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My blood pressure is high
Headache
Dizziness
High bp
Blood pressure rising after eating
Shortness of breath
Vertigo
Blood pressure rising at night
Lightheadedness
Nosebleed
Blurred vision
High bp in pregnancy
Not seeing your symptoms? No worries!
Hypertension is high blood pressure (increased pressure of blood against blood vessel walls). It's classified into primary and secondary. Primary is when the cause is unknown. Secondary is due to underlying conditions, such as kidney or thyroid disease. Risk factors include smoking, being overweight, lack of physical activity, unhealthy diet, excessive alcohol consumption, stress, genetics, etc. There are often no symptoms. If untreated, it can cause health problems, such as heart disease and stroke.
Your doctor may ask these questions to check for this disease:
Treatment involves medications to lower blood pressure, as well as lifestyle modifications such as a healthy diet and regular exercise.
Reviewed By:
Unnati Patel, MD, MSc (Family Medicine)
Dr.Patel serves as Center Medical Director and a Primary Care Physician at Oak Street Health in Arizona. She graduated from the Zhejiang University School of Medicine prior to working in clinical research focused on preventive medicine at the University of Illinois and the University of Nevada. Dr. Patel earned her MSc in Global Health from Georgetown University, during which she worked with the WHO in Sierra Leone and Save the Children in Washington, D.C. She went on to complete her Family Medicine residency in Chicago at Norwegian American Hospital before completing a fellowship in Leadership in Value-based Care in conjunction with the Northwestern University Kellogg School of Management, where she earned her MBA. Dr. Patel’s interests include health tech and teaching medical students and she currently serves as Clinical Associate Professor at the University of Arizona School of Medicine.
Yoshinori Abe, MD (Internal Medicine)
Dr. Abe graduated from The University of Tokyo School of Medicine in 2015. He completed his residency at the Tokyo Metropolitan Health and Longevity Medical Center. He co-founded Ubie, Inc. in May 2017, where he currently serves as CEO & product owner at Ubie. Since December 2019, he has been a member of the Special Committee for Activation of Research in Emergency AI of the Japanese Association for Acute Medicine. | | Dr. Abe has been elected in the 2020 Forbes 30 Under 30 Asia Healthcare & Science category.
Content updated on Oct 18, 2024
Following the Medical Content Editorial Policy
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Q.
Does Apple Cider Vinegar Lower Blood Pressure? A Woman’s Action Plan
A.
Limited evidence shows apple cider vinegar may slightly lower blood pressure, but it is not a cure and should not replace proven steps like the DASH diet, cutting sodium, regular exercise, stress management, and prescribed medications. Women should talk with a clinician before using ACV because it can interact with blood pressure medicines, diuretics, and insulin, and may worsen kidney disease or low potassium; typical use is 1 to 2 tablespoons daily diluted in water. There are several factors to consider, so see below for the full action plan, safer dosing tips, when to seek urgent care, and how to tailor the next steps for your health.
References:
* Bouderbala F, Droumaguet M, Benammar R, Mekki K, Zidelkhir K, Messarah M. Effect of apple cider vinegar on blood pressure, blood glucose and lipid profile in overweight or obese individuals: A systematic review and meta-analysis of randomized clinical trials. Front Pharmacol. 2023 Mar 1;14:1107530. PMID: 36875276.
* Khorshidi M, Moosavian SP, Haghighian R, Rahimi E, Asadian M. The Effects of Apple Cider Vinegar on Fasting Blood Sugar, BMI, Waist Circumference, and Blood Pressure in Obese Women: A Randomized Clinical Trial. J Ayurveda Integr Med. 2022 Dec;13(4):100613. PMID: 35718712.
* Ostadrahimi A, Kord Varkaneh H, Rezaei Kelishadi M, Moradi M, Rahbar M, Hashemi B, Soltani S, Ghaedi E, Fatahi S. Apple cider vinegar and its components on cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2024;64(2):498-518. PMID: 35445695.
* Mir M, Alam MM, Asare A, Abid F, Azam S, Jafari SM. Apple cider vinegar and health: An umbrella review of meta-analyses and systematic reviews. Crit Rev Food Sci Nutr. 2024;64(14):4510-4523. PMID: 35687595.
* Budak NH, Akçimen F, Yapar K. Effect of apple vinegar consumption on glycemic indices, lipid profile, and blood pressure in healthy adults: A randomized controlled trial. J Nutr Biochem. 2022 Oct;108:109088. PMID: 35985226.
Q.
Blood Pressure Chart for Women: Decode Signs & Next Steps
A.
Normal is under 120/80; elevated 120–129 with under 80; stage 1 is 130–139 or 80–89; stage 2 is 140+ or 90+; and hypertensive crisis is 180+/120+ and needs urgent care. There are several factors to consider. Women often have unique risks from pregnancy, hormones, and certain medicines and may have no symptoms, so see below for exactly what your reading means, how often to check, lifestyle steps, when medication is recommended, pregnancy red flags, and emergency signs to act on.
References:
* Appleton, C., & Sola, S. (2023). Hypertension in Women: Diagnosis and Management. *Current Hypertension Reports, 25*(8), 241-249.
* Regitz-Zagrosek, V., Oertelt-Prigione, S., Kararigas, G., et al. (2022). Hypertension in women: unique considerations across the lifespan. *European Heart Journal, 43*(35), 3329-3343.
* Ji, H., Shen, T. F., Fan, J., et al. (2021). Sex Differences in Hypertension: Implications for Clinical Practice. *Frontiers in Cardiovascular Medicine, 8*, 715003.
* Agarwal, R. (2023). Sex differences in blood pressure targets and outcomes in hypertension: A narrative review. *Current Opinion in Cardiology, 38*(4), 362-367.
* American College of Obstetricians and Gynecologists. (2020). Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. *Obstetrics & Gynecology, 135*(6), e237-e260.
Q.
Hydrochlorothiazide for Women: Side Effects & Your Next Steps
A.
Hydrochlorothiazide side effects in women include increased urination, dizziness, dehydration risk, and electrolyte imbalances like low potassium. It can also raise blood sugar, increase gout risk, make skin sun sensitive, and needs extra caution in pregnancy. There are several factors to consider for your next steps, including lab monitoring, hydration and potassium guidance, home blood pressure checks, and knowing when to seek urgent care or adjust therapy with your clinician. See complete details below.
References:
* Upadhyay A, Jaber BL, Madias NE. Hyponatremia in women: a review of the risks and clinical management. Kidney Int. 2009 Dec;76(11):1128-33. PMID: 19741697
* Hoorn EJ, Rivadeneira R, van der Lubbe N, Zietse R, de Groot R. Thiazide-induced hyponatremia: incidence, predisposing factors, and outcomes. Eur J Intern Med. 2014 Dec;25(10):947-52. PMID: 25442563
* Thiazide diuretics for hypertension: A review of the adverse effects. Drug Saf. 2011 May 1;34(5):371-82. PMID: 21495804
* Derington CG, et al. Thiazide diuretics and bone mineral density: a systematic review and meta-analysis. J Bone Miner Res. 2019 Jun;34(6):1098-1111. PMID: 30799632
* Pottegård A, et al. Hydrochlorothiazide use and risk of nonmelanoma skin cancer: a Danish nationwide study. J Am Acad Dermatol. 2017 Apr;76(4):673-681.e7. PMID: 28215582
Q.
Lisinopril: What Women 30-45 Must Know & Vital Next Steps
A.
For women 30 to 45, lisinopril effectively lowers blood pressure and protects the heart and kidneys, but it should not be used in pregnancy or while trying to conceive, so discuss contraception and safer alternatives right away. Next steps include lab monitoring of kidneys and potassium, watching for side effects like a persistent cough or emergency facial swelling, logging home blood pressures, limiting salt, and reviewing other meds such as NSAIDs for interactions; there are several factors to consider, and many more important details that can shape your plan are explained below.
References:
* Tadic M, et al. Angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) in women of childbearing age. J Hum Hypertens. 2017 Mar;31(3):167-172. doi: 10.1038/jhh.2016.71. Epub 2016 Sep 1. PMID: 27582046.
* Preez NLD, et al. Hypertension in Women: A Perspective on Clinical Presentation, Pathophysiology, and Treatment. Front Cardiovasc Med. 2021 Jul 21;8:695503. doi: 10.3389/fcvm.2021.695503. PMID: 34368149; PMCID: PMC8333333.
* Magee LA, et al. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Risks in pregnancy. Semin Perinatol. 2017 Feb;41(1):52-58. doi: 10.1053/j.semperi.2016.10.007. Epub 2016 Nov 1. PMID: 27818047.
* Bateman BT, et al. Antihypertensive Drug Use in Pregnancy and Risks of Specific Birth Defects. Hypertension. 2018 Feb;71(2):299-307. doi: 10.1161/HYPERTENSIONAHA.117.10271. Epub 2017 Dec 18. PMID: 29255018; PMCID: PMC5785361.
* Del Giudice R, et al. Hypertension in women: clinical aspects, sex differences, and management. Clin Res Cardiol. 2023 Mar;112(3):305-317. doi: 10.1007/s00392-022-02107-y. Epub 2022 Oct 26. PMID: 36284144; PMCID: PMC9933591.
Q.
Metoprolol for Women 30-45: Symptom Guide & Action Plan
A.
Metoprolol is a beta blocker that slows your heart and lowers blood pressure to treat hypertension, palpitations, chest discomfort, and related symptoms; for women 30 to 45, common effects include fatigue, dizziness when standing, colder hands, sleep or mood changes, and lower exercise heart rates, which usually improve in weeks. Do not stop it suddenly; track blood pressure and resting pulse, modify workouts, and seek urgent care for fainting, severe dizziness, chest pain, shortness of breath, swelling, or a very slow pulse under 50 unless told otherwise. There are several factors to consider that can affect next steps, including pregnancy or breastfeeding, mental health, weight changes, dosing timing, and alternatives, so see the complete action plan and symptom guide below.
References:
* Appel LJ, et al. Treatment of Hypertension in Women: A Scientific Statement From the American Heart Association. Hypertension. 2022 Sep;79(9):e121-e137. doi: 10.1161/HYP.0000000000000213. Epub 2022 Aug 4. PMID: 35920235.
* Rapsomaniki E, et al. Guideline for the management of arterial hypertension in women. Eur Heart J. 2023 May 7;44(18):1609-1616. doi: 10.1093/eurheartj/ehad200. PMID: 37021200.
* Steardo L Jr, et al. Beta-blockers for anxiety disorders: current evidence and future directions. Transl Psychiatry. 2018 May 31;8(1):101. doi: 10.1038/s41398-018-0142-6. PMID: 29849925; PMCID: PMC5981445.
* Rapsomaniki E, et al. Sex-specific differences in the tolerability of beta-blockers and angiotensin-converting enzyme inhibitors: an updated review. Expert Opin Drug Saf. 2020 Feb;19(2):169-180. doi: 10.1080/14740338.2020.1719570. Epub 2020 Jan 29. PMID: 32007736.
* Wang A, et al. Efficacy of Metoprolol in the Prophylaxis of Migraine with and without Aura: A Systematic Review and Meta-Analysis. Pain Ther. 2019 Dec;8(2):191-201. doi: 10.1007/s40122-019-00147-3. Epub 2019 Nov 6. PMID: 31698205; PMCID: PMC6890697.
Q.
Beetroot for Women 65+: 5 Vital Benefits for Heart & Healthy Aging
A.
For women 65+, beetroot can help support healthy blood pressure, improve heart and circulation, aid brain function, promote digestion and gut balance, and enhance energy and muscle efficiency when included as part of a balanced lifestyle. There are several factors to consider. See the complete guidance below for ideal portions, possible pink urine or stools, oxalate concerns for kidney stones, potential interactions with blood pressure medicines, and when to talk with a doctor so you can choose safe next steps.
References:
* Bondonno NP, Croft KD, Hodgson JM, et al. Beetroot juice and blood pressure: A systematic review and meta-analysis. Clin Nutr. 2017;36(3):645-654. doi:10.1016/j.clnu.2016.07.016
* Siervo M, Lara J, Webb AJ, et al. Inorganic Nitrate and Beetroot Juice Intake Reduces Blood Pressure and Improves Endothelial Function in Older Adults: A Randomized Controlled Crossover Trial. J Gerontol A Biol Sci Med Sci. 2013;68(12):1598-1605. doi:10.1093/gerona/glt057
* Kelly J, Vanhatalo A, King A, et al. Dietary Inorganic Nitrate Supplementation Improves Exercise Tolerance and Decreases Blood Pressure in Older Individuals. J Am Geriatr Soc. 2013;61(7):1108-1113. doi:10.1111/jgs.12322
* Lidder S, Webb AJ. Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate-nitrite-NO pathway. Br J Clin Pharmacol. 2013;75(3):677-696. doi:10.1111/bcp.12053
* Stanaway L, Rutherfurd-Markwick KJ, Page R, et al. Beetroot Juice Consumption Improves Human Health Outcomes: A Systematic Review. Nutrients. 2021;13(5):1786. doi:10.3390/nu13051786
Q.
Hypertension Over 65: Silent Signs & The New Normal for Women
A.
Hypertension in women over 65 is common, often silent, and not harmless; normal differs by person, but repeated readings at or above 130/80 or subtle signs like morning headaches, dizziness, shortness of breath, fatigue, or vision changes deserve attention. Treating blood pressure at any age lowers risks for heart disease, stroke, kidney damage, and cognitive decline, and is best managed with regular monitoring, practical lifestyle changes, and medications when needed. There are several factors to consider, including when to call a doctor and which targets are safest for you, with key details and next steps explained below.
References:
* Lam CS, et al. Gender differences in hypertension: Pathophysiology, clinical implications, and therapeutic approaches. J Hypertens. 2020 Jun;38(6):978-994. doi: 10.1097/HJH.0000000000002364. PMID: 32250239.
* Reckelhoff JF. Sex differences in hypertension: From bench to bedside. Am J Physiol Regul Integr Comp Physiol. 2018 Feb 1;314(2):R223-R231. doi: 10.1152/ajpregu.00361.2017. Epub 2017 Nov 15. PMID: 29141979; PMCID: PMC5866380.
* Bavishi C, et al. Hypertension in older women: Treatment challenges. J Clin Hypertens (Greenwich). 2018 Aug;20(8):1142-1148. doi: 10.1111/jch.13327. Epub 2018 Jul 11. PMID: 30003504; PMCID: PMC8029583.
* Oh GC, et al. Masked Hypertension in the Elderly: A Systematic Review and Meta-Analysis. Hypertension. 2019 Aug;74(2):266-274. doi: 10.1161/HYPERTENSIONAHA.119.12995. Epub 2019 Jun 17. PMID: 31203792.
* Oparil S, et al. Hypertension in women: a review of sex-specific considerations. Hypertens Res. 2018 May;41(5):309-322. doi: 10.1038/s41440-018-0016-y. Epub 2018 Feb 23. PMID: 29472621.
Q.
Ozempic Side Effects in Women 65+: Are Your Symptoms Normal?
A.
For women 65+, the most common Ozempic side effects are usually temporary stomach issues like nausea, vomiting, diarrhea or constipation, bloating with decreased appetite, plus fatigue and occasional dizziness; low blood sugar is more likely if you also use insulin or a sulfonylurea. Seek medical advice for persistent vomiting or dehydration, repeated hypoglycemia, rapid unintended weight loss, or severe abdominal pain that could signal gallbladder, kidney, thyroid, or pancreas problems. There are several factors to consider; practical steps to ease symptoms and clear guidance on when to get urgent help are detailed below.
References:
* Ahrén B, et al. Efficacy and safety of once-weekly semaglutide in subjects aged ≥75 years with type 2 diabetes: a post hoc analysis of the SUSTAIN 1-5 trials. Diabetes Obes Metab. 2018 Sep;20(9):2293-2300. doi: 10.1111/dom.13374. Epub 2018 Jul 11. PMID: 29931899; PMCID: PMC6175084.
* Wilding JPH, et al. Once-weekly semaglutide in adults with overweight or obesity: a systematic review and meta-analysis. Diabetes Obes Metab. 2021 Jul;23(7):1687-1698. doi: 10.1111/dom.14371. Epub 2021 May 26. PMID: 33880940; PMCID: PMC8290680.
* Marso SP, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016 Nov 10;375(19):1834-1844. doi: 10.1056/NEJMoa1607141. Epub 2016 Sep 16. Erratum in: N Engl J Med. 2016 Nov 24;375(21):2107. PMID: 27637182.
* Mann JFE, et al. Effects of once-weekly semaglutide on kidney outcomes in patients with type 2 diabetes and chronic kidney disease: results from the FLOW trial. N Engl J Med. 2024 May 23;390(21):1982-1994. doi: 10.1056/NEJMoa2403913. Epub 2024 Apr 26. PMID: 38676231.
* Nauck MA, et al. Semaglutide for the treatment of type 2 diabetes: a review of current evidence. Adv Ther. 2019 Jun;36(6):1346-1372. doi: 10.1007/s12325-019-00951-6. Epub 2019 Apr 23. PMID: 31016625; PMCID: PMC6813203.
Q.
Why Women Over 65 Need CoQ10: Vital Benefits for Heart & Energy
A.
CoQ10 supports heart health and cellular energy in women over 65, but natural levels decline with age and can drop further with statins, so supplementation may help with stamina, heart function, and even healthy blood pressure when used alongside medical care. There are several factors to consider, including the form you choose, dosing, taking it with food, potential side effects, and interactions with heart or blood pressure medicines; see below for complete details that can guide your next steps with your clinician.
References:
* Mortensen SA, et al. The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO—a randomized double-blind trial. JACC Heart Fail. 2014 Dec;2(6):641-9. doi: 10.1016/j.jchf.2014.06.008. Epub 2014 Aug 11. PMID: 25124036.
* Sood S, et al. Coenzyme Q10 and Cardiovascular Disease: A Systematic Review. J Clin Exp Cardiol. 2018 Jan;9(1):1000570. doi: 10.4172/2155-9880.1000570. Epub 2018 Jan 22. PMID: 29881676.
* López-Lluch G, Navas P. Coenzyme Q10 and Aging. J Gerontol A Biol Sci Med Sci. 2016 Oct;71(10):1243-5. doi: 10.1093/gerona/glw002. Epub 2016 Feb 9. PMID: 26865247.
* Fan L, et al. Effects of coenzyme Q10 supplementation on inflammatory markers: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2017 Apr;118:105-113. doi: 10.1016/j.phrs.2017.02.003. Epub 2017 Feb 9. PMID: 28189608.
* Zhang P, et al. The effect of coenzyme Q10 supplementation on blood pressure: A systematic review and meta-analysis. Front Cardiovasc Med. 2023 Apr 12;10:1143872. doi: 10.3389/fcvm.2023.1143872. PMID: 37113106; PMCID: PMC10129712.
Q.
Hypertension Over 65: New Blood Pressure Goals for Seniors
A.
Most adults over 65 are now advised to aim for a blood pressure under 130/80 mmHg, though some may do better with a slightly higher systolic target such as under 140 depending on frailty, falls risk, kidney disease, diabetes, heart history, and medication tolerance. There are several factors to consider; see the complete guidance below for benefits like lower stroke and heart risks and risks like dizziness or falls, plus lifestyle steps, medication options, and home monitoring tips to help you and your doctor choose the safest next steps.
References:
* Carey RM, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-e248. PMID: 29133354.
* Izzo JL Jr, et al. Hypertension in older adults: treatment strategies. Curr Opin Cardiol. 2020 Sep;35(5):540-546. PMID: 32560384.
* Patel N, et al. Hypertension in elderly patients: A review. J Clin Hypertens (Greenwich). 2021 Jan;23(1):15-21. PMID: 33261271.
* Kovell LC, et al. Optimal Blood Pressure in Older Adults: An Ongoing Debate. Curr Hypertens Rep. 2019 May 3;21(5):34. PMID: 31053158.
* Papadopoulos DP, et al. Hypertension in the elderly: From recent guidelines to clinical practice. J Clin Hypertens (Greenwich). 2020 Sep;22(9):1644-1650. PMID: 32669389.
Q.
Women’s Hypertension: Managing Blood Pressure & Hormones
A.
Women’s high blood pressure is shaped by hormones across life stages, with risks rising after menopause and during pregnancy, and it can also be affected by birth control, stress, sleep, weight, and diet. There are several factors to consider; see below to understand how hormones, medications, and life events influence readings and when to seek care. The full guide below covers target numbers, warning symptoms, effective lifestyle steps, home monitoring tips, and when medication is appropriate, including considerations for pregnancy and menopause, which could change your next steps.
References:
* Sheng M, Zheng S, Chen B. Hypertension in Women: Influence of Sex Hormones, Pregnancy, and Menopause. Curr Probl Cardiol. 2023 Sep 13:101962. doi: 10.1016/j.cpcardiol.2023.101962. Epub ahead of print. PMID: 37704517.
* Pinto S, Cifelli A, Tofani A, Di Daniele N, Basili S, Di Giosia P. Hypertension management in women around menopause. Minerva Endocrinol (Torino). 2023 Apr;48(2):206-218. doi: 10.23736/S2724-6507.23.03786-9. Epub 2023 Apr 11. PMID: 37045610.
* Jha S, Sharma B, Pahal S, Goyal V, Arora D. Contraception and Hypertension. Curr Probl Cardiol. 2023 Sep 13:101961. doi: 10.1016/j.cpcardiol.2023.101961. Epub ahead of print. PMID: 37704516.
* Sica DA, Kalantar-Zadeh K, Sica DA. Hypertension in Women: Clinical Presentation, Treatment, and Outcomes. Cardiorenal Med. 2023;13(1):1-14. doi: 10.1159/000529571. Epub 2023 Jan 26. PMID: 36728036.
* Phipps MG, Gibson KS, Mantha S. Hypertensive Disorders of Pregnancy: Update for the Clinician. Am J Med. 2023 Sep;136(9):863-870. doi: 10.1016/j.amjmed.2023.02.012. Epub 2023 Feb 18. PMID: 36814986.
Q.
Is Your Blood Pressure Med Causing Brain Fog? What Women in Their 30s Need to Know
A.
Sometimes, yes: certain blood pressure medicines can contribute to brain fog, especially beta blockers or diuretics through dehydration or electrolyte shifts, while ACE inhibitors and ARBs are usually neutral. Uncontrolled hypertension itself can also affect attention and processing, so benefits and quality of life need to be balanced. There are several factors to consider; see below to understand more, including safe next steps with your doctor and urgent warning signs that require immediate care.
References:
* Chiu S, Zoungas S. Antihypertensive drugs and cognitive function: Current understanding and future directions. J Hum Hypertens. 2019 Jun;33(6):397-405. doi: 10.1038/s41371-018-0138-y. Epub 2018 Nov 13. PMID: 30419330.
* Patel RS, Solas C, Gurovich AN, Miller DR, Nystoriak MA. Sex Differences in Antihypertensive Treatment and Cognitive Outcomes. Curr Hypertens Rep. 2023 Apr;25(4):119-127. doi: 10.1007/s11906-023-01242-2. Epub 2023 Mar 28. PMID: 36979942; PMCID: PMC10050809.
* Chau V, Tamir S, Bell CM, et al. β-blockers and cognitive function in older adults: A systematic review and meta-analysis. Age Ageing. 2020 Jul 1;49(4):528-537. doi: 10.1093/ageing/afaa063. PMID: 32402120.
* Qing Y, Lu Y, Sun B, Hu Z, Ding Y. Hypertension and cognition: a systematic review of the underlying mechanisms and potential interventions. Hypertens Res. 2019 Jan;42(1):33-43. doi: 10.1038/s41440-018-0164-9. Epub 2018 Dec 7. PMID: 30527376.
* Bath PM, Scutt P, Blackburn DJ, et al. Antihypertensive treatment and cognitive decline: A systematic review and meta-analysis. J Alzheimers Dis. 2017;60(1):153-171. doi: 10.3233/JAD-170138. PMID: 28800832; PMCID: PMC6312480.
Q.
Midodrine: 5 important things doctors want you to know
A.
Midodrine raises blood pressure by tightening blood vessels and is used for orthostatic hypotension and, in select cases of advanced liver disease, to support kidney function. Doctors emphasize knowing who benefits, watching for side effects including supine hypertension and urinary retention, following three times daily dosing away from bedtime, and monitoring lying and standing blood pressure while staying hydrated and considering compression stockings. There are several factors to consider; see below for complete details that could affect your next steps.
References:
Planas R, Montserrat A, Balleste B, Balleste R, Arroyo V, Gines P. (2001). Midodrine improves circulatory and renal function in cirrhotic… Hepatology, 11556376.
Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT. (2008). Hyponatremia and mortality risk in patients with end-stage liver… Hepatology, 18725014.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with… Journal of Hepatology, 24986678.
Q.
What is midodrine used for?
A.
Midodrine is used to raise blood pressure by tightening blood vessels; its main evidence-based uses are neurogenic orthostatic hypotension and, in advanced liver disease, type 1 hepatorenal syndrome when combined with octreotide and albumin. There are several factors to consider, including dosing frequency and avoiding doses near bedtime due to supine hypertension risk, potential side effects, and important precautions and interactions; see below for complete details that could influence your next steps and when to contact a clinician.
References:
Sanyal AJ, Boyer TD, Garcia-Tsao G, et al. (2008). Randomized placebo-controlled trial of midodrine and octreotide plus albumin in type 1 hepatorenal syndrome… J Hepatol, 19185944.
Low PA, Opfer-Gehrking TL, Textor SC, Benarroch EE, Fealey RD, Suarez GA, Allen RP. (1997). Randomized, placebo-controlled study of midodrine in patients with neurogenic orthostatic hypotension… Mayo Clin Proc, 9289076.
European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis… J Hepatol, 30496478.
Q.
Can blood pressure medications cause dizziness?
A.
Yes, blood pressure medications can sometimes cause dizziness as a side effect. See below to understand more.
References:
Burrell LM. (1997). A risk-benefit assessment of losartan potassium in the .... Drug safety, 9010643.
https://pubmed.ncbi.nlm.nih.gov/9010643/
Nicholson JP, Resnick LM, Pickering TG, Marion R, Sullivan P, & Laragh JH. (1985). Relationship of blood pressure response and the renin .... The American journal of medicine, 3881942.
https://pubmed.ncbi.nlm.nih.gov/3881942/
Capone P, Vukovich RA, Neiss ES, Bolton S, & Reeves RL. (1983). Multicenter dose-response study of the effect .... Clinical therapeutics, 6342786.
Q.
How much salt should I limit if I'm on hypertension medicine?
A.
If you have high blood pressure and take medication, it's important to limit your salt intake to help manage your condition. Experts suggest keeping your daily sodium intake to less than 2,300 milligrams, and ideally around 1,500 milligrams for better results. See below to understand more.
References:
Nolan P, & McEvoy JW. (2024). Salt restriction for treatment of hypertension - current state .... Current opinion in cardiology, 38078601.
https://pubmed.ncbi.nlm.nih.gov/38078601/
Gupta DK, Lewis CE, Varady KA, Su YR, Madhur MS, Lackland DT, et al. (2023). Effect of Dietary Sodium on Blood Pressure: A Crossover Trial. JAMA, 37950918.
https://pubmed.ncbi.nlm.nih.gov/37950918/
van Brummelen P, Schalekamp M, & de Graeff J. (1978). Influence of sodium intake on hydrochlorothiazide-induced .... Acta medica Scandinavica, 696414.
Q.
Should I take my blood pressure medicine in the morning or at night?
A.
Some studies suggest taking blood pressure medicine at night may help reduce heart risks, but the best time can vary. It's important to follow your doctor's advice on when to take your blood ressenre medioson. See below to understand more.
References:
Maqsood MH, Messerli FH, Skolnick AH, Newman JD, Berger JS, & Bangalore S. (2023). Timing of Antihypertensive Drug Therapy: A Systematic .... Hypertension (Dallas, Tex. : 1979), 37212152.
https://pubmed.ncbi.nlm.nih.gov/37212152/
de la Sierra A, Ruilope LM, Martínez-Camblor P, Vinyoles E, Gorostidi M, Segura J, & Williams B. (2024). Impact of timing of antihypertensive treatment on mortality. Journal of hypertension, 37796235.
https://pubmed.ncbi.nlm.nih.gov/37796235/
Mackenzie IS, Rogers A, Poulter NR, Williams B, Brown MJ, Webb DJ, et al. (2022). Cardiovascular outcomes in adults with hypertension .... Lancet (London, England), 36240838.
Q.
What happens if I miss a dose of my hypertension medication?
A.
Missing a dose of your hypertension medication can cause your blood pressure to rise, but the effect varies depending on the medication you're taking. See below to understand more.
References:
de Leeuw PW, Fagard R, & Kroon AA. (2017). The effects of missed doses of amlodipine and losartan on .... Hypertension research : official journal of the Japanese Society of Hypertension, 28100922.
https://pubmed.ncbi.nlm.nih.gov/28100922/
Hernández-Hernández R, Armas de Hernández MJ, Armas-Padilla MC, Carvajal AR, & Guerrero-Pajuelo J. (1996). The effects of missing a dose of enalapril versus .... Blood pressure monitoring, 10226213.
https://pubmed.ncbi.nlm.nih.gov/10226213/
Düsing R, Brunel P, Baek I, & Baschiera F. (2013). Sustained blood pressure-lowering effect of aliskiren .... Journal of clinical hypertension (Greenwich, Conn.), 23282123.
Q.
What foods and drinks can help lower blood pressure?
A.
Certain foods and drinks can help lower blood pressure effectively. By incorporating these dietary changes into your daily routine, you can make significant strides in managing hypertension.
References:
Strilchuk L, Cincione RI, Fogacci F, Cicero AFG. Dietary interventions in blood pressure lowering: current evidence in 2020. Kardiol Pol. 2020 Aug 25;78(7-8):659-666. doi: 10.33963/KP.15468. Epub 2020 Jun 30. PMID: 32631027.
Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM; American Heart Association. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension. 2006 Feb;47(2):296-308. doi: 10.1161/01.HYP.0000202568.01167.B6. PMID: 16434724.
Q.
What is the best ARB for high blood pressure? Comparing and differentiating ARB medications for hypertension.
A.
Angiotensin receptor blockers (ARBs) are a class of medications commonly used to manage high blood pressure (hypertension) and other cardiovascular conditions. While all ARBs work by blocking the effects of angiotensin II, a hormone that constricts blood vessels, there are differences in their efficacy, safety profiles, and specific indications.
References:
Dézsi CA. The Different Therapeutic Choices with ARBs. Which One to Give? When? Why? Am J Cardiovasc Drugs. 2016 Aug;16(4):255-266. doi: 10.1007/s40256-016-0165-4. PMID: 26940560; PMCID: PMC4947116.
Abraham HM, White CM, White WB. The comparative efficacy and safety of the angiotensin receptor blockers in the management of hypertension and other cardiovascular diseases. Drug Saf. 2015 Jan;38(1):33-54. doi: 10.1007/s40264-014-0239-7. PMID: 25416320; PMCID: PMC4303500.
Q.
What is a normal blood pressure for people in their 50s and 60s?
A.
The "normal range" for blood pressure is defined as a systolic blood pressure below 120 mmHg and diastolic blood pressure below 80 mmHg.
References:
Saiz LC, Gorricho J, Garjón J, Celaya MC, Erviti J, Leache L. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev. 2022 Nov 18;11(11):CD010315. doi: 10.1002/14651858.CD010315.pub5. PMID: 36398903; PMCID: PMC9673465.
Whelton PK, Bundy JD, Carey RM. Intensive Blood Pressure Treatment Goals: Evidence for Cardiovascular Protection From Observational Studies and Clinical Trials. Am J Hypertens. 2022 Nov 2;35(11):905-914. doi: 10.1093/ajh/hpac045. PMID: 35390116; PMCID: PMC9629457.
Flack JM, Adekola B. Blood pressure and the new ACC/AHA hypertension guidelines. Trends Cardiovasc Med. 2020 Apr;30(3):160-164. doi: 10.1016/j.tcm.2019.05.003. Epub 2019 May 15. PMID: 31521481.
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https://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2006.00226.xOliveras A, de la Sierra A. Resistant hypertension: patient characteristics, risk factors, co-morbidities and outcomes. J Hum Hypertens. 2014 Apr;28(4):213-7. doi: 10.1038/jhh.2013.77. Epub 2013 Aug 29. PMID: 23985879.
https://www.nature.com/articles/jhh201377Elliott WJ. Systemic hypertension. Curr Probl Cardiol. 2007 Apr;32(4):201-59. doi: 10.1016/j.cpcardiol.2007.01.002. PMID: 17398315.
https://www.sciencedirect.com/science/article/abs/pii/S0146280607000035?via%3DihubJudd E, Calhoun DA. Apparent and true resistant hypertension: definition, prevalence and outcomes. J Hum Hypertens. 2014 Aug;28(8):463-8. doi: 10.1038/jhh.2013.140. Epub 2014 Jan 16. PMID: 24430707; PMCID: PMC4090282.
https://www.nature.com/articles/jhh2013140