help lower blood pressure by helping your blood vessels relax. Examples include:

• Amlodipine

• Verapamil

The most common side effects may include:

• Dizziness

• Headaches

• Swelling in your ankles

• Constipation

If you find yourself resisting blood pressure medication, it's important to think about why you might be reluctant to start medication. Make a list of your concerns and take them to your next appointment. It's very normal to have questions and concerns about a chronic health condition, like high blood pressure.

A healthcare professional can work with you to make a treatment plan that fits your needs. Together, you can ensure that the benefits will outweigh potential risks and side effects.

Can you take blood pressure meds while still making lifestyle changes?

Yes, you can take blood pressure medications and still make changes to your lifestyle to help keep your blood pressure in the normal range. In fact, lifestyle changes are a key component of blood pressure treatment, even alongside medication.

Starting a blood pressure medication doesn't mean you'll need to be on that medication for the rest of your life. A healthcare professional can help you monitor your blood pressure over time. Medications can always be adjusted or discontinued.

How to talk to a healthcare professional about taking blood pressure medication

It's never too early to talk with a healthcare professional about your blood pressure. Have you noticed that your blood pressure is at the higher end of normal? Or do you already know you have high blood pressure and you've been trying to make lifestyle changes for some time? Either way, it's time to make that appointment to discuss next steps.

Keep in mind for your appointment

It's a good idea to prepare for your appointment to make sure your goals are met:

• Bring in a log of your blood pressure readings from home. This will help the healthcare professional you're seeing understand your blood pressure trends. (Sometimes blood pressure readings in the office will be higher than your normal ones at home.)

• Take notes. Ask what your goal blood pressure is and write it down.

• Talk about lifestyle changes and ask for help. Be ready to discuss what lifestyle changes you've already made and to ask for the help you need in making more challenging lifestyle changes. For example, you may want to ask for help with smoking cessation, resources for stress management, or a referral to a dietician.

• Discuss medication options. Ask about different medication options and what benefits or side effects you can expect.

• Make a plan. Make a plan for improving your blood pressure and monitoring your heart health at home.

After the appointment, keep track of your blood pressure at home. If you notice your blood pressure isn't meeting your goal - either it's too high or too low - reach out to your primary care provider to make changes to your plan.

Frequently asked questions