Lifestyle changes or medication, or a combination of both, can lower your blood pressure. Lifestyle changes are recommended for everyone with elevated readings of any kind. For many people, the results of losing weight, exercising, limiting salt, and generally adopting a healthy eating plan can be as signi?cant as the use of any single medication. Many different types of medications are available, and different drugs or drug combinations work better for some people. You and your doctor have lots of options, and your treatment will be most successful if you work together to ?nd the treatments that work best for you.
Your doctor will help you set a target reading and determine how to reach it. Do not hesitate to tell your doctor as much as you can about your eating, smoking, and drinking habits; whether you exercise regu- larly; or what other medications or supplements you take. The more you understand about the factors that contribute to your high blood pressure reading, the more likely you are to bring it down.
Your doctor will approach your treatment by considering three fac- tors: the blood pressure reading itself; whether there is already some damage to your arteries or other organs; and whether you have other conditions, such as diabetes, that might affect your treatment. If you are still in the prehypertensive category and have no other complications, you may be able to bring your blood pressure down to less than 120/80 mm Hg in a year just by changing your lifestyle (see below).
If you have stage 1 or stage 2 hypertension without organ damage or complicating conditions, the goal will be to bring your reading down to a prehypertensive level. Doctors have found that many people will need to take more than one medication to reach their target blood pressure. If you are at stage 1, lifestyle changes are an essential ?rst step. If lifestyle changes fail to achieve your target blood pressure, your doctor may subsequently prescribe a diuretic and maybe other drugs as well (see page 59). If you are in stage 2 hypertension (a reading of 160/100 mm Hg or higher) without complications, you will almost certainly need to take more than one drug, one of which will probably be a diuretic, to achieve good blood pressure control. But continue making lifestyle modifications—improvements in your diet and exercise habits—while taking the medications.
If you have high blood pressure (stage 1 or stage 2), and you have another condition—for instance, you have already had a heart attack, you are at high risk for developing coronary artery disease (see page
211), or you have kidney disease or diabetes—your doctor will prescribe medications that have proven to be bene?cial for your conditions. Of course, a healthier lifestyle is a must as well. With these conditions, achieving a blood pressure goal as low as 130/80 mm Hg may be the wisest course.
Warning: Be alert for any signs of stroke. These include headache, confusion, weakness, numbness, dif?culty speaking, slurred speech, or weakness on one side of the body. If you have any of these signs, seek emergency treatment at a hospital promptly.
No matter what your blood pressure reading, personal medical situ- ation, history, or treatment plan, sticking to the treatment is the only way to reach your goal. That goal starts with a number, but it is much more than that.