OKEECHOBEE — Picture a snake that swallowed a mouse.  You can observe the mouse moving down the snake’s body.  The systolic blood pressure is like the mouse.  Its the highest pressure the artery walls have to cope with.  The diastolic blood pressure is the lowest pressure the artery walls get to relax with, like the snake areas without the mouse.

Over the years there have been many guidelines on treating the blood pressure.  Terms such as pre-hypertension, stage 1 high blood pressure, stage 2 high blood pressure are no longer used.  Years ago normal blood pressure was less than 165/90.  The current goal for all blood pressure is less than 130/80. 140/85 in the elderly. It turns out white coat hypertension carries the same risks as regular hypertension. To get more accurate readings, sit quietly for 5 minutes in a dark room with feet on the floor and back supported, then check blood pressure 3 times..

This lower pressure goal significantly reduces the complications of high blood pressure.  Complications include dementia, stroke, heart attacks, heart failure, kidney failure, blindness and premature death.  Its called the “silent killer.”

High blood pressure can usually be controlled with a strict diet.  The DASH diet has the most scientific data behind it.  Keeping the salt intake low can significantly lower blood pressure.  Losing weight if overweight helps.  Drinking more than 2 alcoholic drinks daily significantly increases the blood pressure.  

Sometimes these methods fail; for those medication will be necessary. Many classes of medications are available. 

1) Diuretics (“water pills”) Thiazide diuretics remove salt and water from the body.  They are very effective.  They can lower serum potassium, so blood tests are needed for monitoring.  Hydrochlorothiazide (HCTZ) only lasts 12 hours so it should be given twice daily.  Chlorthalidone is stronger and lasts 24 hours.  Combination pills are available to raise the potassium such as Maxzide and Dyazide.  Diuretics can raise the blood sugar a little.  Can’t be taken if the kidney function is poor.

2) ACE inhibition.  ACE inhibitors and ARBS protect the kidneys, especially in diabetics.  They can make your blood test look worse because it raises creatinine.  Regular blood tests are needed.  Lisinopril and ramipril are the most commonly used ACE inhibitors.  Losartan and other are ARBS.

3) Beta Blockers: They block adrenaline, improve heart function, improve white coat HTN. The beta blockers Toprol (long acting metoprolol succinate) and Coreg (carvedilol) have data behind them that they  prevent cardiovascular complications, atenolol doesn’t have those benefits.  They don’t require blood tests.

4) Calcium channel blockers.  They work by relaxing the artery walls.  The most commonly used is Norvasc (amlodipine), which can cause swelling.  Verapamil causes constipation, so its good for patients with chronic diarrhea.  Procardia (nifedipine) is another option in this class.  No blood tests are needed with this class.

5) Alpha blockers.  These medications keep the arteries from squeezing too hard.  The most commonly used one is Clonidine.

6) Spironolactone: blocks chemicals that cause high blood pressure.  Can raise potassium.  Requires regular blood tests.

7) Bidil is a combination of heart medicines, isosorbide and hydralazine.  Its mostly effective in African Americans, but can be used for others as well

8) Loop diuretics like Lasix (furosemide), Bumex (bumetanide) and torsemide only work for high blood pressure if the kidneys are bad, stage IV or worse.  They cause low potassium and magnesium, so they will require regular blood tests.

9) Nitroglycerine can be used for individuals who have acutely high blood pressure, greater than 175, to get the pressure down quickly.