Blood pressure is a measure of heart pumping pressure.

What is blood pressure?
Blood pressure is the pressure of the blood circulating in your arteries.
It is produced mostly by the contracting heart. The top measurement is the systolic pressure when the heart is at maximum contraction. The diastolic reading is the bottom number and is the pressure when the heart muscle is relaxed between beats. Blood pressure commonly fluctuates throughout the day.

What is considered normal blood pressure?
A normal blood pressure is about 120/80.
Anything over a consistent level of about 120/80 for adults is considered to be
hypertension. Especially, when over 130/90 and persistent.
Children have a much lower normal BP.

How is blood pressure measured?
Ideally, BP measurements should be taken throughout the day and over several days rather than relying on a single BP measurement taken in the doctor’s office.
The patient should sit relaxed.
The cuff and manometer should be at about the level of your heart.
The cuff size should be at least two thirds as long as the distance between your shoulder and elbow. Small cuffs will give you a false high blood pressure reading.

BP varies throughout the day and night and periodic monitoring over several days is important in order to determine whether you have raised blood pressure or not.

What is high blood pressure or hypertension?
High blood pressure or hypertension is also known as the silent killer because it can lead to some major medical problems without you having symptoms. This is the easiest and cheapest potentially life-saving condition that you can screen for yourself.

What are the causes of raised BP or hypertension?
Most commonly (primary or essential hypertension) is related to:
poor lifestyle choices, poor diet, being overweight, smoking, stress, family history and age (arteries less elastic).

Secondary hypertension has an identifiable cause such as:

  • Kidney artery disease
  • Endocrine/adrenal (hormonal) disorders
  • Medications such as oral contraceptives, NSAIDs over long periods and illegal drugs

What can you do to normalize your BP?
Make determined and disciplined lifestyle changes.

  • Weight loss (get to the ideal weight for your height)
  • Healthy diet and smaller portions
  • Minimize salt intake
  • Minimize caffeine intake
  • Exercise (mainly for cardio benefits)
  • Stop smoking
  • Moderate alcohol consumption
  • Meditation/yoga

Determined and disciplined lifestyle changes to normalize BP may eliminate: 

  • Some doctor visits
  • Medications
  • Cost of visits and medications
  • Side effects of medications
  • Risk of diseases and impaired quality-of-life issues associated with hypertension
  • Treatment cost of diseases caused by hypertension

Untreated or inadequately treated hypertension leads to:

  • Dementia
  • Stroke
  • Blindness
  • Heart attack
  • Kidney failure
  • Loss of erections
  • Death

Hypertension is generally underdiagnosed
About one third of the population is unaware they have hypertension.

Hypertension is not well-controlled in most patients
About two thirds of those diagnosed do not have their BP under control because;

  • They are not taking their medications as instructed
  • Not taking the medications because of side effects and or, cost
  • Overtreatment and being dizzy from low BP

The goals of adequate BP treatment are:

  • To normalize your BP throughout the entire day (while on treatment you should monitor your BP throughout the 24 hour period as your current medicine may be controlling your BP only part of the day)
  • To have no side effects
  • To have no impact on quality-of-life or erections
  • To provide a cost effective treatment along with your commitment to lifestyle changes. This should prevent the morbidity and mortality arising from untreated or inadequately treated BP.

What classes of drugs are available for treatment of BP?

  • Angiotensin converting enzyme (ACE) inhibitors, enalapril, captopril, lisinopril, benazepril, etc these medicines allow blood vessels to relax by preventing the hormone angiotensin from constricting the blood vessels
  • Calcium channel blockers (CCBs), amlodipine, verapamil, diltiazem, etc these drugs prevent calcium from entering the smooth muscle of blood vessels and the heart causing relaxation of these muscles and therefore, wider blood vessels.
  • Angiotensin 11 receptor blockers (ARBs), irbesartan, losartan, valsartan, eprosartan, etc these drugs block the action of angiotensin and relax blood vessels.
  • Alpha blockers, doxazosin, hytrin, etc block the alpha constricting receptors of smooth muscle causing them to relax. These drugs can also relax prostatic smooth muscle and improve urinary flow.

These 4 classes of antihypertensives listed above are less likely to impact your erections but may still do so. Trying another drug within the same family of medications may be reasonable before moving on to another family of drugs if you feel you have side effects or your erections are compromised.

Can BP control require more than one drug?

Sometimes one medication is insufficient to normalize your BP and a combination of drugs may be necessary. For example, one can start with a low dose of say hytrin and slowly increase the dosage. If BP is still high once you have reached a maximum dose for the hytrin a second medication such as irbesartan can be added and slowly increased till your pressure has normalized. Alternatively, you may start with a medication other than hytrin. Rarely, even two different medications may be insufficient to control your BP and further evaluation may be necessary.

What are the common side effects of BP medicines? 

(specific drug actions and reactions should be researched in more detail elsewhere). Side effects are common and can impact quality-of-life and or, erections.
Common side effects include: 

  • Feeling different, noticing heart beats, aches, etc.
  • ACEs are often associated with a cough.
  • ARBs are often associated with dizziness but may improve erections.
  • CCBs are often associated with ankle swelling or constipation (and possibly a risk for breast cancer).
  • Thiazide diuretics are often associated with loss of erections and increased urination. Thiazides are not an ideal drug for sexually active men.
  • Beta blockers commonly cause loss of libido, altered genital sensation and impotence or loss of erections (untreated BP causes the same issues – several other medications can affect erections). You can still take a medication such as cialis or viagra to improve erections but your BP may drop a little further.

Treatment of high blood pressure can save your life.  

Although adequate treatment of hypertension is vital, many of the drugs used to treat raised BP produce undesirable effects. Commonly physicians don’t ask whether or not you have side effects as they are relying on you to tell them. Also, many providers  will start you on some sample medication that they have been given by a pharmaceutical rep. Should you decide to continue with that medication you may be in for some sticker shock when picking up the prescription as these sample drugs are not generics.
Once you have made appropriate lifestyle choices and your pressure has normalized, periodic monitoring should be undertaken to ensure that your BP stays normal.
If you still have a raised blood pressure despite lifestyle changes and or, medications further evaluation and treatment may be necessary. See a physician.

What is the cost of having your BP taken?
Most drug stores have equipment where you can check your blood pressure for free.
You can also buy blood pressure measuring devices at little cost. Taking your BP is easy and you can do this several times a day for several days so you have an idea of what your average BP is. If after making lifestyle changes your blood pressure is still high you should visit with a doctor.

The cost of a doctor’s visit can vary between $80 – $250. Shop around and ask for cash pay pricing near you. Most physicians will gladly give you a discount for cash pay so they don’t have to deal with burdensome health insurance plans.

Cash pay pricing beats insurance-based pricing and hassles. Check prices before you book. 

Book your Blood Pressure visit

Written by HEALTHdrum