Treatment with medication

When is drug treatment started for high blood pressure?
Drug treatment to lower blood pressure is usually advised for:

• All people who have a blood pressure that remains at 160/100 mmHg or above after a trial of any lifestyle changes, where relevant.
• People with a blood pressure that remains at 140/90 mmHg or above after a trial of any lifestyle changes, where relevant AND who have:
  • Diabetes, or 
  • An existing cardiovascular diseases, or 
  • A 2 in 10 risk (or more) of developing a cardiovascular disease within the next 10 years (as described above).
• People with a blood pressure of 130/80 mmHg or more who have certain diseases. For example, people who have certain complications from diabetes, people who have had a recent heart attack, stroke or TIA (transient ischaemic attack). Also, some people with certain chronic (ongoing) kidney diseases.

What is the target blood pressure to aim for?
If you are taking medication to lower high blood pressure:

• If you are otherwise well but are diagnosed with high blood pressure then the target is to reduce blood pressure to below 140/85. This target generally applies to people who have a 2 in 10 risk (or more) of developing a cardiovascular disease within the next 10 years but who have not developed any disease.
• In some cases, the target is to get the blood pressure below 130/80 mmHg. This generally applies to people who have diseases where very good blood pressure control is important. This includes:
  • People who have a cardiovascular disease.
  • People with diabetes.
  • People who have a chronic kidney disease.

Your GP or practice nurse will advise you what your target blood pressure is.

What drugs are used to lower blood pressure?
There are several drugs that can lower blood pressure. The one chosen depends on such things as: if you have other medical problems; if you take other medication; possible side-effects of the drug; your age; your ethnic origin; etc. Some drugs work well in some people, and not so well in others. One or two drugs may be tried before one is found to suit.

One drug reduces high blood pressure to the target level in less than half of cases. It is common to need two or more different drugs to reduce high blood pressure to a target level. In about a third of cases, three drugs or more are needed to get blood pressure to the target level. In some cases, despite treatment, the target level is not reached. However, although to reach a target level is ideal, you will benefit from any reduction in blood pressure.

A separate leaflet called 'Medication for High Blood Pressure' gives more details.

How long is medication needed for?
In most cases, medication is needed for life. However, in some people whose blood pressure has been well controlled for three years or more, medication may be able to be stopped. In particular, in people who have made significant changes to lifestyle (such as lost a lot of weight, or stopped heavy drinking, etc). Your doctor can advise.

If you stop medication, you should have regular blood pressure checks. In some cases the blood pressure remains normal. However, in others it starts to rise again. If this happens, medication can then be started again.

Smoking and high blood pressure

Smoking does not directly affect the level of your blood pressure. However, smoking greatly adds to your health risk if you already have high blood pressure. If you smoke, you should make every effort to stop. If you smoke and are having difficulty in stopping, then see your practice nurse for help and advice.

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