Fighting Back
In people with mild hypertension (systolic pressure of 130 to 139 mm Hg, diastolic of 80 to 89), ADA recommends starting with diet, exercise, and other changes to bring the pressure down. Studies have shown that cutting down on salt, losing excess weight, reducing alcohol consumption, getting more exercise, and eating more fruits, vegetables, and low-fat dairy products may help get blood pressure in line. Some research suggests that having low potassium may increase blood pressure, but talk with your doctor before taking a supplement: Too much potassium may be harmful for seniors and those with kidney disease. A healthy, well-balanced diet should provide all the potassium you need. In people with more severe hypertension or when blood pressure remains high after three months of lifestyle changes, your doctor may decide that medication is necessary.

There are numerous blood pressure medications, many of which are also used for other conditions, such as heart failure, angina, and arrythmia. Many people, especially those with diabetes, require multiple medications to reach their blood pressure targets.

Because these medications lower blood pressure, their side effects may include drowsiness, light-headedness, and erectile dysfunction. Special care must be taken during pregnancy, so be sure to let your doctor know if you are or plan to become pregnant. Here is a rundown of common blood pressure–lowering medications; many of them are also available as combinations, with two types of medication in a single pill.

• Alpha blockers dilate blood vessels to reduce blood pressure. They work by keeping the hormone norepinephrine from flexing the muscles in blood vessel walls.
• Angiotensin-converting enzyme (ACE) inhibitors increase the size of blood vessels, giving blood more wiggle room and thereby lowering blood pressure. A common side effect of ACE inhibitors is developing a cough. ACE inhibitors have a bonus function for people with diabetes because they can help protect against kidney damage (nephropathy).
• Angiotensin receptor blockers (ARBs) work similarly to ACE inhibitors, increasing blood vessel capacity. ARBs also can protect against nephropathy in people with diabetes.
• Beta blockers make the heart beat slower and with less intensity, decreasing the force of blood as it enters the arteries.
• Calcium channel blockers alter calcium mobility in the heart and vessels, which affects how hard the heart pumps. This medicine can both relax the heart and dilate the arteries to reduce blood pressure.
• Diuretics, such as thiazides, are the oldest and most well-studied blood pressure–lowering medications. They work by getting the kidneys to rid the body of excess fluids and sodium through urination, reducing blood volume and pressure. It is important to monitor potassium levels, though.

Taking multiple meds can be a headache, and cutting salt out of your diet may seem like tough going. But figuring out a way to keep your blood pressure down—for the sake of your eyes, kidneys, and heart—is just too important to ignore. A healthy blood pressure is something you and your doctor can achieve. So maybe it’s time to put a little gentle pressure on yourself and get started.