What can the Doctor do?

The aim of the doctor’s treatment is to lower your blood pressure and advice you on changing your lifestyle. For most people this means that they have to take one or more kinds of pills every day and at the same time change their lifestyle. Your doctor evaluates your blood pressure in the context of other conditions that affects whether you – in a few years – have a heart attack or a stroke. This concerns smoking, your weight, exercise, your intake of alcohol and the presence of other illnesses that also causes an increases risk of blood clots – namely diabetes, too high an amount of fat in the blood and albumin in the urine.

1. Evaluate whether your blood pressure is so high that you need treatment
Since a too high blood pressure greatly affects your daily life – you have to change your lifestyle and take medication for the rest of your life – the doctor wants to make sure your blood pressure really is so high that you need treatment. As mentioned earlier, your blood pressure varies depending on many conditions. A single measurement of too high blood pressure does not necessarily mean that you have too high blood pressure continuously.

Therefore, if the doctor measures a too high blood pressure you are asked to come again a few weeks later to have your blood pressure measured again. The doctor can also choose to send you home with a blood pressure monitor so you can measure your own blood pressure. Several daily measurements at home can be used to determine whether your blood pressure is continuously too high and not just too high when you visit the doctor. Some people become so nervous when they visit the doctor that their blood pressure goes up.

If your blood pressure is measured to bee too high several times in a row the doctor probably chooses to medicate you. How high should the blood pressure be before the doctor starts treatment?

If your blood pressure is less than 140/90, you do not need treatment.

If your blood pressure is more than 160/100, you need treatment.

But what about the middle group who has a blood pressure of more than 140/90 but less than 160/100. For this group, the doctor performs an overall evaluation for the person concerned of the risk of having a heart attack or a stroke over the next 10 years. If you smoke, are overweight, have too much fat in the blood or suffer from other illnesses ( for example diabetes, too much fat in the blood or albumin in the urine) your total risk of having a heart attack or a stroke is so big that the doctor treats your blood pressure even though it is ‘only’ 145/95. However, is your blood pressure 149/95 and you exercise regularly, do not weigh too much, do not smoke, eat healthy, and the amount of fat in your blood is low, the doctor will probably not medicate you.

As you can see, it is not just blood pressure but also our lifestyle that determines whether you should be medicated for the rest of your life. If you lose weight, stop smoking, eat healthily and exercise, it will not only lower your blood pressure but at the same time you may be able to avoid medication for a period.

As a rule of thumb, the doctor checks whether you can change your lifestyle enough over 3-6 months for you to avoid medication.

2. If possible, find the cause of your elevated blood pressure
The doctor will attempt to find the cause of your elevated blood pressure. This is seldom accomplished. Out of 100 people with too high blood pressure, it is only possible to find the cause with 3-5 people.

Most often, kidney diseases are the cause you find of too high blood pressure. Therefore, the doctor examines whether you have problems with the kidneys and in that connection asks for a urine sample. If it appears that you have a kidney disease, the treatment is directed towards that.

With far most people, there is no explanation of the elevated blood pressure. That is just the way it is!

3. Examine for other conditions that affect your risk of having a heart attack or a stroke
As mentioned earlier, it is not only the blood pressure that requires treatment if you want to live long and well. Therefore, the doctor advice you on how to stop smoking, weight loss, regular exercise and alcohol.

The doctor also takes blood samples to measure how much fat you have in the blood and to see whether you have diabetes. Your urine is examined for the presence of albumin that can be sign of damage to the kidneys.

The amount of fat in your blood is measured by help of cholesterol. There are two kinds of cholesterol – the ‘bad’ (LDL) and the ‘good’ (HDL). Not surprisingly, it is about having a lot of the ‘good’ and little of the ‘bad’ cholesterol. Exactly what your cholesterol should be depends on the doctor’s final evaluation – but as a rule of thumb, it should be less than 5.0.

If you have too much cholesterol in the blood, the doctor first of all advises you with regard to your diet – possibly refer you to a dietician. After 3-6 months on a diet, the doctor measures your cholesterol again. If it is still too high, the doctor prescribes medication that lowers your cholesterol.

If you have diabetes, the doctor gives you a certain kind of medication that lowers your blood pressure (read later on).

4. Lower your blood pressure significantly
All studies show that your blood pressure should be lowered to 140/90 or lower. The lower your blood pressure is, the lower is your risk of having a heart attack or a stroke. Can the blood pressure not be too low? Yes it can be too low, but this happens very rarely. Far most people have their blood pressure lowered all the way down to 120/70 without any problems.

If your blood pressure is180/100, your cholesterol is too high and you smoke – then your risk of having a blood clot within 10 years be of more than 40%. If you take medication and your blood pressure drops to 140/90, your risk is of 20%. If you at the same time, stop smoking and eat healthy enough to lower your cholesterol, your risk is only of 10%. So it pays off to do something about it.

Which medicines can the doctor prescribe?

The doctor can lower your blood pressure by using a number of different medicines and by advising you about your lifestyle. As you know, it is not only the blood pressure but also your lifestyle that determines whether you have to take medication for the rest of your life. If you lose weight, stop smoking, eat healthy and exercise on a daily basis, it not only lowers your blood pressure but at the same time you will be able to avoid taking medication the rest of your life. As a rule of thumb, the doctor checks whether you are able to change your lifestyle sufficiently over 3-6 months for you to avoid medication.

However, for most people with continuously too high blood pressure, medication is necessary and good. Which kind of medicine the doctor chooses depends on a number of different conditions – including whether you suffer from other illnesses, your age and possible side effects that might occur. The goal is to get your blood pressure lower than 140/90 without any side effects. When you have started medicinal treatment, the doctor asks you to return for check-up after a few weeks. At this check-up, the doctor measures your blood pressure again and asks you how you feel. If the blood pressure is fine and you do not notice the medication, everything is well and you continue your treatment. If the blood pressure is still too high, the doctor either increases the dose (taking more pills of the same kind), try a different medication or combine with a new medication (take different pills). At the following check-ups, the doctor measures your blood pressure and asks about possible side effects from the medication. The check-ups continue like this with a few weeks interval until your blood pressure is sufficiently low. Around half of all people with too high blood pressure can make do with one kind of medication while the rest takes 2-3 different kinds of medication every day.

When the blood pressure is satisfactorily regulated, you still need to come to regular check-ups with your doctor. The doctor would like to see you for control 1-2 times a year to make sure that everything is well.

Further reading on Special groups with too high blood pressure