Let’s look at how doctors care for high blood pressure (also known as hypertension) with lab tests, lifestyle improvements and medications, while watching for possible side effects of medications.

Even without symptoms or signs of illness other than blood pressure being high, a doctor may want to order baseline tests to see how your body is doing, such as:

• Blood tests to check blood chemistries, sugar, cell count, cholesterol.

• Urine test to look for protein, sugar, blood cells.

Patients who have pre-hypertension, which means their blood pressure is elevated but not high enough to be called “mild hypertension”, have blood pressures of 120-129 systolic and less than 80 diastolic, do not need high blood pressure medication but should begin lifestyle improvements:

• Avoid salt (eat foods low in salt and avoid sauces).

• Start exercising more.

• Lose some weight if overweight.

• Stop smoking or using other tobacco products.

• Reduce alcohol intake or stop drinking alcohol completely.

In a patient with mild hypertension, meaning 130–139 systolic or 80–89 diastolic, lifestyle improvements are sometimes not enough to bring the blood pressure down even after trying for 3–6 months.

• A doctor might start medication in such a patient, with the goal of getting hypertension under control within three more months.

• Common initial treatment is starting one of four types of medications: ACE inhibitor, ARB, CCB, or diuretic drugs.

• After an initial 1-week period of checking home blood pressures, a patient can follow their doctor’s instructions on how often to keep checking (it might be 2-4 times a month). Patients record their measurements on paper, online, or in an app, to show their doctors their blood pressure readings at follow-up visits.

• Routine follow-up video visits help the doctor see the progress of dietary improvements, weight reduction and other lifestyle modification goals.

• Annual urine or blood tests might be needed to check for kidney problems, high cholesterol or high blood sugar, in patients with any degree of hypertension.

In a patient with moderate hypertension, meaning 140–179 systolic or 90–119 diastolic, medication plus lifestyle improvements are started together as treatment.

•  When treating high blood pressure, doctors often use a combination of two drugs, beginning at a lower dose but increasing the dose if the patient continues to have high measurements.

• When two drugs are not effective enough, doctors might add a third drug instead of using larger doses of 2 drugs.

• If a patient is frail or elderly, doctors often use lower doses or start with just one drug.

•  Sometimes, a doctor might do an ECG (electrocardiogram) to check for excess strain on the heart or irregular heartbeats. 

When you or someone you care about is interested in preventing or treating hypertension, some FAQs are:

• What should I eat to help prevent or control high blood pressure?

• What’s the difference among pills for treating hypertension?

• What are some side effects of the medications?

• What happens if I don’t treat or control my hypertension?

What should I eat to help prevent or control high blood pressure?

Healthy eating generally means foods with less salt, less fat, and fewer calories, such as fresh vegetables, apples, pears, oranges, whole wheat pasta, brown rice, skim milk or 1% milk.

• A wise choice for hypertension patients is using spices, herbs, and flavorings that don’t contain salt. Avoid high-salt foods such as most frozen meals or restaurant foods, and soy sauce, teriyaki sauce, or stir-fry sauce. If counting sodium (salt) intake, the usual daily limit is 1500 mg to 2300 mg.

• Popular among high blood pressure patients is the DASH Diet, which includes fruits, vegetables and whole grains, while reducing sodium (salt) intake.

• Doctors advise staying away from high fat foods such as butter, margarine, whole milk, oily salad dressing, fatty meat or fried food, for better health in general. 

What’s the difference among pills and their side effects?

There are at least five common types of hypertension pills. If diet, exercise and lifestyle changes are not helping enough, then doctors start with one or two types of pills and adjust the dosing or change medications depending on how a patient’s blood pressure responds during treatment. A variety of pills contain combinations of two types of hypertension drugs.

ACE inhibitor drugs

“Angiotensin-converting enzyme inhibitors” prevent blood vessel narrowing; thus an ACE inhibitor drug lets blood vessels stay at a more relaxed, more open size. Some possible side effects of ACE inhibitors include:

• Dry, hacking chronic cough.

• Loss of taste.

• High potassium.

• Dizziness.

• Swelling of the face (also called angioedema).

• Rarely, kidney damage.

• *Not for use if pregnant or planning to be pregnant.

• Examples of ACE inhibitor drugs:

  • lisinopril (Zestril, Prinivil).

  • enalapril (Vasotec).

  • captopril (Capoten).

ARB drugs

"Angiotensin 2 receptor blockers” also block blood vessel narrowing; thus leaving blood vessels in a more relaxed, more open size. Some possible side effects of ARB drugs include:

• Dizziness.

• High potassium.

• Skin swelling (edema).

• Kidney problems.

• *Not for use if pregnant or planning to be pregnant.

• Examples of ARB drugs:

  • valsartan (Diovan).

  • losartan (Cozaar).

  • candesartan (Atacand).

Beta blocker drugs

"Beta blockers” relax blood vessels to lower blood pressure. Beta blockers also slow down the heart rate. Some possible side effects of beta blockers include:

• Dizziness.

• Insomnia.

• Cold hands and feet.

• Tiredness or depression.

• Slowed heart rate.

•  Asthma symptoms.

•  Sexual dysfunction or impotence.

• May mask the signs of low blood sugar if diabetic.

• *Ask a doctor first, if pregnant or planning to be pregnant.

•  Examples of beta blocker drugs:

  • metoprolol (Lopressor, Toprol).

  •  atenolol (Tenormin).

  • bisoprolol (Zebeta).

CCB drugs

“Calcium channel blockers” prevent calcium from getting into muscle cells of the heart and blood vessels; thus a CCB drug lets blood vessels stay relaxed and not be narrowed. Some possible side effects of CCBs include:

• Palpitations.

• Swollen ankles.

• Constipation.

• Headache.

•  Dizziness.

•  Examples of CCB drugs:

  • amlodipine (Norvasc, Lotrel).

  • nifedipine (Procardia, Adalat, Nifedical).

  •  diltiazem (Cardiazem, Dilacor, Tiazac).

Diuretic drugs

“Water pills” or diuretics remove sodium (salt) from the body by flushing it out in the urine; thus diuretics lower the amount of salt and water in the blood vessels. Some possible side effects of diuretics include:

• Dizziness, weakness, leg cramps.

• Increased or more frequent urination.

• Low potassium.

• Low sodium.

• Sexual dysfunction or impotence.

• Increased blood sugar level in diabetics.

• Gouty arthritis.

• Examples of diuretic drugs:

  • indapamide (Lozol).

  • hydrochlorothiazide (Microzide, Oretic).

  • chlorothiazide (Diuril).

  • spironolactone (Aldactone).

What happens if I don’t treat or control my hypertension?

In the early stages or first years of having high blood pressure, a person usually has no outward symptoms. It is a silent disease often unnoticed by the patient while it damages bodily organs, which is why people should check their blood pressure at home. Untreated, hypertension can lead to serious problems that doctors hope to protect their patients from, such as:

• Stroke
  High blood pressure over time may cause a blood vessel to burst and start bleeding inside the brain.

• Heart attack
  Hypertension damages the arteries that nourish the heart. When a heart artery is clogged, the person has a heart attack.

• Peripheral vascular (blood vessel) disease
  High blood pressure also damages arteries in the legs, arms, kidneys, eyes, and brain. Poor leg circulation causes leg pains.

• Kidney disease and kidney failure
  Damaged kidneys are less able to remove extra fluid from the body. A patient can become bloated with retained fluid.

• Eye damage
  Damage to blood vessels in the lining (retina) at the back of the eye can lead to bleeding inside the eye, blurred vision and blindness.

• Vascular dementia
  Hypertension leads to problems with reasoning, judgment and memory, due to decreased blood flow to the brain.

• Pregnancy complications
  High blood pressure affects about one in 10 pregnancies, sometimes just during pregnancy, but other times before, during, and after. 

Remember, high blood pressure is often a silent disease so check yourself with a home blood pressure monitor, or ask your primary care doctor about buying a home monitor if you don’t have one yet. Preventing and treating hypertension is important from a public health viewpoint too, as high blood pressure leads to death in about 360,000 people each year in the U.S., or about one out of 900 Americans.