The World Health Organization has declared hypertension a global health crisis. An astounding 45% of adults in the United States have high blood pressure, and it was a primary or contributing cause of death for almost 500,000 people in the United States in 2018 alone.
Yet, many people with hypertension take little heed of it. The lack of urgency and commitment to self-care behaviors is partly because hypertension often presents without overt symptoms. Although many patients are cognizant of the damage that hypertension can do to their hearts, they may be unaware of the full toll it can take on other organ systems and the extent to which this damage can impair their quality of life. Years of excessive pressure enlarge the heart’s left ventricular walls and damage the arteries’ lining, making them less pliable and leading to the buildup of fatty deposits, which affects the heart, but also can lead to blindness, stroke, dementia, sexual dysfunction, and even osteoporosis.
Assisting patients to have a clear picture of the effects of their choices and the tremendous control they can have over hypertension through lifestyle measures can empower them to make the best decisions for themselves. Unfortunately, the pros and cons of long-term use of medications compared to the benefits and disadvantages of lifestyle measures are rarely explored with patients.
Unfortunately, it is common for people with hypertension to take two or more medications to control their blood pressure throughout their life. Common blood pressure medications such as diuretics come with the risk of increased urination, dehydration, gout, and hypokalemia, which can cause muscle weakness. Calcium channel blockers are known to bring on swelling in the lower extremities, heartburn, nausea, and dizziness, while angiotensin-converting enzyme (ACE) inhibitors often induce a chronic dry cough. Both angiotensin II receptor blockers (ARBs) and ACE inhibitors can raise the potassium level in the blood, requiring patients to follow a low potassium diet in which they must limit such healthful and enjoyable foods as oranges, sweet potatoes, leafy green vegetables, and nuts.
Using the risks of poor outcomes and or medications’ side-effects to bludgeon fear into patients is likely unadvisable. But providers should stress patients’ autonomy to make informed decisions and regularly remind them that with a small amount of weight loss, changes in diet, increased physical activity, and medication if needed, it is possible to bring blood pressure under control.
Lifestyle measures such as a healthful diet with sodium reduction, regular exercise, smoking cessation, alcohol modification, and healthy weight achievement have many proven positive physical benefits. These well documented improvements include cardiovascular strength and endurance, improved metabolic profiles, and inflammation reduction. Lifestyle measures, although effective, can be difficult to achieve if they require the omission of comfortable and well-liked behaviors that provide joy and connection for the patient. Healthy changes to lifestyle activities requires persistence and diligence and are often time-consuming, but they are essential if the patient wants to gain control over their blood pressure.
Lifestyle measures on their own may not be sufficient to control everyone’s high blood pressure. On balance, do their positives outweigh their negatives? That is up to each patient to decide. But it is essential for providers to empower patients with knowledge and strategies and present the information in the context of developing patient self-efficacy, so that they can make the best decisions for their own health.
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Nora Saul is a Registered Dietitian and Certified Diabetes Care and Education Specialist. Nora has more than 25 years of experience in the field of diabetes education, consulting for the Joslin Diabetes Center and other industry partners. Nora leads content development for Silver Fern’s diabetes products and training.