Q: Can you give me a bit of a primer on high blood pressure? I’m worried my husband may have it.
A diagnosis of hypertension requires accurate measurement of blood pressure. Your community pharmacist is trained to measure your blood pressure as part of monitoring how well your blood pressure-lowering medication(s) is/are working for you. At many pharmacies, these measurements can be logged with your patient profile and printed out before you visit your doctor or nurse practitioner. This way, you and your primary care practitioner can track your progress over time. Except for people with very high blood pressure, hypertension is usually diagnosed after your primary care practitioner has examined the pattern of your blood pressure measurements over several months.
Home blood pressure monitoring devices are an accurate way to measure your blood pressure. Hypertension Canada recommends blood pressure monitoring occur while sitting with your back supported. Your legs should be uncrossed, with your feet flat on the floor. You should rest for at least five minutes before taking a measurement. Your arm should be bare and supported. A properly fitting cuff is essential to getting an accurate blood pressure measurement. Your pharmacy team can help measure you for an appropriate cuff size. The middle of the blood pressure cuff should be at heart level. The lower level of the cuff should be 3 cm above the elbow crease. There should be no talking or moving during blood pressure measurements.
There are different blood pressure targets depending on your cardiovascular risk, other medical conditions (i.e., diabetes, kidney disease), and goals. A person at low cardiovascular risk may have a goal blood pressure of 140/90 mmHg or under, while someone with diabetes may have a goal blood pressure of under 130/80 mmHg. Talk to your pharmacist or other health care provider about your cardiovascular risk level, and about your specific goals. It can take four to six weeks after starting a new medication or dosage for the full effect to occur.
Once you start taking blood pressure-lowering medication, you generally take it for life. Although medication therapy is important, non-drug therapy is also very important. Removing salt from your diet can have the same impact on lowering your blood pressure as introducing medication. Achieving a daily salt intake of under 5 g per day (less than 2 grams per day of sodium) may decrease your blood pressure up to 10 to 15 mmHg. Live an active lifestyle. Thirty minutes of moderate aerobic physical activity (i.e., cycling, gardening, lane lap swimming) most days of the week is an effective way to lower your blood pressure.
A common reason for lack of blood pressure control is missing doses of medications. Because hypertension is silent, we may fool ourselves into believing that we are okay, and don’t need to continue taking these pills. Hypertension is a chronic disease and the majority of Canadians will require life-long treatment. Many blood pressure medications now come in combination formulations to lessen the number of tablets you need to ingest daily. Another great idea is to combine taking your daily blood pressure medication with an already established routine. For example, placing your pills beside your alarm clock and taking them as soon as the alarm rings in the morning, or placing the pill next to your car keys to take before you leave for work. Whatever your approach, it is important to try not to miss doses or run out of prescription refills. If you are having difficulty remembering to take your pills, or if you want to know if you are on the simplest blood pressure-lowering medication therapy possible, make an appointment with your pharmacist for a medication review. For more information, check out the resources in the sidebar.
Dr. Kevin McLaughlin (PharmD, BScPharm, BSc, ACPR) practices at Kennebecasis Drugs, in Rothesay N.B. His opinions expressed in this column are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment.