Information for Patients: Make Sure Your Blood Pressure is Low Enough to Protect You!
An earlier post explained how high blood pressure means your arteries are already abnormal. If the blood pressure is not adequately addressed, the arteries become more abnormal, and the pressure rises even higher in a vicious cycle of worse arterial disease leading to higher pressure. High blood pressure is the easiest and least expensive heart-related disease to manage. It is also the most common heart-related condition seen by primary care. Those who follow best practices control blood pressure in 90% of their patients. Despite the ease of treating this condition, only 44% of Americans with diagnosed high blood pressure have their level reduced to less than 140/90. I want my blood pressure to be 130/80 or less and it consistently below that target. You can achieve the same thing and it is one of the most important things you can do for your health. The best medicines to lower blood pressure also protect other organs.
If you already have artery blockages, chronic kidney disease, heart failure, age over 60, or other artery disease, achieving a blood pressure of 130/80 or less is especially important. You already have organ damage. Treating high blood pressure is pretty simple and you can know what to ask for. Here are the medicines that I would use in the order that I would use them.
1. Lisinopril 20 mg. a day ($4/mo) or losartan 50 mg. a day ($9/mo)
2. Hydrochlorothiazide 12.5 mg a day ($4/mo)
3. Amlodipine 5 mg. a day ($9/mo)
4. Spironolactone 12.5 mg. a day ($4/mo) or eplerenone 25 mg. ($20/mo. on GoodRx)
Treating high blood pressure is really simple. Begin with lisinopril or losartan. If your pressure is not at goal add hydrochlorothiazide. If that does not work, add amlodipine etc. If you go through the list and the pressure is still high, circle back and double the dose until the pressure is controlled. You can obtain all four of the first-choice medications for $16 a month. For most people, it takes 3 or 4 medications to achieve the blood pressure goal. When you are taking these medications, you are not only lowering the blood pressure. You are also protecting important organs like the heart, brain, kidney, and arteries. Be aggressive early because it is easier to control blood pressure then. If you don’t control the pressure early, the pressure goes up and organ damage continues. When the kidneys and heart are damaged, it may be more dangerous to use lisinopril or spironolactone. The best way is the easiest way.
Many of my patients were reluctant to start medication for blood pressure and once started they were eager to get off it. That was a mistake. Extra abdominal fat turns on genes that should be quiet. These genes produce increased levels of oxidants that damage the vessels and organs. The medications protect you. They don’t just lower the pressure; they also lower the oxidants and protect the organs. Stay on at least a small dose of lisinopril or losartan and keep your pressure under 130/80. Never stop your medication completely.