The management of hypertension is changing. According to the Journal of the American College of Cardiology, high blood pressure accounts for 1 in 5 deaths among American women and is a greater health burden for women than men. Women develop more pathophysiologic consequences such as heart failure, diabetes, chronic kidney, and coronary artery disease.
In 2017, the American College of Cardiology and AHA lowered the threshold of hypertension to 130/80 mm Hg ( milliliters of mercury) and higher (the previous definition was 140/90 and above).
Many patients believe that controlling high blood pressure (when blood pushes against artery walls more forcefully than normal) with medication is as simple as taking a single drug, but this is often not the case. Correcting this oversimplified view of blood pressure management is one way that blood pressure management is changing.
Multiple drugs
Hypertension, especially among women, often requires multiple drug therapies. The average person requires two to three prescriptions to effectively control hypertension and continual monitoring to tweak types and doses as we age.
Another shift in management is tailoring the treatment to the individual patient based on factors more than the traditional focus of age, sex, and race. Healthcare professionals take diet, activity levels, reproductive history, and other chronic conditions and medications into account. Doctors must choose among over 200 blood pressure medications available – or their combinations – to determine which ones will work best for the individual patient in order to fine-tune treatment. This is important because two-thirds of women aged 65-75 have elevated or high blood pressure. Women aged 70 and older are far more likely than men to have uncontrolled readings despite treatment, according to the American Heart Association.
What the different drugs do
Several drug classifications are used independently or in combination to treat high blood pressure.
Diuretics lower blood pressure by helping kidneys remove extra salt and water from the body.
Beta blockers lower blood pressure by reducing heart rate and lessening the heart’s workload.
ACE inhibitors help blood vessels stay relaxed by blocking an enzyme that causes them to tighten.
ARBs (Angiotensin-receptor blockers) ease blood flow by blocking a receptor that constricts blood vessels when the hormone angiotensin attaches to it.
Calcium-channel blockers relax blood vessels.
So, for example, a woman who is otherwise healthy and exercises a great deal may not tolerate a beta blocker, which can limit the heart’s ability to respond to physical challenges. Or, a woman who experiences heart palpitations may respond better to a beta blocker, which treats both conditions.
Matching the right drug to the patient and her lifestyle is a challenge that doctors have to meet to achieve the best results.
Most serious health problem for women
According to the National Institutes of Health, cardiovascular disease (CVD) is the most serious, neglected health problem for women in both the developing and developed worlds. High blood pressure is among the most important risk factors for developing CVD in women.
It is important to remember that blood pressure control is often a moving target due to lifestyle and health changes as we age. New drugs can change our choices, and your doctor can work with you to create an optimal treatment plan to minimize side effects, including dizziness or lightheadedness. It often requires continuous conversation and close monitoring, even if blood pressure is well controlled for years.
In a follow-up article, we will discuss ways to decrease our risks of developing hypertension.
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Tracy Backer is a Registered Nurse with 39 years in the medical field specializing in critical care nursing. Her health columns appear regularly on Now Habersham. She may be reached at [email protected]. For more health-related content, click here.
