According to CDC, about 70 million Americans adults have high blood pressure – that's 1 in every 3. Only about half of people with high blood pressure are actually managing their condition. If your doctor has told you that you have high blood pressure, they may recommend blood pressure medication to help control that hypertension. The array of medications available can be quite confusing.
Matt Kresl, pharmacist practitioner with Allina Health, discusses high blood pressure medications and the importance of a medication and lifestyle management strategy.
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Blood Pressure Medications 101
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Learn more about Matt Kresl
Matt Kresl, PharmD- pharmacist practitioner
Matt Kresl is a pharmacist practitioner with Allina Health. He started with Allina Health in 2004 and has worked in various patient care and administrative positions. His current practice involves working with primary care providers on improving patient symptoms, better treating chronic diseases, and removing barriers to safety and effectively taking medications.Learn more about Matt Kresl
Transcription:
Melanie Cole (Host): According to the CDC, about seventy million American adults have high blood pressure. That’s one in every three. Only about half of the people with high blood pressure are actually managing their condition. If your doctor has told you that you have high blood pressure, they may recommend blood pressure medication to help control that hypertension. The array of medications available can be quite confusing. My guest today is Dr. Matt Kresl. He’s a pharmacist practitioner with Allina Health. Welcome to the show, Dr. Kresl. First, give us just a little working definition of blood pressure. What is hypertension?
Dr. Matt Kresl (Guest): So, hypertension is kind of defined as, for most patients, greater than 140/90. And so those two numbers can be confusing. So, really, what the high number represents is what’s called “systolic blood pressure”. And so that’s basically telling us what the heart is doing when the heart is actually contracting. And, so, that’s the squeeze that the heart is doing pumping that blood out. And then the low number or the ninety number or less than ninety is considered the diastolic blood pressure. And that’s really what the heart is doing when it’s relaxing. And so, it’s the combination of those two numbers that healthcare givers are looking at to help us find what is high blood pressure and what is low blood pressure.
Melanie: So, if somebody is told that they have high blood pressure, what do you see every day as the most common medications used and what are these medications intended to do, Dr. Kresl?
Dr. Kresl: Yes. So, most patients, when a doctor sees an otherwise healthy patient with high blood pressure, we’ll generally start with a low-risk medicine called a “diuretic” which is kind of a fancy way of saying water pill. What that water pill does is it removes water off of your body and, for reasons that even scientists don’t quite understand, that has a blood pressure lowering effect. Because it’s generally so safe and well tolerated, for many patients, that’s the starting point. But, after that, depending on the medical condition you have, there are certainly other medicines that can be used. But that’s kind of the first start for many patients.
Melanie: So, then, speak about a few of the other medications, maybe ACE inhibitors or angiotensin-receptor blockers? What are those meant to do to the heart?
Dr. Kresl: Yes. So, depending on what medical conditions you have, different blood pressure medicines are used. So, for example, if you have a heart condition, say you’ve had a heart attack in the past or you have a family history of heart disease where family members have died at a very young age from a heart attack or something like that, they’ll use medicine called a “beta blocker”. What a beta blocker does is it slows the work that the heart has to do and that lowers your blood pressure. So, if the heart is working less hard, that’s a good thing for your heart; less work equals less strain. So, those medicines are often used for people with heart conditions. Where patients with diabetes, for example, may use a medicine called, like you mentioned, an angiotensin-receptor blocker or an ACE inhibitor. Again, these are just fancy terms for groups of medicines that have benefit for patients with diabetes. And, the specific benefit for those medicines is really on the kidney. So, people with diabetes are at high risk for kidney disease. In fact, it’s the leading cause of kidney disease in the United States. Those medicines have not only the blood pressure lowering effect but also the kidney protecting effect. So, it’s kind of like getting more bang for your buck when you take a medicine like those for those types of specific conditions.
Melanie: Do people sometimes have to take a combo of the medications?
Dr. Kresl: Yes. So, it’s not uncommon for people to be on two, three. I’ve had patients on up to five different blood pressure medicines. For reasons that aren’t completely understood, some people are more genetically at risk for hypertension, either through family history or sometimes we look at things like lifestyle, sodium intake, and other things. But, yes, there are a wide spectrum of challenges with blood pressure. Again, some people can manage on just one very low dose and others need to be on multiple ones.
Melanie: Do you advise people to keep track of their own blood pressure on a regular basis? How often if that’s the case?
Dr. Kresl: It’s a good question. I would say, for most patients, it’s a good idea to track your blood pressure at home. The American Heart Association actually has recommendations with monitoring and they advocate for a blood pressure monitor that you wrap around your arm similar to what you would use in a doctor’s office. And, there are a lot of blood pressure monitors out there, some of them you wear around your wrists, which I don’t mind for patients. They just aren’t endorsed, I guess, by the American Heart Association and the issue with them is that they can give readings that are inconsistent. But, I would say, as a general rule of thumb, I like when patients monitor their blood pressure at home for a few reasons. One, I know patients experience this what’s called “white coat syndrome” where you go to the doctor’s office and you get super nervous and your nervousness then raises your blood pressure. I think it increases your health literacy and what I mean by that is if you know what number you’re getting on your cuff, then you’re more likely to know what the goal is and how to advocate for yourself in terms of getting to a lower number and I think that it just empowers people to take control of their health. So, I always encourage my patients to buy a blood pressure monitor, especially for those who have a difficult time controlling it.
Melanie: If they don’t work or if you notice your blood pressure fluctuating a lot, do they sometimes have to change dosages of the medications that they are on?
Dr. Kresl: Yes, so blood pressure, you know, it seems like an exact science in the sense that you look at the number. If it’s above 140/90, then we need to take more medicine but sometimes providers will look at one number in isolation and say, “You know what? Let’s just see how this goes.” And that’s why monitoring at home is such a good thing. The nice thing about the medicines we have today is there’s a spectrum of doses we can use and so we generally start at the lowest dose and then we work our way up on the dose until we achieve the benefit that we want. I do want to offer one caveat though which is that often times lifestyle measures, meaning diet and exercise, have been shown in studies to actually have a similar or even sometimes better blood pressure lowering benefit than the medicine. So, you know, it doesn’t kind of preclude you from doing the lifestyle stuff. And, in fact, the lifestyle stuff can be better and it’s obviously safer than taking medicine.
Melanie: Dr. Kresl, what’s the deal with salt? Is that really a bad thing for people that have high blood pressure?
Dr. Kresl: For certain types of people with high blood pressure, yes. And for patients with heart conditions, I would say, that’s where it becomes more of a challenge. The science on salt is not conclusive for patients who don’t have a heart condition, meaning your body’s ability to get rid of salt is generally pretty good, especially if you’re younger. But, I think anybody who’s eaten too much salt and felt their fingers swell up, they’ll tell you that it does have some effects on blood pressure. Really, where it becomes more imperative is when patients have heart failure and they’re salt restricted, in part because their blood pressure can change quite dramatically very quickly if not watched closely.
Melanie: Are blood pressure medications expensive?
Dr. Kresl: These days, actually not. You would think with all the medicines that are out there, many of them are very, very expensive but most patients can be maintained on a blood pressure regimen that’s pretty inexpensive. And, what I mean by inexpensive is that they’re generally generic and there are often times extensive programs through pharmacies where you can get them for $5 or sometimes even less a month. So, the number fluctuates but I can get many patients under control with their blood pressure on one to two medicines for often times $10 or less a month.
Melanie: If they take the pills and adhere to their medication management, does that mean they’re not going to have a heart attack or stroke?
Dr. Kresl: Not necessarily, no. I mean the data on the benefits for a population is conclusive in the sense that better blood pressure control reduces heart attacks and strokes. So, when you’re thinking about taking your blood pressure medicine every day, that’s the gain you stand to get from taking those medicines. But just kind of know that it doesn’t preclude you from getting one but it definitely improves your odds. And as I mentioned before, if you’ve got a preexisting condition like you’ve had a heart attack already or a stroke already or you have diabetes, those blood pressure medicines not only lower your blood pressure, which you get a gain from, but also help protect your heart or kidney from further damage, which is another benefit.
Melanie: So, in the last few minutes, are these typically lifelong medications or can you reverse in, as you said before about lifestyle modifications, can those actually fix your blood pressure or possibly reverse the situation?
Dr. Kresl: Yes. So, the good news is that for a number of patients that I work with who certainly have a goal of reducing the number of medicines they take, you know, if they undergo the lifestyle changes, we, as caregivers, can often times eliminate the blood pressure medicine entirely. And it’s generally kind of negotiated between the patient and the caregiver. Meaning patient comes in and says, “You know, I’ve really made some lifestyle changes. I’ve lost this amount of weight. My blood pressure’s been under control for the last, say, year and a half or two years.” And the doctor or provider says, “Yes, okay, let’s see how you do on a drug holiday, meaning you don’t take the medicine for some time, and we’ll check your blood pressure and that can be one less pill you have to take through nothing other than lifestyle intervention.”
Melanie: So, give your best advice here to people who are suffering from hypertension, who’ve been told that they do have blood pressure and what you as a pharmacist practitioner want them to know about medication management.
Dr. Kresl: I would say that, in general, blood pressure is hard because it’s not something you generally feel but it is known as the silent killer for a reason. The medicines are generally well tolerated. We generally start at the lowest dose. They have been proven to be effective and they’re one of those medicines that you can get into and take for a relatively modest price. So, it’s a medicine with low potential cost and high potential gain. So, it’s something that’s I think important for everybody to be aware of, the potential benefits of managing it with medicines.
Melanie: Thank you so much for being with us today, Dr. Kresl. It’s such important information. You're listening to The WellCAST with Allina Health. For more information, you can go to www.allinahealth.org. That's www.allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): According to the CDC, about seventy million American adults have high blood pressure. That’s one in every three. Only about half of the people with high blood pressure are actually managing their condition. If your doctor has told you that you have high blood pressure, they may recommend blood pressure medication to help control that hypertension. The array of medications available can be quite confusing. My guest today is Dr. Matt Kresl. He’s a pharmacist practitioner with Allina Health. Welcome to the show, Dr. Kresl. First, give us just a little working definition of blood pressure. What is hypertension?
Dr. Matt Kresl (Guest): So, hypertension is kind of defined as, for most patients, greater than 140/90. And so those two numbers can be confusing. So, really, what the high number represents is what’s called “systolic blood pressure”. And so that’s basically telling us what the heart is doing when the heart is actually contracting. And, so, that’s the squeeze that the heart is doing pumping that blood out. And then the low number or the ninety number or less than ninety is considered the diastolic blood pressure. And that’s really what the heart is doing when it’s relaxing. And so, it’s the combination of those two numbers that healthcare givers are looking at to help us find what is high blood pressure and what is low blood pressure.
Melanie: So, if somebody is told that they have high blood pressure, what do you see every day as the most common medications used and what are these medications intended to do, Dr. Kresl?
Dr. Kresl: Yes. So, most patients, when a doctor sees an otherwise healthy patient with high blood pressure, we’ll generally start with a low-risk medicine called a “diuretic” which is kind of a fancy way of saying water pill. What that water pill does is it removes water off of your body and, for reasons that even scientists don’t quite understand, that has a blood pressure lowering effect. Because it’s generally so safe and well tolerated, for many patients, that’s the starting point. But, after that, depending on the medical condition you have, there are certainly other medicines that can be used. But that’s kind of the first start for many patients.
Melanie: So, then, speak about a few of the other medications, maybe ACE inhibitors or angiotensin-receptor blockers? What are those meant to do to the heart?
Dr. Kresl: Yes. So, depending on what medical conditions you have, different blood pressure medicines are used. So, for example, if you have a heart condition, say you’ve had a heart attack in the past or you have a family history of heart disease where family members have died at a very young age from a heart attack or something like that, they’ll use medicine called a “beta blocker”. What a beta blocker does is it slows the work that the heart has to do and that lowers your blood pressure. So, if the heart is working less hard, that’s a good thing for your heart; less work equals less strain. So, those medicines are often used for people with heart conditions. Where patients with diabetes, for example, may use a medicine called, like you mentioned, an angiotensin-receptor blocker or an ACE inhibitor. Again, these are just fancy terms for groups of medicines that have benefit for patients with diabetes. And, the specific benefit for those medicines is really on the kidney. So, people with diabetes are at high risk for kidney disease. In fact, it’s the leading cause of kidney disease in the United States. Those medicines have not only the blood pressure lowering effect but also the kidney protecting effect. So, it’s kind of like getting more bang for your buck when you take a medicine like those for those types of specific conditions.
Melanie: Do people sometimes have to take a combo of the medications?
Dr. Kresl: Yes. So, it’s not uncommon for people to be on two, three. I’ve had patients on up to five different blood pressure medicines. For reasons that aren’t completely understood, some people are more genetically at risk for hypertension, either through family history or sometimes we look at things like lifestyle, sodium intake, and other things. But, yes, there are a wide spectrum of challenges with blood pressure. Again, some people can manage on just one very low dose and others need to be on multiple ones.
Melanie: Do you advise people to keep track of their own blood pressure on a regular basis? How often if that’s the case?
Dr. Kresl: It’s a good question. I would say, for most patients, it’s a good idea to track your blood pressure at home. The American Heart Association actually has recommendations with monitoring and they advocate for a blood pressure monitor that you wrap around your arm similar to what you would use in a doctor’s office. And, there are a lot of blood pressure monitors out there, some of them you wear around your wrists, which I don’t mind for patients. They just aren’t endorsed, I guess, by the American Heart Association and the issue with them is that they can give readings that are inconsistent. But, I would say, as a general rule of thumb, I like when patients monitor their blood pressure at home for a few reasons. One, I know patients experience this what’s called “white coat syndrome” where you go to the doctor’s office and you get super nervous and your nervousness then raises your blood pressure. I think it increases your health literacy and what I mean by that is if you know what number you’re getting on your cuff, then you’re more likely to know what the goal is and how to advocate for yourself in terms of getting to a lower number and I think that it just empowers people to take control of their health. So, I always encourage my patients to buy a blood pressure monitor, especially for those who have a difficult time controlling it.
Melanie: If they don’t work or if you notice your blood pressure fluctuating a lot, do they sometimes have to change dosages of the medications that they are on?
Dr. Kresl: Yes, so blood pressure, you know, it seems like an exact science in the sense that you look at the number. If it’s above 140/90, then we need to take more medicine but sometimes providers will look at one number in isolation and say, “You know what? Let’s just see how this goes.” And that’s why monitoring at home is such a good thing. The nice thing about the medicines we have today is there’s a spectrum of doses we can use and so we generally start at the lowest dose and then we work our way up on the dose until we achieve the benefit that we want. I do want to offer one caveat though which is that often times lifestyle measures, meaning diet and exercise, have been shown in studies to actually have a similar or even sometimes better blood pressure lowering benefit than the medicine. So, you know, it doesn’t kind of preclude you from doing the lifestyle stuff. And, in fact, the lifestyle stuff can be better and it’s obviously safer than taking medicine.
Melanie: Dr. Kresl, what’s the deal with salt? Is that really a bad thing for people that have high blood pressure?
Dr. Kresl: For certain types of people with high blood pressure, yes. And for patients with heart conditions, I would say, that’s where it becomes more of a challenge. The science on salt is not conclusive for patients who don’t have a heart condition, meaning your body’s ability to get rid of salt is generally pretty good, especially if you’re younger. But, I think anybody who’s eaten too much salt and felt their fingers swell up, they’ll tell you that it does have some effects on blood pressure. Really, where it becomes more imperative is when patients have heart failure and they’re salt restricted, in part because their blood pressure can change quite dramatically very quickly if not watched closely.
Melanie: Are blood pressure medications expensive?
Dr. Kresl: These days, actually not. You would think with all the medicines that are out there, many of them are very, very expensive but most patients can be maintained on a blood pressure regimen that’s pretty inexpensive. And, what I mean by inexpensive is that they’re generally generic and there are often times extensive programs through pharmacies where you can get them for $5 or sometimes even less a month. So, the number fluctuates but I can get many patients under control with their blood pressure on one to two medicines for often times $10 or less a month.
Melanie: If they take the pills and adhere to their medication management, does that mean they’re not going to have a heart attack or stroke?
Dr. Kresl: Not necessarily, no. I mean the data on the benefits for a population is conclusive in the sense that better blood pressure control reduces heart attacks and strokes. So, when you’re thinking about taking your blood pressure medicine every day, that’s the gain you stand to get from taking those medicines. But just kind of know that it doesn’t preclude you from getting one but it definitely improves your odds. And as I mentioned before, if you’ve got a preexisting condition like you’ve had a heart attack already or a stroke already or you have diabetes, those blood pressure medicines not only lower your blood pressure, which you get a gain from, but also help protect your heart or kidney from further damage, which is another benefit.
Melanie: So, in the last few minutes, are these typically lifelong medications or can you reverse in, as you said before about lifestyle modifications, can those actually fix your blood pressure or possibly reverse the situation?
Dr. Kresl: Yes. So, the good news is that for a number of patients that I work with who certainly have a goal of reducing the number of medicines they take, you know, if they undergo the lifestyle changes, we, as caregivers, can often times eliminate the blood pressure medicine entirely. And it’s generally kind of negotiated between the patient and the caregiver. Meaning patient comes in and says, “You know, I’ve really made some lifestyle changes. I’ve lost this amount of weight. My blood pressure’s been under control for the last, say, year and a half or two years.” And the doctor or provider says, “Yes, okay, let’s see how you do on a drug holiday, meaning you don’t take the medicine for some time, and we’ll check your blood pressure and that can be one less pill you have to take through nothing other than lifestyle intervention.”
Melanie: So, give your best advice here to people who are suffering from hypertension, who’ve been told that they do have blood pressure and what you as a pharmacist practitioner want them to know about medication management.
Dr. Kresl: I would say that, in general, blood pressure is hard because it’s not something you generally feel but it is known as the silent killer for a reason. The medicines are generally well tolerated. We generally start at the lowest dose. They have been proven to be effective and they’re one of those medicines that you can get into and take for a relatively modest price. So, it’s a medicine with low potential cost and high potential gain. So, it’s something that’s I think important for everybody to be aware of, the potential benefits of managing it with medicines.
Melanie: Thank you so much for being with us today, Dr. Kresl. It’s such important information. You're listening to The WellCAST with Allina Health. For more information, you can go to www.allinahealth.org. That's www.allinahealth.org. This is Melanie Cole. Thanks so much for listening.