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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?
1Get the | 2Compare | 3Your | 4Your | 5Quiz | 6Your Summary |
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 may 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, your doctor may recommend that you 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.
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.
| Blood pressure category | First number (systolic) | Second number (diastolic) | |
|---|---|---|---|
| Normal | Less than 120 | AND | Less than 80 |
| Elevated | 120 to 129 | AND | Less than 80 |
| High blood pressure (hypertension)-Stage 1 | 130 to 139 | OR | 80 to 89 |
| High blood pressure (hypertension)-Stage 2 | 140 or more | OR | 90 or more |
The top and bottom numbers are both important. High blood pressure means the top number is 130 or higher or the bottom number is 80 or higher, or both.
What are the risks of not lowering your blood pressure?
High blood pressure can damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, and other problems. The goal of treating high blood pressure is to lower your risk of health problems that are caused by, or made worse by, high blood pressure.
Your doctor can help you know your risk of health problems like heart attack and stroke.
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).
- 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.
Your doctor will give you a blood pressure goal. Your goal will be based on your health and your age. Your blood pressure goal can help you prevent problems caused by high blood pressure.
If your blood pressure is just a little high, and your overall risk for health problems such as heart disease is low, you may choose to try to lower your blood pressure with lifestyle changes without taking pills. If healthy habits aren't enough to bring your blood pressure down to your goal, your doctor may recommend that you take pills.
If your blood pressure is more than a little high, or you have other risk factors, you may want to consider taking pills in addition to lifestyle changes. The higher your blood pressure, the more benefit you will get from taking medicines.
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. Ask your doctor what level of activity is safe for you. To lower blood pressure, your doctor might recommend that you try to do moderate exercise at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week.
- 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.
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 more than a little high.
- 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.
- Lifestyle changes have not lowered your blood pressure to your goal.
Compare your options
Compare
What is usually involved? |
| |
|---|---|---|
What are the benefits? |
| |
What are the risks and side effects? |
|
- 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.
- 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.
- Especially if your blood pressure is higher, you won't lower your risk of heart attack and stroke as much as you would if you also took medicines.
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.
I'm not concerned about the side effects of blood pressure medicine.
I'm worried about the side effects of pills.
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.
My other important reasons:
My other important reasons:
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
What else do you need to make your decision?
Check the facts
Decide what's next
Certainty
1. How sure do you feel right now about your decision?
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 and References
| Author | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Primary Medical Reviewer | Martin J. Gabica, MD - Family Medicine |
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
| Specialist Medical Reviewer | Michael P. Pignone, MD, MPH, FACP - Internal Medicine |
- Whelton PK, et al. (2017). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, published online November 13, 2017. DOI: 10.1016/j.jacc.2017.11.006. Accessed November 20, 2017.
- Diao D, et al. (2012). Pharmacotherapy for mild hypertension. Cochrane Database of Systematic Reviews (8).
- Eckel RH, et al. (2013). 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437740.48606.d1.citation. Accessed December 5, 2013.
- Go AS, et al. (2013). An effective approach to high blood pressure control: A scientific advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. DOI: 10.1161/HYP.0000000000000003. Accessed December 30, 2013.
- James PA, et al. (2013). 2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Journal of the American Medical Association. DOI: 10.1001/jama.2013.284427. Accessed December 18, 2013.
- Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458-2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.
- Whelton PK, et al. (2017). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, published online November 13, 2017. DOI: 10.1016/j.jacc.2017.11.006. Accessed November 20, 2017.
High Blood Pressure: Should I Take Medicine?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- 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 may 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, your doctor may recommend that you 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.
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.
| Blood pressure category | First number (systolic) | Second number (diastolic) | |
|---|---|---|---|
| Normal | Less than 120 | AND | Less than 80 |
| Elevated | 120 to 129 | AND | Less than 80 |
| High blood pressure (hypertension)-Stage 1 | 130 to 139 | OR | 80 to 89 |
| High blood pressure (hypertension)-Stage 2 | 140 or more | OR | 90 or more |
The top and bottom numbers are both important. High blood pressure means the top number is 130 or higher or the bottom number is 80 or higher, or both.
What are the risks of not lowering your blood pressure?
High blood pressure can damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, and other problems. The goal of treating high blood pressure is to lower your risk of health problems that are caused by, or made worse by, high blood pressure.
Your doctor can help you know your risk of health problems like heart attack and stroke.
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).
- 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.
Your doctor will give you a blood pressure goal. Your goal will be based on your health and your age. Your blood pressure goal can help you prevent problems caused by high blood pressure.
If your blood pressure is just a little high, and your overall risk for health problems such as heart disease is low, you may choose to try to lower your blood pressure with lifestyle changes without taking pills. If healthy habits aren't enough to bring your blood pressure down to your goal, your doctor may recommend that you take pills.
If your blood pressure is more than a little high, or you have other risk factors, you may want to consider taking pills in addition to lifestyle changes. The higher your blood pressure, the more benefit you will get from taking medicines.
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. Ask your doctor what level of activity is safe for you. To lower blood pressure, your doctor might recommend that you try to do moderate exercise at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week.
- 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.
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 more than a little high.
- 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.
- Lifestyle changes have not lowered your blood pressure to your goal.
2. Compare your options
| Take medicine for high blood pressure | Try lifestyle changes first | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
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.
I'm not concerned about the side effects of blood pressure medicine.
I'm worried about the side effects of pills.
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.
My other important reasons:
My other important reasons:
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
5. What else do you need to make your decision?
Check the facts
1. Is it true that you your doctor might recommend blood pressure medicine based on your health?
- Yes
- No
- I'm not sure
2. Do you still need to make lifestyle changes if you are taking pills for high blood pressure?
- Yes
- No
- I'm not sure
3. Do lifestyle changes lower blood pressure for everyone?
- Yes
- No
- I'm not sure
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?
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.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
| Primary Medical Reviewer | Martin J. Gabica, MD - Family Medicine |
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
| Specialist Medical Reviewer | Michael P. Pignone, MD, MPH, FACP - Internal Medicine |
- Whelton PK, et al. (2017). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, published online November 13, 2017. DOI: 10.1016/j.jacc.2017.11.006. Accessed November 20, 2017.
- Diao D, et al. (2012). Pharmacotherapy for mild hypertension. Cochrane Database of Systematic Reviews (8).
- Eckel RH, et al. (2013). 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437740.48606.d1.citation. Accessed December 5, 2013.
- Go AS, et al. (2013). An effective approach to high blood pressure control: A scientific advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. Hypertension. DOI: 10.1161/HYP.0000000000000003. Accessed December 30, 2013.
- James PA, et al. (2013). 2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Journal of the American Medical Association. DOI: 10.1001/jama.2013.284427. Accessed December 18, 2013.
- Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458-2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.
- Whelton PK, et al. (2017). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, published online November 13, 2017. DOI: 10.1016/j.jacc.2017.11.006. Accessed November 20, 2017.
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Current as of: February 28, 2018
