How effective is it?

Doctors like to have proof in the form of medical studies that the drugs are effective and work as advertised. But this process takes ten years or more after a drug has been approved by the Food and Drug Administration (FDA) and comes onto the market, and many of the drugs in this chapter have been around for only a few years. Drug manufacturers often claim that a new drug in the same class as a proven old drug should work the same. However, the new drug may produce side effects that only become apparent after years of use on thousands of people. So you always have to be wary.

How much can it lower blood pressure as compared to another drug?

Up to a certain point, the lower the blood pressure, the better off the patient. However, several studies have shown that when the blood pressure goes below a certain level (which is not the same for each person), the risk of a heart attack increases (possibly because the pressure is so low that not enough blood is reaching the heart muscle). None of the commonly used drugs, when used alone, lower the blood pressure past that point. But of the various classes, thiazide diuretics lower the systolic blood pressure more than the others. (It lowers the diastolic blood pressure about the same as other drugs.)

Do drugs that lower blood pressure to the same extent have the same effect on disease and death?

Thiazide diuretics lower blood pressure more than the other classes of commonly used drugs.

It’s natural to assume that a blood-pressure-lowering drug prevents the longterm consequences of high blood pressure, but this isn’t necessarily the case. Nevertheless, the old standards, especially the thiazide diuretics, have proven effective  against long-term consequences.

In fact, the evidence shows that even when a drug other than a thiazide diuretic lowers the blood pressure to the same extent, thiazides prevent disease and death more than other blood-pressure-lowering drugs. If you’ve concluded that I have a definite preference for thiazide diuretics as initial drug treatment for high blood pressure, you’re right.

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If you’re thinking of becoming pregnant in the near future, get a blood pressure measurement and record it. Then, if your blood pressure is high during your pregnancy, you and your doctor will know whether the reading is new or has been at that level for awhile.

Chronic high blood pressure

A woman with chronic high blood pressure has a blood pressure of more than 140/90 mm Hg on repeated occasions, and it’s present before pregnancy or recognized before the 20th week of the pregnancy. Because many women haven’t had their blood pressure measured before a pregnancy and because blood pressure falls normally during the first six months of a pregnancy, chronic high blood pressure may go unnoticed until the final three months of the pregnancy.

As I note in the previous section, a woman with chronic high blood pressure may be able to stop medication until the baby is born. There is no evidence that the outcome of the pregnancy improves if the mother’s blood pressure is treated for the short duration of a pregnancy. However, if the diastolic blood pressure is above 100 mm Hg or the mother’s heart or kidneys are damaged, she should continue the medication.

The favorite medication for high blood pressure during pregnancy is methyldopa because it’s effective and safe for both the mother and the growing fetus. If the woman is already on a diuretic, she can continue it, but she should not start taking it during the pregnancy because it tends to lower the blood volume — which needs to be greater during a pregnancy. If methyldopa is ineffective, labetalol is another drug that has been successful.

If you’re pregnant and have high blood pressure, become familiar with the drugs . Do not take any of the angiotensin-converting enzyme (ACE) inhibitors, the angiotensin II receptor blockers, or the direct renin inhibitors because they all endanger the fetus. They must be stopped as soon as a woman becomes pregnant, preferably before pregnancy.

A woman who begins a pregnancy with a diagnosis of chronic high blood pressure should not do strenuous exercise during the pregnancy. The risk to the fetal blood supply is too great.

Chronic high blood pressure poses increased risks to the mother and the fetus, and these risks are even more dangerous in African American women and women with diastolic blood pressure over 110 mm Hg. The main risks are

• Developing preeclampsia
• Disease such as retarded growth and death for the fetus
• This must be monitored with monthly ultrasound studies.
• Significant worsening of the mother’s kidney function if kidney disease is present

Omron HEM-780 Automatic Blood Pressure Monitor Features

    * Cleared by the FDA to help detect morning hypertension
    * IntelliSense monitor inflates cuff to the ideal level with each use
    * Large digital panel displays blood pressure and pulse readings
    * Cuff fits arms 9 to 17 inches in circumference
    * Main unit measures 5.16 x 3.31 x 6.09 inches (WxHxD)

The easy to apply cuff, auto inflation, its accuracy, the memory, the averaging feature, the AC converter all make it worth the slightly higher price over other Omrons.

Not only does the HEM-780 Automatic Blood Pressure Monitor utilize Omron’s patented IntelliSense technology, but it also features the innovative Comfit Cuff. The ComFit Cuff is pre-formed for a quick and proper fit that is perfect for both medium and large-sized arms (nine to 17 inches). It’s easy to apply the cuff to your arm without any assistance — simply wrap the cuff around your arm and press start. In seconds your blood pressure and pulse are displayed on the large digital panel. Proven time and time again, Omron’s IntelliSense technology ensures accurate, clinically-proven, and comfortable readings. And with a 90-memory recall with date and time stamp, you can track your blood pressure and pulse progress as your work towards a healthier lifestyle.

To take an accurate reading, first position the green marker directly over the artery on the inside of your arm.

Next, place your arm on a table so the cuff is positioned at the same level as your heart.

Omron HEM-780 Automatic Blood Pressure Monitor Features：Premium auto inflation with Comfit cuff

Omron HEM-780 Automatic Blood Pressure Monitor Advanced Diagnostics：  

    * Detects irregular heartbeat
    * 200 total memory
    * Advanced averaging
    * Date and time
    * Hypertension indicator
    * Detects morning hypertension
    * 2-user plus guest mode
    * TruRead

Q&A – Blood Pressure Monitors

What is IntelliSense?
The IntelliSense Monitor inflates the cuff to the ideal level with each use. No adjustments are required by the user to select an inflation level. This is especially convenient for hypertensive users and for people with certain arrhythmia or heart disorders, because their blood pressure is more likely to fluctuate. The advantage is fast personalized inflation for maximum comfort.
What is a ComFit cuff?
The patented pre-formed cuff expands to fit regular and large arms comfortably and easily.
How is an Irregular Heartbeat Shown?
This advanced monitor can detect irregular heartbeats while your blood pressure is being measured. If an irregular heartbeat is detected, an accurate blood pressure reading is displayed along with the irregular heartbeat symbol.
What is Morning Hypertension?
The American Heart Association (AHA) recommends you take blood pressure readings in the early morning and evening. With the touch of a button you can review an eight week history of your morning and evening weekly blood pressure averages.

More Omron HEM-780 Automatic Blood Pressure Monitor

Within the setting of diabetes, the target blood pressure is <130/80. The topic of target blood pressures has been well-researched, and several large studies have consistently shown that significant improvements in lengthy term cardiovascular and kidney health do not become apparent until blood stress is reduced to this level. For this reason, doctors tend to be very aggressive when devising treatment plans for diabetic sufferers.

Some studies have suggested that certain groups of diabetic sufferers — like those with preexisting kidney problems — benefit most from blood pressures less than 120/80. Data has shown that the risk of cardiovascular problems and further kidney damage approach their lowest measurable values within this range. Because it is difficult to reduce blood pressure to this level, it is a recommendation usually reserved only for specific patients.
Non-Drug Therapy

The official guidelines of both the American Heart Association and the American Diabetes Association state that blood pressures within the range of 130-139/80-89 should first be treated with “non-pharmacologic” (no medicine) options. These options include:

• Weight loss
• Salt restriction
• Dietary changes
• Quitting smoking
• Limiting alcohol intake

In sufferers without diabetes, strict adherence to these rules very often leads to significant drops in blood pressure, enough so that drug therapy may not be needed. While the same can occur in diabetic patients, it is less common, and drug therapy is usually needed. These changes are still worthwhile, though, because they increase the effectiveness of the drug therapy and ultimately lead to better blood pressure manage.

Drug Therapy

Drug therapy is a necessary step for most sufferers at some point during treatment. Vast amounts of research have been done in an effort to determine which drug or drug combination is the “best” for treating high blood pressure in patients with diabetes. Though study results vary slightly, there is a near universal consensus that the best drugs to use within the setting of diabetes are:

• ACE Inhibitors
• Angiotensin Receptor Blockers (ARBs)
• Diuretics (Thiazides)

These drugs specifically address several concerns associated with higher blood pressure within the setting of diabetes including volume expansion, blood vessel stiffness, and kidney damage. Though some doctors initially begin therapy by trying a diuretic on its own, it is more common to begin with an ACE Inhibitor. Ultimately, some ACE Inhibitor / ARB combination is usually the treatment of choice, with a diuretic added if needed. Though this is the most common type of drug treatment, other drugs may be included depending on specific patient factors.

If your doctor chooses to start therapy with a diuretic, be aware that this is not a bad choice, and there is evidence to support this decision in certain types of sufferers. It will be clear very quickly whether the treatment is working or not, and adjustments will be made if necessary.
Follow-Up Care

Whatever the specific treatment being administered, proper follow up care is important to managing the lengthy term success of your therapy. Within the beginning, you’ll likely see your doctor monthly, or even bi-weekly, until an effective plan is in place. Then, many doctors will ask you to come back every three months for the first year. This close follow up is used to track changes in blood pressure and establish a baseline for certain physical parameters like electrolyte levels (potassium and sodium within the blood) and kidney function.

After the first year, your doctor may choose to switch to six month appointments, or might want you to continue on the three-month schedule. If you are asked to continue the three month schedule, this is not a cause for alarm, it just means that much more time is needed to ensure that everything is going as planned. A growing number of doctors are asking all diabetic patients with higher blood stress to come in every three months. Keeping these appointments is important. Treatment is most effective when paired with a schedule of proper follow-up care.

    Sometimes people with high blood pressure have thefollowing symptoms: Headache , Dizziness , Blurred vision , Nausea.

Chronic High Blood Pressure Symptoms:Heart attack , Heart failure , Stroke or "mini stroke" (transient ischemic attack, TIA) ,Kidney failure ,Eye damage with loss of vision , Peripheral arterial disease ,Outpouchings of the aorta, called aneurysms .

Malignant Hypertension Symptoms:

1.In malignant hypertension, the diastolic blood pressure (the lower number) often exceeds 140 mm Hg.

2.Malignant hypertension may be associated with headache, light-headedness, or nausea.

3.This degree of high blood pressure requires emergency hospitalization and lowering of blood pressure to prevent brain hemorrhage or stroke.

General tips for controlling blood pressure include the following:

1.Maintain a healthy weight.Lose weight and keep it off.

2.Quitting smoking (A Quit Smoking Tip) and moderating alcohol consumption will also help keep your blood pressure in the healthy range.

3.Reduce sodium (salt) intake.

4.Take medicines as directed.

5.Eat a nutritious, low-fat diet.

6.Exercise regularly.

7.Get your blood pressure checked periodically. Consider getting an accurate and easy-to-use home monitor.

8.Take your blood pressure medications as directed, even if you’re feeling fine.

9.Reduce stress and practice relaxation: Physical activity will help with this.