Wednesday, December 30, 2009
Types of Blood Pressure Medications
Many medications known as antihypertensives are available by prescription to lower high blood pressure. There are a variety of classes of HBP medications, and they include a number of different drugs.
See an illustration of antihypertensives
* Some of the major types of commonly prescribed cardiovascular medications are summarized in this section. For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking; however, the AHA is not recommending or endorsing any specific products. If your prescription medication isn't on this list, remember that your healthcare provider and pharmacist are your best sources of information. It's important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects. Never stop taking a medication and never change your dose or frequency without first consulting your doctor.
High Blood Pressure
Also called: HBP, HTN, Hypertension
Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure.
Your blood pressure reading uses these two numbers, the systolic and diastolic pressures. Usually they are written one above or before the other. A reading of
- 120/80 or lower is normal blood pressure
- 140/90 or higher is high blood pressure
- 120 and 139 for the top number, or between 80 and 89 for the bottom number is prehypertension
High blood pressure usually has no symptoms, but it can cause serious problems such as stroke, heart failure, heart attack and kidney failure. You can control high blood pressure through healthy lifestyle habits and taking medicines, if needed.
National Heart, Lung, and Blood Institute
- Start Here
- High Blood Pressure
(National Heart, Lung, and Blood Institute)
Also available in Spanish
- High Blood Pressure: Things You Can Do to Help Lower Yours(American Academy of Family Physicians)
Also available in Spanish
- Hypertension
(Patient Education Institute)
Also available in Spanish
- High Blood Pressure
High Blood Pressure Diet
Hypertension is another name for high blood pressure.
It is a condition that occurs when the pressure inside of your arteries is too high. Because it is a silent disorder the only way to detect hypertension is to have your blood pressure measured.
Hypertension is a very common problem that affects about 50 million people in the United States alone.
That’s about 1 out of every 4 adults. It is more common as people grow older and is more common and more serious in African Americans.
What do the numbers mean?
Blood pressure measures the natural pressure created by blood pumping through your veins and arteries. Blood pressure is read as two numbers, one over the other. The top number, or systolic blood pressure, measures the blood pressure when the heart pumps. The bottom number, or diastolic blood pressure, measures the blood pressure between heartbeats when the heart rests.
Hypertension is blood pressure that is over 140/90
Optimal blood pressure is under 120/80
Risk factors you can control
9 out of every 10 people who have hypertension do not have a known cause for their condition. A family history of hypertension is a risk factor for developing the condition. With or without a family history, you have a chance of avoiding or controlling hypertension by:
• Keeping your weight under control
• Keeping physically fit
• Eating a healthy diet low in sodium and rich in nutrients potassium, magnesium and calcium
• Limiting alcohol intake (no more than 2 mixed drinks or two 12 oz. cans of beer or two 6 oz. glasses of wine daily)
• Never smoking or quitting immediately
• Avoiding medications that might increase your blood pressure:
o Decongestant nasal sprays and pain medications called non-steroidal anti-inflammatory drugs (NSAIDS)
Therapeutic foods
• Increase consumption of vitamin C-rich foods (citrus fruits, strawberries, red peppers, dark green leafy vegetables)
• Increase consumption of vitamin E-rich foods (almonds, hazelnuts, wheat germ, peanut butter)
• Increase consumption of magnesium-rich foods (soybeans, tomatoes, beans, nuts & seeds, squash, broccoli, dark green leafy vegetables, tofu, wheat germ, halibut, swiss chard)
• Increase consumption of potassium-rich foods (grapefruit, grapes, tomatoes, beans, apricots, asparagus, beets, broccoli, corn, cucumbers, dates, salt-water fish, lamb)
• Increase consumption of calcium-rich foods (yogurt, sardines, salmon (canned with bones), milk, cheese, dark green leafy vegetables, broccoli)
• Try cooking with less salt. Experiment with spices such as, parsley, basil, oregano, ginger, sesame, dill, cilantro, curry, pepper, and thyme to reduce the amount of salt used in cooking
• Cut back on sodium, including that in processed foods and in many drugs (check labels for soda, sodium, or salt). Avoid commercial sauces like soy or Worcestershire and commercial salad dressings (check labels for sodium content)
• When eating out, ask for your food cooked without added salt
Physical Activity
Start slowly and build up gradually. American College of Sports Medicine (ACSM) recommends 20 to 60 minutes of aerobic activity 3 to 5 days per week. Aerobic activity will strengthen your heart and reduce your risk of developing heart disease. It will also help to control your weight. Try brisk walking, jogging, biking, hiking, group exercise classes (water aerobics, kick-boxing, judo), running stairs, rowing, and team sports (football, soccer).
Hypertension can lead to other serious health problems:
Routinely monitoring your blood pressure is important. Hypertension has been called a “silent killer” because it has no specific symptoms and it can lead to death. People who have hypertension that is not treated with lifestyle modifications and medications (if necessary) are likely to experience one or several of the following conditions:
• Coronary artery disease, heart attack, heart failure, or abnormal heart beat.
• Kidney failure
• Peripheral vascular disease, hardening and narrowing of the arteries (atherosclerosis) that supply blood to the arms, legs, and other parts of the body
• Retinopathy, or damage to the tiny blood vessels that supply blood to the light-sensitive lining of the back of the eye
• Stroke
Sources:
American Heart Association. “Why Should I Care?” http://www.americanheart.org/hbp/care.jsp
National Heart, Lung and Blood Institute, Publication 03-5232, 2003.
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High Blood Pressure: 21 Natural Remedies
What are the Best Natural Medicines for High Blood Pressure?
By Dr. Nicole Sundene
High blood pressure or “hypertension” is a tough nut to crack with natural medicines. But, since I am just your “blog doctor” and not your real doctor, I can step out on a limb and tell you why you REALLY have high blood pressure.
Of course, there are many etiologies to this common disease; however, most cases are because we have gotten fat, old, and out of shape. Yes, there are exceptions to the rule, so don’t be hitting the contact form to send me hate mail.
This is just tough love people!
Regardless, I just announced the pink elephant in the room. So as stated in my tricky little diatribe on “Chocolate Chips Better than Viagra?” we want an “elastic” cardiovascular system and not a non-compliant one. And when I say non-compliant, I am not talking about a badly behaving cardiovascular system. I am talking about elasticity of your arteries.
Alternative treatments are not as efficacious as they could be when it comes to hypertension, and diet and exercise are the key to keeping blood pressure low. The fact that you are no longer young and fit is the real problem, and we all inevitably develop hardening of the arteries known as “atherosclerosis”, which is the leading cause of high blood pressure.
While you are working to adopt a healthier lifestyle I would recommend a basic regime of aWhole Foods Diet, magnesium, coQ10, vit C, Potassium, and fish oil (do NOT take if you are on anti-coagulants), as these nutrients combine well with most medications (always remember to
check with your naturopathic doctor or family doc before implementing ANYTHING new.)
Monitor your blood pressure three times a day while making new changes to ensure you are not over-medicating with natural remedies.
The best natural medicines for high blood presssure:
1. Magnesium: 300-500mg daily (may need
to divide doses to avoid diarrhea) Magnesium is a muscle relaxant and the arteries are all surrounded with smooth muscle.
When the smooth muscle surrounding your arteries relaxes, it causes your arteries to dilate which results in a drop of blood pressure. Most people are deficient in magnesium anyway, as the richest sources are found in green veggies. I would guess about 90% of American’s are magnesium deficient.
2. CoQ10: 100 mg daily (You should be on this anyway if you have high cholesterol as statins deplete this nutrient, and the common sign is muscle weakness or pain, or in the severe form rhabdomyolyosis).
CoQ10 is depleted by statins (lipitor, lovastatin, etc) inhibition of HMGCoA reductase in the cholesterol pathway, so it is best to replete this potent antioxidant, and you may feel
more energetic on your lipitor. I am just waiting for a pharmaceutical company to smartly come out with a statin that includes CoQ10. This nutrient is expensive, but it is worth the bang for the buck if you can afford it.
If you can’t afford it, remember that exercise is free and it is one of the better treatments anyway. If you have high BP check with your doc before starting a new exercise program as they may want to do an EKG or exercise stress test. Otherwise, be sure to purchase a high quality brand of CoQ10 in an emulsion (liquid capsule not tablet) form as this nutrient is fat soluble.
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3. Garlic: Liberally in the diet (cooking does reduce the allicin content, s
o raw is best but I understand if you still need to keep a few friends around…it just means you have to eat m
ore cooked or roasted garlic to attain the same therapeutic effect.)
Or just take garlic as directed if you are going with a supplement form. (Kyolic brand has been widely studied and shown to be efficacious according to the studies.)
Because various studies have shown garlic to be effective as an anti-hypertensive agent, I would start slow and monitor blood pressure. Garlic also lowers blood sugar, so if you are diabetic you should check your sugars more often while implementing this natural therapeutic for hypertenstion.
4. Potassium: at 24 mmol (ask your doc for a prescription, but chances are you are already on this as most anti-hypertensives are potassium depleting) If you want to get this from dietary sources, then just eat green leafies and fruits like bananas. Check with your doctor before using this as a therapeutic agent if you have kidney disease or if you are already on a potassium sparing diuretic medication (used for high BP.)
5. Vitamin C: 1000 mg twice daily. Emergen-C packets are the simplest way to achieve this along with vitamin C rich foods.
One of the cheapest and most well studied anti-oxidants by Linus Pauling: the theory with vitamin C and blood pressure is that high blood pressure typically results from a few causes.
Hyptertension is caused either by problems in the kidneys, or “atherosclerosis” or hardening of the arteries. We want arteries to be compliant as I noted in my tirade, “Chocolate Better than Viagra?”Vitamin C is a very cheap antioxidant that
helps prevent the LDL from “oxidizing” and forming the hardened plaques in our arteries that cause them to lose their elasticicty. Think of vitamin C as the nutrient that keeps your pipes from rusting. Just about everyone should be on vitamin C anyways.
6. Calcium: 800 mg daily. Most Americans do not achieve this in the diet. Research has shown that calcium will slightly help to lower blood pressure…and we’ll take every little bit we can. Natural medicines work well in incremental steps and synergistically.
The goal with most of these supplements is to create an additive effect. Most people are deficient in this essential nutrient anyway, as 800mg is required for the average adult. Take your calcium and magnesium 1-2 hours before bed to ensure a good night’s sleep as they are also great muscle and nervous system relaxants.
7. Fish Oil: 1 tablespoon of cod liver oil or salmon oil daily. Omega 3 fatty acids, as noted in my article “Fish vs Flax” if you have hypertension, I frankly wouldn’t waste my time with flax oil.
Trust me, I love flaxseeds, and I put everyone on them, but if you are really trying to get a therapeutic effect you need something that is further along the anti-inflammatory pathway. If you haven’t seen the biochemistry of what I’m talking about then quit arguing with me about this.
Many nutrient cofactors and coenzymes that most Americans are also deficient in are needed to convert flax to what fish oil is. Also those of Northern European descent such as Scandinavians likely are deficient in the enzyme needed to convert flax seeds, as their traditional diet is based on cold water fish rich in Omega 3’s.
8. Rauwulfia: Don’t use this herbal medication without consulting your naturopathic physician. This is “big medicine” in my opinion, and should not be used without being adequately monitored. However, a randomized study showed less depression when compared to reserpine. Ask your naturopathic physician about this medicine.
9. Stevia: The herb known for it’s sweetness has also been shown to reduce blood pressure at 500 mg three times daily. If you have high blood pressure, you have my permission to try out some of the new stevia containing foods and beverages such as Zevia soda. I prefer the “Wisdom of the Ancients” in the green packets as my fav Stevia. Keep some packets on you and try it in your coffee or tea instead of your typical sweetener. Just don’t use too much as it is REALLY sweet!
10. L-Arginine: 2 grams three times daily. The amino acid that is famous in those late night infomercials for “Extenze” L-arginine works to enhance blood flow by being the precursor to nitric oxide production. Nitric oxide dilates our blood vessels and when we go back to the hose analogy we decrease the flow when we take our thumb off the hose. That is what L-arganine and similar nutrients do for hyptertension.
11. The Dash Diet: Involves extreme sodium reduction to <2000mg>
12. Tai Chi: This gentle exercise is perfect for everyone trying to lose weight or reduce arthritis, stress, or just increase agility, balance and peace of mind. Tai Chi is totally fab! Find a few favorite Tai Chi moves from classes at your gym or favorite video and try to incorporate at least five to twenty minutes of these gentle stretches in to your day. Do you know when I do them? When someone says “Can you hold please?” I then put them on speaker phone and say “sure no prob.” Sometimes I can get a whole fifteen minutes in.
13. Weight Loss: Nag, nag, nag…lose weight. Yah, yah, yah….You’ve heard
it. If you are over-weight you know it so I would recommend following my simpleweight loss plan, and if you can’t do t
hat then please consider investing in some long term help such as Author Mary O’malley’s enlightening work, “The Gift of Our Compulsions” to address the route underlying cause of your disordered eating
issues.
Of course our metabolism gloriously slows down about 1% each year, which accounts for the 10 pound weight gain each decade.
It may be just a discipline thing. Each year we have to learn to eat 1% less, otherwise each decade we will gain at least ten pounds. How is that for a birthday present?
14. Decrease/Eliminate Caffe
ine: Caffeine is just like throwing gasoline on the hypertensive fire.
Now the reason why people get those “caffeine headaches” is because they are used to caffeine restricting all their blood vessels…but once the body metabolizes all the caffeine we get the painful rebound headache effect called “vasodilation” which means that our arteries dilate and cause a throbbing headache.
So why do we care about caffeine headaches? Because when we constrict blood vessels we increase blood pressure.
Remember again sticking your finger over the hose when you were a child and making the water shoot further? Well that is not necessarily a good thing in the body. A cup or two of coffee a day typically isn’t the problem, it is caffeine in excess.
If you have severe hypertension you may want to consider switching to decaf green tea, or herbal tea. Otherwise, you can likely enjoy certain caffeinated beverages socially, or moderately as long as your hypertension is within optimal range through the use of other natural modalities or prescription medicines.
15. Quit sugar. Sugar is the culprit for many diseases, and although not typically associated with hypertension may be the root cause. Try eliminating sugar or cutting back for a few weeks and track your daily numbers.
I have heard many anecdotal reports from Naturopaths about patients reducing salt and not seeing any results, so they tried reducing sugar (which we all need to do anyways!) and SHAZAM…the blood pressure goes down.
Refined sugar throws the body out of balance because it simply is just not natural. Everyone in industrialized countries should read Dr. Scott Olson’s brilliant book “Sugarettes,” to fully understand how refined sugar is destroying your body from the inside out.
16. Consider food allergies. A recent study has linked food allergies to hypertension. Food allergies can cause a myriad of problems and a food allergy elimination diet is a great thing for everyone to try at some point. I was forced to do it enthusiastic as a student to try this challenge as mandated by my teacher, and surprised at the results.
Basically it entails you have to eat completely differently for about a month and then you test the foods you most commonly eat to determine if they are causing a symptom within a three day window.
What is the first thing your doctor does if they think you are having an allergic reaction? They check your pulse and BP. Low grade allergies may go unnoticed, and high blood pressure or a rapid pulse may be the only clue.
17. Not enough good oil, too much bad oil. As discussed in my article “Olive Oil Reduces DNA Damage” we want to increase our good fats such as olive, fish, and flax, and decrease fried and fatty foods.
Think of saturated fat as little cement bricks building up in your arteries and making them hard and narrow. The good fats as recommended in “The Mediterranean Diet” are what will keep your cardiovascular system running like a race car. Most men worry about changing the oil in their cars more than they do than changing the oils in their body. But, just remember impotence is better prevented.
18. Coleus forskhohlii: Ask your naturopath about this herb. I don’t recommend self treatment with herbs for high blood pressure. But the studies show it to be efficacious, and it is certainly worth trying.
19. Manage Stress. Blah blah blah stress. I can see you all rolling your eyes as you read this, but really stress is often the root cause of hypertension. Having worked eight years as a medical assistant I have seen enough cases of “White Coat Hypertension” to know that stress causes high blood pressure.
The doctor’s office may not be that thing that gets your blood pressure raging, but if you have high blood pressure you likely need to cut back on activities, work, and practice some breathing exercises shown to reduce BP such as “Square Breathing” or “Five Minutes to Zen.” Consider taking up a relaxing hobby, musical instrument, or new craft.
20. Eat celery and parsley. Who knew that garnish on your plate is an actual diuretic? Celery has been used anecdotally with many pati
ents. If you are trying to lose weight, increase fiber, or just be healthy….celery should be a daily snack anyway.
21. Exercise *shudder* I know. I know. You probably have high blood pressure because you don’t exercise. I put this last because it is the most important and I would like to go off on a little bit of a rampage on why none of the aforementioned natural substances or pharmaceutical medications will work in the way that diet and exercise will.
Why is that? Well hyptertension is a sign that you are in poor physical condition, that is if you have the typical form of high blood pressure caused by being overweight, overage, and over the whole exercise thing. There are other forms, but the average American has high blood pressure because they are out of shape.
It is time to start eating better, exercising daily, as well as add in a few supplements to help maintain a healthy “flexible” cardiovascular system. You cardiovascular system cannot be “conditioned” without exercise for twenty minutes daily in the cardio zone which is 70-80% of your max heart rate (220-your age mine is 33) x .7= 130. Shoot for daily and then if you hit five days a week or even three days a week it will make your blog doctor happy.
So in order for me to make any progress with preventing cardiovascular disease I need to be working out as mentioned in my article on “Exercise.”
Keep in mind that herbs such as dandelion that have been shown to be efficacious against anti-hypertensive medications such as furosmeide require HIGH doses in order to be effective. In order to lower pressure using dandelion, you have to literally take tablespoons of the tincture daily…and that is LEAF not root. The root serves to detox the liver and the leaf is used for blood pressure.
Be sure you are always using the correct form of the plant. Many research studies done to show herbal medicines as ineffective have been done on the wrong form of the plant, whether intentional or not. Always read the label and make sure you are purchasing the correct form of the herb you are using.
Exercise, Whole Foods Diet, fish oil, vitamin C, CoQ 10,magnesium, and potassium are the most benign substances on this list if you are concerned about combining them with anti-hypertensive drugs. That combined with diet and exercise should help you gain better control of your numbers.
You may at some point want to discuss lowering your blood pressure medicine if not phasing off it, as the goal is to be on as few meds as possible, and many patients do not like the typical side effects of high blood pressure medicine such as fatigue, dizziness, and so forth.
Once stable on natural meds, your blood pressure should still be monitored daily to ensure there is not an additive effect and you end up with too low blood pressure aka “hypotension” and that the BP is optimally under 120/80 if not 120/70.
If you tend towards hypertension remember that anytime you are not feeling well the first thing you should grab is your home blood pressure cuff (best brand is Omron according to my pharmacist,) unless you need to call 911 because you are having chest pain or any other cardiac symptoms such as pain in the neck, arms, flu like symptoms, sweating, and so forth. As my very wise cardiology teacher Dr. Pournadeli states, “anytime their is pain above the belly button assume MI (Myocardial Infarction=Heart Attack) until ruled out.”
Stroke, heart attack, impotence, kidney failure, and eye disease are all part of the ugly sequalae to uncontrolled high blood pressure. Prevention is key with hypertension. Try one new thing at a time and give it a few days to make sure it is not causing adverse side effects.
Thanks for stopping by my kitchen table,
~Dr. Nicole Sundene
©http://KitchenTableMedicine.com
Related Reading:
Tips on How to Lower Sodium
Alternative Treatments for Hypertension
References:
1. The beneficial effect of regular endurance exercise training on blood pressure and quality of life in patients with hypertension. Clin Exp Hypertens. 2004 Apr;26(3):255-65.
2. The beneficial effects of Tai Chi Chuan on blood pressure and lipid profile and anxiety status in a randomized controlled trial. J Altern Complement Med. 2003 Oct;9(5):747-54.
3. Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT).
Hypertension. 2002 Nov;40(5):612-8.
4. Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, phase II. Ann Intern Med. 2001 Jan 2;134(1):1-11.
5. Blood pressure response to caffeine shows incomplete tolerance after short-term regular consumption. Hypertension. 2004 Apr;43(4):760-5. Epub 2004 Feb 16.
6. Effects of coffee on ambulatory blood pressure in older men and women: A randomized controlled trial. Hypertension. 1999 Mar;33(3):869-73.
7. Food allergies and migraine. Lancet. 1979 May 5;1(8123):966-9.
8. A randomised controlled trial of stress reduction for hypertension in older African Americans. Hypertension. 1995 Nov;26(5):820-7.
9. Randomized, double-blind, placebo-controlled trial of coenzyme Q10 in isolated systolic hypertension. South Med J. 2001 Nov;94(11):1112-7.
10. The effect of low-dose potassium supplementation on blood pressure in apparently healthy volunteers. Br J Nutr. 2003 Jul;90(1):53-60.
11. Effect of potassium supplementation on blood pressure in Chinese: a randomized, placebo-controlled trial. J Hypertens. 2001 Jul;19(7):1325-31.
12. Effects of magnesium supplementation in hypertensive patients: assessment by office, home, and ambulatory blood pressures. Hypertension. 1998 Aug;32(2):260-5.
13. supplementation in patients with essential hypertension: assessment by office, home and ambulatory blood pressure. J Hypertens. 1998 Nov;16(11):1693-9.
14. Effect of vitamin C on ambulatory blood pressure and plasma lipids in older persons. J Hypertens. 2000 Apr;18(4):411-5.
15. A randomized controlled trial of high dose ascorbic acid for reduction of blood pressure, cortisol, and subjective responses to psychological stress. Psychopharmacology (Berl). 2002 Jan;159(3):319-24.
16. Short report: the effect of fish oil on blood pressure and high-density lipoprotein-cholesterol levels in phase I of the Trials of Hypertension Prevention. J Hypertens. 1994 Feb;12(2):209-13.
17. Blood pressure lowering in elderly subjects: a double-blind crossover study of omega-3 and omega-6 fatty acids. Am J Clin Nutr. 1991 Feb;53(2):562-72.
18. Does fish oil lower blood pressure? A meta-analysis of controlled trials. Circulation. 1993 Aug;88(2):523-33
19. Hypotensive effect of long-acting garlic tablets allicor (a double-blind placebo-controlled trial)] Ter Arkh. 2002;74(3):76-8.
20. A randomised crossover comparison of reserpine and sustained-release nifedipine in hypertension. Cent Afr J Med. 1997 Dec;43(12):344-9.
21. Effect of oral L-arginine on oxidant stress, endothelial dysfunction, and systemic arterial pressure in young cardiac transplant recipients. Am J Cardiol. 2004 Sep 15;94(6):828-31
22. Effect of oral L-arginine on blood pressure and symptoms and endothelial function in patients with systemic hypertension, positive exercise tests, and normal coronary arteries. Am J Cardiol. 2004 Apr 1;93(7):933-5
23. Oral arginine reduces systemic blood pressure in type 2 diabetes: its potential role in nitric oxide generation. J Am Coll Nutr. 2002 Oct;21(5):422-7
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Tuesday, December 29, 2009
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