Need Blood Pressure Medication?

My blood pressure is high, but the doctor wants me to lose weight before considering medication. Isn’t this dangerous? How high should blood pressure be before you need medication to lower it?

– April 12, 2011

Hypertension (high blood pressure) is the most common form of cardiovascular disease in the United States, affecting nearly one in three adults. High blood pressure is a serious threat to health because it makes the heart work harder, increasing its oxygen demands and raising the risk of heart attack, stroke and kidney disease.

Some people can lower and control their blood pressure with healthy lifestyle measures: quitting smoking (if that’s an issue), maintaining normal weight, getting regular exercise, and avoiding excess dietary sodium (processed foods are the main source). Even a 10 percent weight loss can sometimes bring high blood pressure under control. Limiting your intake of caffeine (in coffee, tea, sodas, and energy drinks) and alcohol can also help. I consider practicing relaxation methods to be even more important.

I discussed your question about when drug treatment for hypertension is appropriate with Stephen R. Devries, M.D. He is a preventive cardiologist and associate professor in the division of cardiology at Northwestern University’s Feinberg School of Medicine and co-editor of Integrative Cardiology, a new book from Oxford University Press that is part of the Weil integrative medicine library. Like other books in this series, Integrative Cardiology is aimed at health professionals but can also be used by patients and their families, as well as by health-conscious individuals concerned with heart disease issues.

Dr. Devries agrees that focusing first on lifestyle changes is a very sensible strategy for patients with “borderline” blood pressure readings. However, he said, medication usually is needed if readings continue to exceed 140/90 (or 130/80 for diabetics or those with kidney disease), despite lifestyle changes. But even when drugs are prescribed, Dr. Devries emphasizes the importance of continuing with a low-salt diet that includes lots of vegetables and fruit, exercise, and stress reducing techniques, all of which can help keep the required dosages to a minimum.

Andrew Weil, M.D.

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