High Blood Pressure – FAQs


In our clinic, we take care of a lot of people with high blood pressure. And we get a lot of questions.

Once I start blood pressure medicine, will I have to take it for the rest of my life?
The answer here is a straightforward “yes” and “maybe”. Once started on blood pressure medication, most people will need to continue it for the rest of their lives. Keep in mind that the normal aging process brings with it many unwanted changes, including a gradual increase in our blood pressures. And we all know how hard it is to give up bad/unhealthy habits. However, if sufficiently motivated to improve our lifestyles—more exercise, no smoking, achieving and maintaining our ideal weight, really restricting our salt intake—it might be possible to stop our BP medicine. This will need to be carefully coordinated with you physician, but yes, it’s possible. Maybe.

What’s the best time of day to take my medication, morning or night?
I’m glad you asked this question. A lot of people wonder about this, and it turns out to be important. For a long time, we didn’t think it made any difference as to when you took these medicines. The only consistent advice was not to take your fluid pill right before going to bed. Not unless you wanted to get up several times during the night and risk falling over the dog.
We now know that aside from those fluid pills (still good advice to take these in the morning), your other blood pressure medicines should be taken at night, before you go to bed. From a statistical standpoint, more heart attacks and strokes occur in the early morning hours—frequently upon arising—and are thought to be due at least in part to a sudden rise in uncontrolled blood pressure. If your medicine was taken the morning before, it has most likely left your system and left you unprotected. Some of the long-acting drugs have helped here, yet this continues to be our most vulnerable time of day. Take you pills before bed.

The guy at the health food store recommended some stuff for my blood pressure. What do you think?
It all depends on what stuff. There are a few things that might help, but most of the claims by the manufacturers of these supplements are unfounded. They haven’t gone to the trouble and expense to do the necessary research to prove their effectiveness. Or the research might have been done and demonstrated no benefit—maybe even some harm. Yet they continue to be on the shelves of your health food store because no one’s really watching. There’s very little oversight in this important and costly area of our healthcare.
You can find out what you need to know by going to: www.nccam.nih.gov/health/herbsataglance.htm.

My aunt told me to drink a tablespoon of vinegar every night and my blood pressure would be fine. Is she crazy?
You’ll have to answer the last part, but I can tell you about vinegar. There have been many claims regarding the health benefits of regularly consuming apple (white) vinegar. Lowering cholesterol, losing weight, controlling diabetes, and lowering blood pressure. To date, there is no good evidence that supports any of these claims. On the other hand, white vinegar is effective in removing clogs from drains, breaking down glue for easy removal, and helping strip wallpaper. Should you decide to give it a try for medicinal purposes, be aware that it can attack the enamel of your teeth, causing cavities and sensitivity.

I read where Kosher salt is better for you than the regular kind. What do you think?
This is the orthopedic conundrum, only repackaged.
“Mrs. Jones, the x-ray shows little Billy’s wrist is fractured.”
“Thank heavens! At least it’s not broken or cracked.”
It’s all the same. Kosher salt, sea salt, black salt, Himalayan pink salt, Celtic salt, regular table salt—they’re all pretty much equivalent when it comes to their sodium content. There might be some slight variations in contaminants and trace amounts of minerals such as calcium, magnesium, and potassium, but when it comes to your blood pressure and health, there’s not a grain of difference.

I read that ibuprofen is bad for your blood pressure, but naproxen is okay. What do you think?
I think, once again, don’t believe everything you read. You’re right about the ibuprofen. It’s one of our nonsteroidal anti-inflammatory drugs (NSAIDs) and it can raise our blood pressure as well as worsen some of the other cardiovascular risks. But the same is true for all of the NSAIDs, including naproxen. If you have high blood pressure, you’ll need to avoid these drugs. A baby aspirin (81mg) is also an NSAID, but there’s no evidence connecting it with worsening hypertension. And for the record, acetaminophen is not an NSAID, nor does it interfere with the control of our BP.

One of my friends said I’ll have to give up coffee now that I’m on blood pressure medicine. Is that true?
This is tough for me, because I’m an avid coffee drinker—regularly consuming anywhere from 2-6 cups per day. The most current evidence indicates that caffeine can cause an acute rise in blood pressure, but not to excessive levels, and then it normalizes over the next half hour or so. This response is seen less frequently in those of us who are accustomed to drinking coffee or tea. If you regularly drink coffee and your blood pressure is normal, you should be fine. It might be reasonable to conduct a home trial. Check your blood pressure, drink a cup of your favorite brew, then repeat your pressure in fifteen or twenty minutes. If your systolic pressure goes up by more than 10 points, you may be “caffeine sensitive”. If the rise is less than this, you’re probably okay. It would be a good idea to discuss these findings with your physician.
If I get my pressure under control, can I stop taking medicine? And if so, can I stop “cold-turkey?”
Not just yet, and no. As we considered in our first question, it may be possible to stop taking blood pressure medicine if you have achieved your goal and adjusted your lifestyle. You’ll want to be sure you maintain your weight (assuming this has happened), and can continue your other lifestyle changes. Then work with your physician, making sure she advises you along the way. As to how to stop, most medications will need to be tapered—usually over two or three weeks—while your pressure is being carefully monitored. This is especially true for the beta-blockers, since stopping cold-turkey with some of these can precipitate serious problems, including a heart attack or worse.
My nephew is in pre-med, and he told me as long as one of my blood pressure numbers was okay, I’d be fine. You agree with that?
Say what? Where does your nephew go to school? Of course this is not okay. While it’s true there is something called “systolic hypertension”—a condition where our systolic pressure is elevated while our diastolic remains in or near the normal range—this is something that usually occurs as we grow older, is still serious, and it’s something most experts would address. Otherwise, we’re going to target both of our numbers, keeping in mind that elevations in our systolic and diastolic pressures each bring their own set of problems and complications.
I’m about to have a life-insurance physical and don’t want to tell them I take blood pressure medicine. Is there any way they can find out?
Remember what Mark Twain once said:
“If you tell the truth,
you don’t have to remember anything.”
That’s still good advice, aside from the fact that we should always strive to be honest. In this particular case, you’d better be. There are tests that can be done (usually on a urine specimen) to determine the presence of several classes of blood pressure medicines, as well as some of the statins. You’ll find yourself better off by accurately noting your current medications than should you be caught in an intentional deception. Don’t find yourself trapped in that “tangled web”.

The nurse at my doctor’s office says there’s no difference between using a regular size BP cuff or a large one. As you can see, I’ve got big arms. Does it really matter what size the cuff is?
Of course it does. If the cuff is too small, your pressure is going to be over-estimated. And if too large, the reading will be lower than the actual numbers. Remember, the cuff needs to be placed with its lower edge one inch above the elbow, and it should cover 2/3 of the upper arm. Make sure this is done correctly.
Everyone in my family has high blood pressure—going back as many generations as I know about. I’m going to have it, so that’s that, and there’s nothing I can do.
Is there a question here, or just a statement of futility? It’s true that genetics play a significant role in most areas of our lives (nature versus nurture), and our blood pressures are no exception. We are beginning to learn more about this important area and in fact see a trend of hypertension within families and close relatives. While its familial presence should alert you to the possibility of developing high blood pressure, there’s no cause for despair. Rather, this should be viewed as a challenge, something to be managed and overcome. So yes, you can do something about it.

Doc, I read your book about lowering cholesterol. You talk about your faith, and I was wondering how you balance that with being a physician? How do you combine your faith with your science?
I’m glad you asked that question, because it’s the easiest one yet. Francis Bacon (1561-1626) might have said it best.
“Little knowledge of science
makes a man an atheist,
but in-depth study of science
makes him a believer in God.”
The psalmist was right – we are fearfully and wonderfully made.

(Taken from my book “60 Ways to Lower Your Blood Pressure”.)

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