When it comes to blood pressure control, lifestyle changes have their limits. Once diagnosed with high blood pressure, it is critical that you meet your blood pressure goal, and in many cases, that can only be done with the addition of medication.

If you are diagnosed with hypertension, it is essential to get treatment started quickly to lower your blood pressure. While there is no complete cure for primary or essential hypertension, there is a lot that you and your doctor can do to reduce and control your blood pressure. The two primary strategies are to:

1. Make changes in the way you live
2. Take antihypertensive medications as prescribed by your doctor.

For most patients, it is necessary to do both.

Lifestyle changes
The things you eat, the things you do (or do not do), what is happening in your life, and many other factors can all influence your blood pressure. The American Heart Association has developed recommendations for very specific lifestyle changes that can help you lower and control your blood pressure.

These include:

• Lose weight if you are overweight
• Eat a healthy diet low in saturated fat, cholesterol and salt
• Be more physically active
• Limit alcohol to no more than one drink per day for women or two drinks a day for men
• Take medicine the way your doctor tells you to
• Know what your blood pressure should be and work to keep it at that level

Drug therapy
When lifestyle changes alone are not enough to help you achieve and maintain your optimum blood pressure, your doctor will probably augment your therapy by prescribing one or more medications. (Most persons with high blood pressure will eventually need two or more medications to achieve ideal control.) There are a few things to bear in mind when you begin drug therapy:

• Everybody responds differently to medications. You may have to go through trial periods on one or more drugs before finding the right combination of medications that are right for you.
• Results take time. It sometimes takes many weeks for some drugs to begin producing the desired effect. You need to be patient.
• Drugs can have side effects that may make you feel worse than you did before you were diagnosed. Be sure to report all side effects to your doctor, but stay on the medication until you are told otherwise.
• Taking pills and capsules can be an inconvenience, but it is well worth it to avoid heart attack, stroke, and other consequences of hypertension.
• Once you begin taking blood pressure medicine, you may have to take medication for the rest of your life. However, if you successfully modify your lifestyle (by losing weight, for instance) and keep your hypertension under control for at least one year, your physician may consider stepping down your medication.

Key antihypertensive agents and how they work

Class of drug Action

• Diuretics: Sometimes called "water pills" because they work in the kidney and flush excess water and sodium from the body.
• Beta-blockers: Block the response of the heart and blood vessels to nerve stimuli. This makes the heart beat slower and with less force. Blood pressure falls and the heart works less hard.
• Angiotensin: Converting enzyme (ACE) inhibitors  Prevent the formation of a hormone called angiotensin II, which normally causes blood vessels to narrow. These drugs cause blood vessels to relax and blood pressure goes down.
• Angiotensin receptor antagonists (ARB's): Block the response of blood vessels from angiotensin II. As a result, the vessels widen and blood pressure goes down.
• Calcium channel blockers: (CCBs)  Keep calcium from entering the muscle cells of the heart and blood vessels. This relaxes the blood vessels and pressure goes down.
• Alpha-blockers: Block the response of blood vessels to alpha nerve stimuli, which allows blood to pass more easily, causing the blood pressure to go down.
• Alpha-beta-blockers: Work the same way as alpha-blockers but also slow the heartbeat, as beta-blockers do. So less blood is pumped through the vessels and the blood pressure goes down.
• Nervous system inhibitors (including centrally acting drugs): Relax blood vessels by controlling nerve impulses. This causes blood vessels to get wider so that blood pressure goes down.
• Vasodilators: Open blood vessels directly by relaxing the muscle in the vessel walls, causing the blood pressure to go down.

Monitoring and follow-up

• If you are diagnosed with hypertension, you will have regularly scheduled appointments with your doctor. Keep them.
• Check your blood pressure at regular intervals - as often as your doctor recommends. A quality home monitor can be helpful as long as you use it properly.
• Between appointments, if you have any of the symptoms listed below, or if your blood pressure remains high even with treatment, call your doctor right away.
• Severe headache
• Excessive fatigue
• Confusion
• Visual changes
• Nausea and vomiting
• Chest pain
• Shortness of breath
• Significant sweating