Heart & Cardiology/Lowering High BP & BP Terminology
QUESTION: Hello Dr Ahmed,
I have two questions.
The first is to do with BP terminology. If I have a SYS BP of 160mmhg and want to lower it to 110mmhg, do I say I want to lower it by 50 "points"? Is points the right word?
Also, looking at studies on supplements that lower BP, the most they lower SYS BP is by 5 - 10 points(?) over 4-12 weeks. If I need to lower my BP by 50 points, then I would need 5-10 different supplements? Or at least a cocktail of different supplements?
Thank you for any advice.
50 points is an acceptable term for that.
So its true that in trials of blood pressure medications (i assume by supplements you mean medications) most will lower bp by a margin of 5-10 points. For people lowering bp by 50 points, then almost certainly a combination of 2 or more medications will be required. Some people are more sensitive the medications than others.
I always tell my patients however that its important to note that many lifestyle interventions can help and most certainly should be used in combination. For example taking up exercise can lower BP by a similar magnitude, as can weight loss etc. Sodium intake is important as not only does it contribute to elevated blood pressure, but elevated sodium levels lead to resistance to antihypertensive therapy. Simple lifestyle measures can make a big difference and may even avert the need for use of multiple medications.
Hope that was helpful,
---------- FOLLOW-UP ----------
QUESTION: Thankyou, Dr Ahmed.
Yes, that was helpful.
In my research I notice that different medications/supplements that are proven to lower BP do so using different "mechanisms". For example, direct vasodilation, inhibiting chemicals that vasoconstrict, increasing NO availability etc. Offhand, how many different metabolic pathways does the body have that involve BP regulation? Are there any books for the layman on this subject?
My cardiologist can spend only a short time with me so I need to prepare myself when I discuss this with him.
There are literally hundreds of different agents that have been investigated to lower blood pressure and numerous pathways and mechanisms by which they do this. On top of that many more potential mechanisms are being discovered and novel medications developed. In addition various devices and procedures have also been investigated.
When you see your cardiologist this should not be the topic of conversation. Rather is should focus on agents that are proven to not only reduce blood pressure, but also improve clinical outcomes. These include calcium channel blockers, diuretics and ACE inhibitors for example. The key is to use the medicines that are appropriate for each individual based upon their clinical profile. You can ask why he/she has chosen the agents they did for you, and what benefit they may have in terms of improving your outcome. You should discuss the goals of treatment and the timeframes expected to achieve this. You should also discuss side effects of the medications. Finally i recommend you keep and detail a blood pressure diary using a home monitoring device and record twice daily and take this to any subsequent meeting to monitor efficacy of treatment.
This is a link to the recent recommendations regarding blood pressure control, http://jama.jamanetwork.com/article.aspx?articleid=1791497
that you may find interesting.