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High Blood Pressure: Should I Take Medicine?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

High Blood Pressure: Should I Take Medicine?

Get the facts

Your options

  • Start taking medicine for high blood pressure.
  • Try lifestyle changes first.

If your blood pressure is very high—higher than 160/100, or when either number is higher—you don't have a decision to make. You definitely need medicine to lower your blood pressure.

Key points to remember

  • For some people, lifestyle changes may be enough to lower their blood pressure. Whether this is an option for you depends on how high your blood pressure is, whether you have other health problems, such as diabetes, and whether any of your organs have already been damaged. Your doctor will also consider how likely you are to develop other diseases, especially heart disease.
  • Lifestyle changes are as important as medicine in lowering blood pressure and lowering the risk for heart attack and stroke. Lifestyle changes include losing weight, eating healthy, being active, limiting sodium and alcohol, and not smoking.
  • If healthy habits aren't enough to bring your blood pressure down to your goal, you may need to take pills.
  • Most people who take pills for high blood pressure need to take two or more kinds of pills that work together.
  • Even with pills, you will need healthy habits for the rest of your life to lower your risk for heart attack and stroke.
FAQs

What is high blood pressure?

Blood pressure is a measure of how hard the blood pushes against the walls of your arteries as it moves through your body. It's normal for blood pressure to go up and down during the day. But if it stays up when you are resting, you have high blood pressure.

Adult blood pressure is sorted into four types:

  • Normal blood pressure—less than 120/80 (say "120 over 80")
  • Prehypertension—120/80 or higher, but less than 140/90
  • Stage 1 high blood pressure—140/90 to 159/99
  • Stage 2 high blood pressure—160/100 or higher

What are the risks of not lowering your blood pressure?

When blood pressure is higher than normal most of the time, it starts to damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, and other problems.

Anything that increases your risk for a disease or problem is called a risk factor. High blood pressure is just one of several risk factors that make heart attack and stroke more likely. If you have high blood pressure plus another risk factor, heart attack and stroke are even more likely. Some risk factors are things you can change. Others you can't.

Risk factors for heart attack and stroke that you can change include:

  • Having high blood pressure.
  • Smoking.
  • Having high cholesterol.
  • Being overweight.
  • Not exercising.
  • Having diabetes that isn't under control.

Things you can't change include:

  • Having a parent, sister, or brother with early heart disease (before age 55 for men or before age 65 for women).
  • Being male.
  • Your age. People older than age 65 are more likely to have heart disease.

What is the treatment for high blood pressure?

High blood pressure usually can't be cured. But it can be controlled. The two types of treatment for high blood pressure are:

  • Lifestyle changes.
  • Daily medicines.

For most people, the goal is to get their blood pressure below 140/90. But a person's goal may be lower. Your doctor will give you a blood pressure goal that is based on your health. For example, your goal may be lower if you have other conditions such as diabetes, heart failure, coronary artery disease, or chronic kidney disease.

If your blood pressure is lower than 160/100 and your overall risk for heart disease is low, you may be able to lower your blood pressure to your goal with lifestyle changes without taking pills. Your doctor can help you know your risk for heart disease.

If healthy habits aren't enough to bring your blood pressure down to your goal, you may need to take pills.

Why are lifestyle changes so helpful?

Changes in lifestyle can help control high blood pressure. You may be able to avoid taking pills. If you are already taking blood pressure medicine, making some lifestyle changes may let you take a lower dose.

The combination of lifestyle changes and medicine will have the biggest effect on lowering your risk of heart attack or stroke.

  • Losing as little as 10 lb (4.5 kg) can help lower blood pressure.
  • Physical activity lowers blood pressure, especially if you have been inactive until now. Exercise also helps you manage your weight, but it can lower your blood pressure even if you don't lose weight.
  • Reducing salt in your diet can help control high blood pressure. Try to limit the amount of sodium you eat to less than 1,500 mg a day.
  • Eating heart-healthy foods can help lower blood pressure. The DASH (Dietary Approaches to Stop Hypertension) eating plan includes fruits, vegetables, and low-fat or nonfat dairy foods.
  • Drinking more than 3 alcohol drinks a day may raise your blood pressure. It can also interfere with some blood pressure medicines. Limiting alcohol to 2 drinks a day for men and 1 drink a day for women may help lower blood pressure.
  • Quitting smoking is important to reduce the risk of heart attack and stroke. Nicotine in tobacco briefly increases blood pressure and heart rate with each use.

For most people, it takes time and patience to replace old habits with new ones. You may need to take blood pressure pills until you decide you are ready to make lifestyle changes.

If you decide to try lifestyle changes first, you and your doctor may want to set a deadline. For example, you might decide that you will try lifestyle changes for 3 to 6 months. Then, if your blood pressure does not come down enough in that time, you may decide to start taking pills.

Why might your doctor recommend taking medicine for high blood pressure?

Your doctor may advise you to take medicine for high blood pressure if:

  • Your blood pressure is 160/100 or higher.
  • You have organ damage or other health problems such as heart failure, coronary artery disease, diabetes, or kidney disease.
  • You have one or more risk factors for heart attack or stroke.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Take medicine for high blood pressure Take medicine for high blood pressure
  • You take medicine every day.
  • You may have to take more than one medicine to find the right mix to lower your blood pressure.
  • You will still need to make lifestyle changes to lower your risk of heart attack and stroke.
  • Medicines help control your blood pressure and lower your risk of heart attack and stroke.
  • Some pills cause dry mouth, weakness or dizziness, or a cough.
  • Blood pressure medicine may be expensive if your insurance doesn't pay for it.
Try lifestyle changes first Try lifestyle changes first
  • You make lifestyle changes such as eating better, exercising, drinking less alcohol, and quitting smoking to lower your high blood pressure.
  • Lifestyle changes help control your blood pressure and your risk of heart attack and stroke.
  • You avoid the side effects of blood pressure pills.
  • You avoid the cost of blood pressure pills.
  • If these changes don't lower your blood pressure enough, you may still need medicine.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about taking medicine for high blood pressure

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

After my doctor told me my blood pressure was too high, she suggested I try to bring it down by changing some of my habits. I quit smoking, went on a diet, and started a walking program. That made me feel healthier, but it didn't bring my blood pressure down very much. Now I take two kinds of blood pressure medicine as well as keeping up with my lifestyle changes. Everything is under control.

Terrence, age 59

I just found out I have high blood pressure. I want to try to make some lifestyle changes before I start taking medicine. I know I need to start out by making small changes and sticking with them. I'm going to start by walking 15 minutes 5 days a week and cutting down on salt by looking for other ways to season my food. After 2 weeks of that, I'll add some more goals and walk a little longer. I really think I can do this.

Magda, age 45

My doctor thinks I might be able to control my blood pressure by losing weight and getting more exercise. I started a diet but I wasn't sure I'd be able to lose weight. And I worry about having a heart attack because of my family history. So I decided to start taking medicine right away. I'll also try to eat healthier and start walking.

Paolo, age 51

About 6 years ago I found out my blood pressure was a little too high. I was a little overweight, and I didn't get much exercise. So I went on a diet and started going to the gym regularly. I was very motivated, because I did not want to have to take medicine if I could avoid it. It worked. My blood pressure came down and has stayed down.

Hanh, age 64

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take medicines for high blood pressure

Reasons to try lifestyle changes first

I've tried being more active and making other lifestyle changes, but it has not lowered my blood pressure enough.

I feel confident that I can succeed at making lifestyle changes.

More important
Equally important
More important

I'm not concerned about the side effects of blood pressure medicine.

I'm worried about the side effects of pills.

More important
Equally important
More important

I want to do everything I can to prevent a heart attack or stroke.

I don't want to take medicine, even if it might lower my risk of heart attack and stroke.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicine

Trying lifestyle changes first

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Is it true that you may need to start taking medicine right away based on your health?

  • YesYou're right. Your doctor might recommend that you take medicine right away if you have very high blood pressure or if you have organ damage or other health problems such as diabetes.
  • NoSorry, that's not right. Your doctor might recommend that you take medicine right away if you have very high blood pressure or if you have organ damage or other health problems such as diabetes.
  • I'm not sureIt may help to go back and read "Get the Facts." Your doctor may advise you to take medicine right away if your blood pressure is 160/100 or higher, you have signs of organ damage, or if you have heart failure, coronary artery disease, diabetes, or kidney disease.
2.

Do you still need to make lifestyle changes if you are taking pills for high blood pressure?

  • YesYou're right. Even with pills, you will need healthy habits for the rest of your life to lower your risk for heart attack and stroke.
  • NoSorry, that's not right. Even with pills, you will need healthy habits for the rest of your life to lower your risk for heart attack and stroke.
  • I'm not sureIt may help to go back and read "Get the Facts." Even with pills, you will need healthy habits for the rest of your life to lower your risk for heart attack and stroke.
3.

If your risk of heart disease is low, can you lower your blood pressure without pills?

  • YesYou are right. If your risk of heart disease is low, you may be able to lower your blood pressure without taking pills. But you will need to adopt healthy habits.
  • NoSorry, that's not right. If your risk of heart disease is low, you may be able to lower your blood pressure without taking pills. But you will need to adopt healthy habits.
  • I'm not sureIt may help to go back and read "Get the Facts." If your risk of heart disease is low, you may be able to lower your blood pressure without taking pills. But you will need to adopt healthy habits.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits

Credits
CreditsHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerRobert A. Kloner, MD, PhD - Cardiology
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

High Blood Pressure: Should I Take Medicine?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Start taking medicine for high blood pressure.
  • Try lifestyle changes first.

If your blood pressure is very high—higher than 160/100, or when either number is higher—you don't have a decision to make. You definitely need medicine to lower your blood pressure.

Key points to remember

  • For some people, lifestyle changes may be enough to lower their blood pressure. Whether this is an option for you depends on how high your blood pressure is, whether you have other health problems, such as diabetes, and whether any of your organs have already been damaged. Your doctor will also consider how likely you are to develop other diseases, especially heart disease.
  • Lifestyle changes are as important as medicine in lowering blood pressure and lowering the risk for heart attack and stroke. Lifestyle changes include losing weight, eating healthy, being active, limiting sodium and alcohol, and not smoking.
  • If healthy habits aren't enough to bring your blood pressure down to your goal, you may need to take pills.
  • Most people who take pills for high blood pressure need to take two or more kinds of pills that work together.
  • Even with pills, you will need healthy habits for the rest of your life to lower your risk for heart attack and stroke.
FAQs

What is high blood pressure?

Blood pressure is a measure of how hard the blood pushes against the walls of your arteries as it moves through your body. It's normal for blood pressure to go up and down during the day. But if it stays up when you are resting, you have high blood pressure.

Adult blood pressure is sorted into four types:

  • Normal blood pressure—less than 120/80 (say "120 over 80")
  • Prehypertension—120/80 or higher, but less than 140/90
  • Stage 1 high blood pressure—140/90 to 159/99
  • Stage 2 high blood pressure—160/100 or higher

What are the risks of not lowering your blood pressure?

When blood pressure is higher than normal most of the time, it starts to damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, and other problems.

Anything that increases your risk for a disease or problem is called a risk factor. High blood pressure is just one of several risk factors that make heart attack and stroke more likely. If you have high blood pressure plus another risk factor, heart attack and stroke are even more likely. Some risk factors are things you can change. Others you can't.

Risk factors for heart attack and stroke that you can change include:

  • Having high blood pressure.
  • Smoking.
  • Having high cholesterol.
  • Being overweight.
  • Not exercising.
  • Having diabetes that isn't under control.

Things you can't change include:

  • Having a parent, sister, or brother with early heart disease (before age 55 for men or before age 65 for women).
  • Being male.
  • Your age. People older than age 65 are more likely to have heart disease.

What is the treatment for high blood pressure?

High blood pressure usually can't be cured. But it can be controlled. The two types of treatment for high blood pressure are:

  • Lifestyle changes.
  • Daily medicines.

For most people, the goal is to get their blood pressure below 140/90. But a person's goal may be lower. Your doctor will give you a blood pressure goal that is based on your health. For example, your goal may be lower if you have other conditions such as diabetes, heart failure, coronary artery disease, or chronic kidney disease.

If your blood pressure is lower than 160/100 and your overall risk for heart disease is low, you may be able to lower your blood pressure to your goal with lifestyle changes without taking pills. Your doctor can help you know your risk for heart disease.

If healthy habits aren't enough to bring your blood pressure down to your goal, you may need to take pills.

Why are lifestyle changes so helpful?

Changes in lifestyle can help control high blood pressure. You may be able to avoid taking pills. If you are already taking blood pressure medicine, making some lifestyle changes may let you take a lower dose.

The combination of lifestyle changes and medicine will have the biggest effect on lowering your risk of heart attack or stroke.

  • Losing as little as 10 lb (4.5 kg) can help lower blood pressure.
  • Physical activity lowers blood pressure, especially if you have been inactive until now. Exercise also helps you manage your weight, but it can lower your blood pressure even if you don't lose weight.
  • Reducing salt in your diet can help control high blood pressure. Try to limit the amount of sodium you eat to less than 1,500 mg a day.
  • Eating heart-healthy foods can help lower blood pressure. The DASH (Dietary Approaches to Stop Hypertension) eating plan includes fruits, vegetables, and low-fat or nonfat dairy foods.
  • Drinking more than 3 alcohol drinks a day may raise your blood pressure. It can also interfere with some blood pressure medicines. Limiting alcohol to 2 drinks a day for men and 1 drink a day for women may help lower blood pressure.
  • Quitting smoking is important to reduce the risk of heart attack and stroke. Nicotine in tobacco briefly increases blood pressure and heart rate with each use.

For most people, it takes time and patience to replace old habits with new ones. You may need to take blood pressure pills until you decide you are ready to make lifestyle changes.

If you decide to try lifestyle changes first, you and your doctor may want to set a deadline. For example, you might decide that you will try lifestyle changes for 3 to 6 months. Then, if your blood pressure does not come down enough in that time, you may decide to start taking pills.

Why might your doctor recommend taking medicine for high blood pressure?

Your doctor may advise you to take medicine for high blood pressure if:

  • Your blood pressure is 160/100 or higher.
  • You have organ damage or other health problems such as heart failure, coronary artery disease, diabetes, or kidney disease.
  • You have one or more risk factors for heart attack or stroke.

2. Compare your options

  Take medicine for high blood pressure Try lifestyle changes first
What is usually involved?
  • You take medicine every day.
  • You may have to take more than one medicine to find the right mix to lower your blood pressure.
  • You will still need to make lifestyle changes to lower your risk of heart attack and stroke.
  • You make lifestyle changes such as eating better, exercising, drinking less alcohol, and quitting smoking to lower your high blood pressure.
What are the benefits?
  • Medicines help control your blood pressure and lower your risk of heart attack and stroke.
  • Lifestyle changes help control your blood pressure and your risk of heart attack and stroke.
  • You avoid the side effects of blood pressure pills.
  • You avoid the cost of blood pressure pills.
What are the risks and side effects?
  • Some pills cause dry mouth, weakness or dizziness, or a cough.
  • Blood pressure medicine may be expensive if your insurance doesn't pay for it.
  • If these changes don't lower your blood pressure enough, you may still need medicine.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about taking medicine for high blood pressure

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"After my doctor told me my blood pressure was too high, she suggested I try to bring it down by changing some of my habits. I quit smoking, went on a diet, and started a walking program. That made me feel healthier, but it didn't bring my blood pressure down very much. Now I take two kinds of blood pressure medicine as well as keeping up with my lifestyle changes. Everything is under control."

— Terrence, age 59

"I just found out I have high blood pressure. I want to try to make some lifestyle changes before I start taking medicine. I know I need to start out by making small changes and sticking with them. I'm going to start by walking 15 minutes 5 days a week and cutting down on salt by looking for other ways to season my food. After 2 weeks of that, I'll add some more goals and walk a little longer. I really think I can do this."

— Magda, age 45

"My doctor thinks I might be able to control my blood pressure by losing weight and getting more exercise. I started a diet but I wasn't sure I'd be able to lose weight. And I worry about having a heart attack because of my family history. So I decided to start taking medicine right away. I'll also try to eat healthier and start walking."

— Paolo, age 51

"About 6 years ago I found out my blood pressure was a little too high. I was a little overweight, and I didn't get much exercise. So I went on a diet and started going to the gym regularly. I was very motivated, because I did not want to have to take medicine if I could avoid it. It worked. My blood pressure came down and has stayed down."

— Hanh, age 64

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take medicines for high blood pressure

Reasons to try lifestyle changes first

I've tried being more active and making other lifestyle changes, but it has not lowered my blood pressure enough.

I feel confident that I can succeed at making lifestyle changes.

       
More important
Equally important
More important

I'm not concerned about the side effects of blood pressure medicine.

I'm worried about the side effects of pills.

       
More important
Equally important
More important

I want to do everything I can to prevent a heart attack or stroke.

I don't want to take medicine, even if it might lower my risk of heart attack and stroke.

       
More important
Equally important
More important

My other important reasons:

My other important reasons:

  
       
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking medicine

Trying lifestyle changes first

       
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Is it true that you may need to start taking medicine right away based on your health?

  • Yes
  • No
  • I'm not sure
You're right. Your doctor might recommend that you take medicine right away if you have very high blood pressure or if you have organ damage or other health problems such as diabetes.

2. Do you still need to make lifestyle changes if you are taking pills for high blood pressure?

  • Yes
  • No
  • I'm not sure
You're right. Even with pills, you will need healthy habits for the rest of your life to lower your risk for heart attack and stroke.

3. If your risk of heart disease is low, can you lower your blood pressure without pills?

  • Yes
  • No
  • I'm not sure
You are right. If your risk of heart disease is low, you may be able to lower your blood pressure without taking pills. But you will need to adopt healthy habits.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

     
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerRobert A. Kloner, MD, PhD - Cardiology

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