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Managing Blood Pressure / Understanding Medications

Taking patient's blood pressureThe single most important thing stroke survivors can do to lower the risk of a second stroke is control their blood pressure. As a caregiver, you also need to control your high blood pressure (HBP) too. Of the 700,000 strokes yearly nearly all have a primary cause of high blood pressure, high cholesterol or diabetes. Controlling your blood pressure may seem confusing and you may not even know what high blood pressure means or what effects it has on your body. The damaging effects of high blood pressure can affect nearly every system! Just because you cannot feel high blood pressure does not mean your body is unaffected.

So what is High Blood Pressure?

High blood pressure (HBP) is the constant elevation of blood pressure in your arteries. Arteries are the vessels that carry blood away from your heart and to the organs of your body. The arteries supply the nutrient rich blood your body needs to survive and your veins carry the blood back to your heart. Having high blood pressure stretches your arteries slowly causing damage and stiffening. Because your arteries are all over your body and in every organ, the damage of high blood pressure is all over your body and in every organ.

High Blood Pressure (HBP) is also called hypertension and numbers are given to stage how high your blood pressure. Let’s say for example that your blood pressure is 150/84.

  • The systolic pressure is the pressure in your arteries when at its highest; your heart has just pumped: 150/- the 150 is your systolic blood pressure.
  • Your diastolic pressure is the pressure in your arteries when at it’s lowest; your heart muscle is relaxed: -/84 the 84 is your diastolic blood pressure.
  • A blood pressure of 150/84 is considered stage 1 hypertension.

Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure developed guidelines to help your practitioner treat your high blood pressure. The stages are based on the risk to your health of having untreated high blood pressure at different levels. Your practitioner might also take into account other medical conditions you have to pick a medication that is right for you. You should contact your Provider to find out what your ideal blood pressure should be.

Category

Systolic (mmHg)

 

Diastolic (mmHg)

Normal

<120

AND

<80

Pre-Hypertension

120-139

OR

80-89

Stage 1

140-159

OR

90-99

Stage 2

>160

OR

>100

Stage 3

>180

OR

>1


What are HBP symptoms?

In the early stages of high blood pressure (HBP) there are no symptoms. However, having high blood pressure for a long enough period of time to damage your body can cause symptoms. These are headache, chest pain, shortness of breath at rest or when lying flat, frothy mucus, lack of energy, less urine, and swollen arms and legs

Consequences of HBP:  
  • Enlarged Heart
  • Dysfunctional Heart
  • Irregular Heart Rate
  • Chest Pain
  • Congestive Heart Failure
  • Aneurysms
  • Kidney Damage
  • Kidney Failure
  • Stroke (Clot/Hemorrhage)
  • Leg Pain
  • Poor Vision
  • Arterial Blood Clot/Gangrene

 

blood pressure

 

Risk Factors for developing HBP:
Family History (Direct relatives like mom, dad, brothers, sisters, and grandparents have the biggest influence)
Age (Men >55) (Women >70)
African American
High Sodium (Salt) Diet (more than 2300mg daily)
Diabetes
Cigarette Smoking (Even just a few daily)
Obesity/Overweight (Body Mass Index of more than 25 for overweight or 30 for Obese)
Click the following link to calculate your BMI http://www.zenfatloss.com/bmi-calculator
Alcohol Consumption (2-3 servings >4 times weekly)
For serving information click the following link http://www.wwu.edu/chw/preventionandwellness/AODWebPDFs/WhatisOneDrink.pdf
Diet low in Potassium, Calcium, and Magnesium (low intake of fruits, vegetables, herbs & dairy products.
Click the following link for good dietary sources of these minerals http://www.nhlbi.nih.gov/hbp/prevent/factors/supls.htm

What Can You Do?

  • MONITOR BLOOD PRESSURE DAILY:
    -An automatic blood pressure cuff on the arm is the most accurate compared to the wrist and finger types. It is best to check your own blood pressure, because it can change from day to day and at times when you are nervous or sick, like in doctors’ offices. You should check your blood pressure four times daily when on new medications and twice daily other times, both in the morning and at night. Keep a log with your daily blood pressure measurements to take with you to your medical office visits. Blood pressure monitors may be covered by your health insurance plans. Ask you practitioner for more information. Click the following link for blood pressure equipmenthttp://www.mountainside-medical.com/categories/Blood-Pressure-Monitors/

(NOTE: there are many other companies for the same equipment; this is only one example.)

  • TAKE MEDICATIONS AS PRESCRIBED;prescription pill bottles
    -Don’t be afraid to bring it to your practitioner’s attention if your blood pressure is still high, or if you have been on drugs for years but you have recently seen an increase in your blood pressure. Just as your body changes, your blood pressure changes.
  • REDUCE YOUR RISKS:
    -Follow a low sodium/salt diet (1500mg daily) by avoiding adding table salt and watching “sodium content” on pre-made meals.
    -Control other medical conditions such as diabetes, kidney disease, thyroid disorders, coronary artery disease, and high cholesterol.
    -Reduce alcohol intake.
    -Increase potassium and magnesium in your diet by consuming more fruits and vegetables, as well as increasing use of spices, nuts and lean meats like fish in your diet (talk with a dietitian, if more information is needed).
    -Lowering stress, limiting intake of caffeinated drinks by avoiding soda, or drinking decaffeinated coffee and stopping smoking (ask your practitioner for recommendations on smoking cessation therapy)
  • EXERCISE:
    -Light exercise, like water aerobics, three days a week for 30 minutes for as short as 4 weeks may lower your blood pressure. BEFORE STARTING AN EXERCISE PROGRAM CONSULT YOUR PRACTITIONER.
    -Exercise programs may be explored at your local YMCA or health fitness club, for more information click the following link: http://www.ymca.net/

THINGS TO REMEMBER:

  • If you are experiencing a drug side effect which makes you not want to take your medication, ask your practitioner if there is something else that you can take.
  • Nearly all blood pressure medications can cause dizziness when standing quickly from sitting or lying. Use caution and hang onto something substantial until you are sure you will not fall.
  • The amount of a drug in your body can be changed by taking other drugs like vitamins, supplements, prescription and over the counter drugs. Some examples are St. John’s wort, garlic, iron, calcium, aspirin, nasal decongestants, or steroids like prednisone.
    • Often people with HBP may be taking a drug or a supplement that is making their blood pressure medication less effective. Drugs that most often affect how blood pressure pills work are birth control pills or estrogen supplements, steroids like those in inhalers, NSAIDS (e.g. aspirin, ibuprofen, and naproxen), caffeine from soda or coffee, diet pills, licorice, and some antidepressants.
  • Taking other medications or herbal preparations should always be made known to your practitioner, even if prescribed by another practitioner.
  • If you or your loved one starts a new medication don’t be afraid to ask your pharmacist what to look for if there could be a drug interaction

Don’t be afraid to ask your practitioner and your pharmacist if you think you or your loved one is having a drug interaction.
DIAL 9-1-1 immediately if your loved one develops stroke symptoms (see below), or has difficulty breathing, rash or swelling as this may be signs of a serious side effect or second stroke.

Stroke symptoms include:

  • SUDDEN numbness or weakness of face, arm or leg - especially on one side of the body.
  • SUDDEN confusion, trouble speaking or understanding.
  • SUDDEN trouble seeing in one or both eyes.
  • SUDDEN trouble walking, dizziness, loss of balance or coordination.
  • SUDDEN severe headache with no known cause.
  • It is important to take medications every day as prescribed. Missing or skipping doses will not help lower risk for heart and kidney damage or a second stroke. If you are having trouble paying for your medications, ask your primary care provider or pharmacist about generic alternatives. The first step is letting a health professional know your having a problem.
  • Many drugs are available in combination! IF YOU ARE TIRED OF TAKING SO MANY PILLS ask your doctor if they make a drug that has both the medications that you take in combination. However, in some cases these drugs are more expensive. Talk with your provider or pharmacist for more information.

Below is a chart of common blood pressure medications. Included are the drug type, the brand/generic names, how it works, and some of the most common side effects. For more information ask your Practitioner or Pharmacist.

Common Drugs for High Blood Pressure (HBP)

Drug Type

Examples

How it Works

Side-effects

ACE (Angiotensin Converting Enzyme) inhibitor

-pril drugs (Zestril® or Prinivil®/lisinopril, Altace®/ramipril, Accupril®/quinapril, Capoten®/captopril, Lotensin®/benazepril, Vasotec®/enalapril)

These drugs stop the body from making a hormone that works on your arteries, by stopping arteries from constricting and keeping blood pressure low.

Dry Cough, rash, lip swelling, high potassium, dizziness on standing, low blood pressure

Beta-Blocker

-olol drugs (Lopressor®/metoprolol tartrate,Toprol XL®/metoprolol succinate, Zebeta®/bisoprolol, Tenormin®/atenolol, Inderal®/propranolol, Coreg®/carvedilol, Sectral®/acebutolol, Normodyne®/labetalol, Corgard®/nadolol, Blocadren®/timolol)

These drugs lower blood pressure by slowing down the heart rate and decreasing the strength of the heart pump

Dizziness, lightheadedness, drowsiness, blurred vision, cold hands and feet, worsening asthma, heart block

ARB’s

(Angiotensin Receptor Blockers)

-sartan drugs

(Cozaar®/losartan, Hyzaar®/losartan w/hydrochlorothiazide, Diovan®/valsartan, Benicar®/olmesartan, Avapro®/irbesartan, etc.)

These drugs block the action of a hormone in the body, and by doing so they dilate blood vessels

high potassium, low blood pressure, dizziness, headache, swelling of lips, birth defects

Alpha inhibitors

-amine or -zosin drugs (Dibenzyline®/phenoxybenzamine, Vasomax®/phentolamine, Uroxatral®/alfuzosin, Minipress®/prazosin, Cardura®/doxazosin)

These drugs work directly on arteries to cause them to dilate. They are also used for urinary retention, enlarged prostate, and anxiety

Rapid heart rate, dizziness, headache, nausea, blurred vision, palpitations, low blood pressure

Calcium Channel Blockers

-dipine & some others (Norvasc®/amlodipine, Procardia® or Adalat®/nifedipine, Plendil®/felodipine, Cardizem®/diltiazem, Verelan®/verapamil)

These drugs work on the heart and arteries.   By decreasing how hard the heart pumps and by dilating arteries these drugs lower blood pressure

 

Headache, nausea, constipation, low blood pressure, swelling of legs and feet, drowsiness, dizziness

Centrally Acting HBP Medications

Many different suffixes common drugs are (Catapres®/clonidine, Tenex®/guanfacine, Aldomet®/methyldopa)

Each has a different action but all work in the brain and spinal-cord to lower blood pressure.

 

Depression, drowsiness, dizziness, dry mouth, sexual dysfunction, night time urination.

Diuretics (Water Pills)

 

It’s not uncommon to take more than one water pill.

Many different kinds most common:

Lasix®/furosemide, Edecrin®/ethacrynic acid, Demadex®/torsemide, Bumex®/bumetanide, Hydrodiuril®/hydrochlorothiazide, Diamox®/acetazolamide, Aldactone®/spironolactone, Midamor®/amiloride, Maxzide®/triamterene

 

These drugs work in different parts of the kidney to increase the amount of urine you produce. By producing more urine you decrease the blood volume and lower blood pressure.

low blood volume, increased concentration of other drugs, thirst, muscle cramps, irregular heart rhythm, nausea, vomiting, constipation, incontinence, gout flaring

 

Additional Information:

The following are some web sites to provide you with more information on blood pressure management and medications. (Please click to view the web sites.)

Stress Management

http://helpguide.org/mental/stress_management_relief_coping.htm

Blood Pressure

http://www.nhlbi.nih.gov/hbp/treat/treat.htm

Dietary Information

http://www.nhlbi.nih.gov/hbp/prevent/h_eating/h_eating.htm

Smoking Cessation

http://www.tobaccofree.org/?gclid=CLfM1PCT0a4CFcW8KgodvxrGCg

http://www.planmyquit.com/index.aspx?cmp=UniversityofToledo

Drug Info A-Z

http://www.drugs.com/drug_information.html

http://www.nhlbi.nih.gov/hbp/treat/bpd_type.htm


References:

Aminuddin, A., Zakaria, Z., Megat Mohd, A., Hamid, Maskon, O., Tan Sook, P., & Fadzilah, F. (2011). Effect of graded aerobic exercise training on blood pressure changes in women with elevated blood pressure. International Medical Journal, 18(3),207-211.

Chen, W., White, C., Phung, O., Kluger, J., Ashaye, A., Sobieraj, D., & ... Coleman, C. (2011). Association between CHADS2 risk factors and anticoagulation-related bleeding: A systematic literature review. Mayo Clinic Proceedings, 86(6), 509-521.

Dormans, T., Gerlag, P., Russel, F., & Smits, P. (1998). Combination diuretic therapy in severe congestive heart failure. Drugs, 55(2), 165-172.

Goodman, L. S., Gilman, A., Brunton, L. L., Lazo, J. S., & Parker, K. L. (2006). Goodman and gilman's the pharmacological basis of therapeutics. (11th ed.). New York: McGraw-Hill Professional.

Harvard College. (2010). Preventing & treating 'brain attack'. Stroke (pp. 27-34). Boston, Massachusetts: Harvard Health Publications.

Izzo, J. L., Levy , D. J., & Black, R. (2000). Importance of systolic blood pressure in older americans. Hypertension: Journal of the American Heart Association, 35(10), 21-24. doi: doi:10.1161/01.HYP.35.5.1021

Lloyd-Jones, D. M., Evans, J. C., Larson, M. G., O'Donnell, C. J., & Levy, D. (1999). Differential impact of systolic and diastolic blood pressure level on jnc-iv staging. Hypertension: Journal of the American Heart Association, 34(3), 381-385. doi: doi:10.1161/.01.HYP.34.3.381

McCance, K., & Huether, S. (2010) Pathophysiology: The biologic basis for disease in adults and children (pp. 606, 1149, 1193). Maryland Heights, Missouri: Mosby, Elsevier.

Taylor, J., & Campbell, K. (2007). Home monitoring of glucose and blood pressure. American Family Physician, 76(2), 255.

Turkoski, B. B., Lance, B. R., & Tomsik, E. A. (2010). Drug information handbook for advanced practice nursing: A comprehensive resource for nurse practitioners, nurse midwives, and clinical specialists, i. Lexi-Comp.

Developed in 2012 by Matt Dixon, BSPS, at the University of Toledo for Caring~Web©.

Last Updated: 6/18/14