Johns Hopkins Health Alerts | Hypertension & Stroke | Q and A About Blood Pressure Drugs

Concerned about the risks associated with blood pressure medication? Roger S. Blumenthal, M.D., medical editor of the Johns Hopkins Heart Bulletin, answers readers’ questions.

Q. I am not averse to taking medication, but my doctor told me that once I start with a high blood pressure medication, I would have to take it forever. I am only 51 years old, so "forever” seems like a real long time. What if I were able to stop smoking, and to lose the 40 to 50 pounds the doctor recommends? Would I still need the high blood pressure drugs? Oxford, MI

A. Weight loss is highly beneficial in terms of dropping blood pressure for most people. Exercise can also be very helpful in reducing blood pressure in individuals with mild to moderate levels of hypertension. Moderate intensity aerobic exercise has been shown to drop systolic (top number) pressure by 10 to 11 mmHg, and diastolic (bottom number) pressure by 7–8 mmHg. But the answer to your question about high blood pressure medication depends on the degree of your hypertension.

It is certainly possible that if your blood pressure is only mildly elevated, a combination of weight loss, exercise, and smoking cessation could lower your blood pressure to the point where medication is not needed. In general, though, most people with high blood pressure tend to remain on their blood pressure medication for life and often require additional medication to control blood pressure as they age.

Q. I know hormone replacement theory is a very controversial topic, but what is your advice for a woman (my 55-year-old wife) who was recently diagnosed with high blood pressure. The hot flashes and sleep problems accompanying Nancy’s menopause are so severe that she now is willing to consider hormonal therapy to relieve her symptoms. She mentioned this to her 60-year-old sister, who warned Nancy that the drugs could make her high blood pressure worse. If this is true, what should she do? Orleans, MA

A. Gynecologists prescribe hormone replacement therapy (HRT) as a highly effective treatment for the more troublesome symptoms of menopause. There is no contraindication to the use of HRT in hypertensive women. There may sometimes be an idiosyncratic reaction to HRT causing high blood pressure, but this is uncommon. Your wife’s blood pressure should be monitored two to three times in the first six months after starting HRT and then routinely afterwards.

Q. My doctor recently started me on high blood pressure medication. He said my blood pressure was slightly elevated and had not gone down since my exam last year. If my blood pressure is really not that high, is there a risk that the drug will lower my blood pressure too much? Hanover, NH

A. It is possible that a high blood pressure medication can work “too well,” and cause someone to become hypotensive, that is, for their blood pressure to drop too low. Physicians typically try to prevent this adverse effect by starting with a low dose of blood pressure medication and slowly increasing the dosage until optimal blood pressure is achieved. Given that your blood pressure is only “slightly elevated,” it is likely that your doctor has prescribed a low dose of medication. If you monitor your blood pressure regularly after starting on the drug, you should be able to avoid hypotension.

For more Alerts and Special Reports, please visit the Hypertension and Stroke Topic page.

Johns Hopkins Health Alerts | Hypertension & Stroke | Q and A About Blood Pressure Drugs