Lowering Blood Pressure: Medication

INTRODUCTION

This is a continuation of our discussion on how to lower blood pressure. The first part dealt with lowering blood pressure without medication. We conclude the 2-part discussion with: lowering blood pressure medication-wise or pharmacologically.

One of the main reasons for the high prevalence of hypertension or high blood pressure in the world, is inability to handle sodium / salt. The problem is worldwide, being worst in people of African descent. We will begin our discussion by addressing this issue of salt and high blood pressure.

Choosing the right type(s) of medication for your hypertension, based on its severity and concurrent factors, is the territory of the health professionals. This article assumes that you will have been fully assessed before being prescribed medication. What we will do is to guide you in order to maximize the effectiveness of the medication, in order to reach the treatment target, a normal blood pressure.

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THE SODIUM-POTASSIUM PUMP

As mentioned in the introduction, hundreds of millions of people in the world have hypertension because of a defective salt-handling mechanism. In our bodies, there are several elements and compounds. Particularly, there are “salts” such as sodium and potassium.

The salts or elements in the body are kept in fine balance. They should not exceed or be below certain normal levels in the blood. Significantly low or high levels of these elements in the blood, cause symptoms or disease.

Sodium (Na+) and potassium (K+) are kept in balance by exchanging with each other at a mechanism called the sodium-potassium pump. Having a lot of sodium on board as happens after taking a lot of salt, causes potassium levels to drop. Taking in potassium from whatever source, causes it to compete with sodium, and decrease its levels.

How does salt affect blood pressure?

Sodium chloride (salt) pulls water wherever in the body it goes. And by doing this, it increases pressure in that compartment. Inside the blood vessels, the pressure equates to blood pressure, as measurable by a blood pressure machine.

Salt draws water into the bloodstream, thus increasing the pressure in the blood vessels

SALT RESTRICTION & HYPERTENSION

People with a defective sodium-potassium pump (above), retain a lot of sodium and cannot excrete it by exchange with potassium. This is what causes hypertension in such individuals and groups of people. Treatment of high blood pressure in such cases requires addressing this faulty physiology.

Top of the list of medications used to treat hypertension in people suspected of having defective sodium handling, are DIURETICS (“water tablets”). These are medications that clear salt and water from the body, through the kidneys with urine. They are very effective and are the cornerstone of treatment.

But equally (if not more) important as the diuretics, is SODIUM OR SALT RESTRICTION. There is no point trying to get rid of salt / sodium from the body, but continuing to take in a lot of it through the mouth!

A salt restricted diet is absolutely necessary for a person confirmed to have hypertension. And sometimes restricting salt intake and using the other methods laid out in the first article, is sufficient to manage mild to moderate hypertension. But even if medication is deployed, its effect in lowering blood pressure is greatly enhanced by a strict low-salt diet.

It is important to also mention that relatives of hypertensive patients, should not see salt restriction as the business of the patient only. They are genetically at risk and would do themselves a favour to take up the healthy practice. It will help them in the long run, as they get older.

Another often forgotten point that needs mention, is that sodium exists in foods in many forms other than sodium chloride. These include sodium nitrate and sodium nitrite, the preservatives that give meats a pink colour, and sodium bicarbonate in baking powder. Particular care should be taken in regard to these food items too.

The other facts about limiting sodium have been dealt with elsewhere, throughout the decades. These include rather adding salt (in moderation) to the cooking pot, than at the table. Also well known is the recommendation to use spices like black pepper in preference to pure salt.

POTASSIUM INTAKE OR SUPPLEMENTATION

The other practice that does the same effect on “the pump” as salt restriction, is potassium intake or supplementation. People with hypertension, on or not on medical treatment, should eat plenty of fruits and vegetables. These are rich in potassium, as are fruit juices.

Some hypertension treatments have the effect of causing abnormally low blood potassium. The biggest culprits in this regard are the diuretics. That is why these medications are frequently prescribed along with potassium supplements.

Potassium supplementation serves two functions. Firstly, it prevents the blood levels of potassium from going too low. Secondly, it keeps the sodium levels in check, thus lowering the blood pressure.

Fruits and vegetables are excellent natural sources of potassium. Bananas are among the best sources

FREQUENCY OF MEDICATION

Medications, including high blood pressure treatments, differ in how long they can persist at considerable levels in the body. Some medications remain at a therapeutic or effective level for a long time, thus enabling once-only dosing.

Other medications last moderately longer periods and require twice-daily (12-hourly) or thrice-daily (8-hourly) dosing. Some medications get cleared or metabolised quickly, requiring 6-hourly or even 4-hourly dosing. These categories of medication exist among hypertension medications.

Understanding the just mentioned fact of the way medicines work, should help you dear reader, to understand the importance of observing the frequency of dosing set for you. If you are supposed to take a certain blood pressure medication at 6:00,14:00 and 22:00, but you only take it at 6:00 and 20:00 for your convenience, you are inconveniencing your cardiovascular system. During the day, (and even at night), there will be periods when your blood pressure rises because medication levels are too low.

Infrequent dosing makes everything to go haywire. It could even show up shortly after taking a dose of medication. Proper, sustained blood pressure control becomes difficult indeed.

BEFORE MEALS OR AFTER MEALS?

Kindly note that some medications need to be taken before meals, or on an empty stomach. This is because food has an effect or effects on such medications, effect which reduces the efficacy of the treatment.

Factors that reduce the efficacy of medications have to be addressed or removed. Chronic diseases like high blood pressure have to be treated adequately. Otherwise a lot of time, effort, money and other resources get wasted on taking medication for years and years, medication that is making little or no effect.

Even if blood pressure gets decreased, if it remains above the recommended level of 140/90, damage is still occuring to the end-organs. The risk of strokes, blindness, heart attacks, kidney disease, etc, is not abolished. We need to totally remove the harmful effects of hypertension on the cardiovascular system, by taking medication diligently.

This article, How To Take Medication, on this very website, will provide further information to clarify this and the next paragraph up.

RATIONAL USE OF MEDICATIONS

When you are on treatment, especially for chronic conditions like hypertension, a global look at all your medication has to be undertaken. This actually applies even at the beginning, before long-term hypertension is embarked upon.

1. there are medications that can cause blood pressure to go up. These include decongestant medications that are used systemically (taken into the bloodstream), and aspirin and other non-steroidal anti-inflammatories.

These medications have to be stopped or substituted if at all possible, when they are felt to be causing BP control to be difficult. At the beginning, removing them and implementing lifestyle changes as discussed in the first article, may be all that is needed. Hypertension treatments may be averted.

2. ensure that treatment of coexisting conditions is optimal. An example has previously been given, of conditions like depression and chronic pain, that can make the control of blood pressure difficult. These conditions have to be put on the best choice of medication, and the dose has to be optimised until control of these confounders is achieved.

3. treatment of hypertension takes a lifetime or years at least. While on the treatment, other circumstances can arise. These include, for example, pregnancy.

Please inform your doctor or other Healthworker of conditions that could be impacted upon by your treatment, or that could impact on the high blood pressure treatment.

WHAT LOWERS BLOOD PRESSURE QUICKLY?

You or your loved one may be having a newly diagnosed raised blood pressure. Or you may be struggling with a chronically raised BP that just won’t come down. But you don’t need to go on a search of how to lower blood pressure fast.

Dear reader if your blood pressure is so high that it poses a grave danger of sudden stroke, death or the likes, it is your Healthcare Worker who should handle that. They will most probably admit you as a hypertensive emergency. And they are the ones who know how to lower blood pressure “immediately”. Indeed, there is reluctance in this new century, to lowering BP too drastically as this itself can cause catastrophes.

CONCLUSION

Treatment of high blood pressure can be easy for some people. But it can be challenging at times. The blood pressure can be resistant to all manner of management.

A holistic management approach is essential in the management of hypertension and other chronic diseases of lifestyle. This multi-pronged strategy has been laid out in these two articles. It incorporates lifestyle adjustments, and the judicious use of medication.

Attention to the proper use of medication is very important, as is adherence to treatment regimens. Any uncertainties about medications should be cleared with the Pharmacist, Nurse or Doctor, as soon as possible. Nothing beats good communication when working in a team setting.

Hypertension treatment should be expected to be lifelong; it most frequently is. Due mental preparation by means of initial and ongoing counseling should be provided. And having a good support system goes a long way to making the achievement of treatment goals possible.

ANY COMMENTS?

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Kindly take a minute or so to share your thoughts on this or any other article on this website. And thanks in advance!

6 Replies to “Lowering Blood Pressure: Medication”

  1. I am so pleased I found this site as I have been looking for advice to reduce my blood pressure.  My current reading is 147/93 which I know is too high. I take cozar (losartan potasico – what is your view on this medication?) and I exercise regularly.  I know I need to lose weight (lockdown paid quite a toll ☹ ) The suggestion for Morton Salt substitute looks like a great idea.  Is it safe?  i.e. what chemicals are they using instead? I see that preserved meats are something to avoid, that is something I have been doing recently, so I seem to be on the right track there. Wow, the suggestion regarding having more potassium to keep sodium levels under control is an excellent one.  Thank you.

    1. Hi Trevor,

      Thanks so much for reading through the article and providing valuable input via your own story.

      147/93 is just high, not too much. You will hopefully get it down to normal soon.

      Losartan is a good and effective medication, belonging to the group called Angiotensin II Receptor Antagonists. It works by relaxing blood vessels. But two issues:

      1. There is an alternative in that class, Olmesartan, which lasts longer in the system and controls BP better and makes doing easier. But it is your usual carer who can make a decision on the choice, based on circumstances

      2. In 2019, there were incidents of losartan that were tainted with a potentially cancer causing compound. I don’t think this ever affected the brand Cozaar though. It is important that you always check with your Pharmacist that stocks of losartan you are supplied with, are not a version of losartan that contains illegally high levels of the carcinogenic compound

      Salt substitutes mostly use Potassium chloride (remember common salt is Sodium chloride?) They are wonderful products. But they can cause a high potassium (also dangerous!) in people with kidney disease (healthy kidneys with good urine output are necessary for flushing out potassium). Other people who should not use potassium chloride salt are those on medications that retain potassium (e.g. ACE Inhibitors, potassium sparing water tablets like spironolactone)

      Warmest regards!

  2. This is a very good article and peeked my interest because I do have medium to high blood pressure! I have lost 23 pounds during the Pandemic by diet and some exercise and am on Blood pressure medication but want to get off of it. I use to be about 140 / 90 and now it is controlled at 113/75. Since loosing weight, I HAVE noticed a decrease in the blood pressure naturally and I ONLY have to take HALF of my medication now. Great article!

    1. Hi John,

      Thanks so much for reading through the article and providing valuable input by means of your own story.

      Wow, congratulations on losing weight and getting your blood pressure under incredible control!

      Regards and please keep monitoring the BP lifelong! (I have provided a machine to do that.)

  3. I found I had high blood pressure by chance when I was asked to have a free check-up at a supermarket. It was that high I went straight to the doctors. Initially, I was given medication. Eventually, it was found the problem was my kidneys and I had to have one removed and it returned to normal. It is important we address the causes rather than just use medication to treat symptoms.

    1. Hi,

      Thanks so very much for reading through the article and for sharing your story!

      You are right indeed – high blood pressure is not a diagnosis. If you visit the 1st part of this discussion, which is linked, you will find that the very issue of kidney disease is mentioned. It is a frequent cause of raised blood pressure. And treatment of hypertension in that setting needs to take into consideration, the presence and type of kidney disease.

      I am happy for you!

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