Long on Meds Blog
How Well Should My Blood Pressure Medications Control My Hypertension?
Taking medication for high blood pressure is not enough if your blood pressure remains too high. For most adults with hypertension, current guidelines recommend a treatment goal below 130/80 mm Hg. The purpose is not simply to produce a better number. Better blood pressure control helps reduce the risk of heart attack, stroke, heart failure, kidney disease, and other complications of hypertension.
Is 140/90 still good enough if I am taking blood pressure medication?
For many years, a blood pressure below 140/90 was considered satisfactory treatment. Evidence accumulated, however, that cardiovascular risk continues below that level. Current American Heart Association and American College of Cardiology guidelines recommend a general treatment goal below 130/80 for adults with hypertension, although treatment should always be individualized.
Why does getting below 130/80 matter?
One of the strongest demonstrations came from the SPRINT trial, which compared a systolic blood pressure target below 120 with the traditional target below 140 in adults at increased cardiovascular risk. More intensive treatment reduced major cardiovascular events and deaths, although it also increased some adverse effects.
The lesson is not that everyone must achieve a systolic pressure below 120. It is that being below 140 does not necessarily mean your hypertension is optimally controlled.
Is it unusual to need more than one blood pressure medication?
No. Most patients require two to four antihypertensive medications to achieve guideline-recommended blood pressure targets. Needing a second or third medication does not mean treatment has failed. Combination therapy is often necessary because different medications lower blood pressure through different mechanisms.
The goal is not to minimize the number of medications at all costs. The goal is to control the disease safely enough to reduce its long-term consequences.
If I need another medication, can I choose one that provides additional benefits?
Clinical effectiveness and safety come first. But when several appropriate blood pressure medications are available, your other health risks can help determine which one provides the greatest overall benefit.
Losartan is a good example. Like other angiotensin receptor blockers (ARBs), it lowers blood pressure but also reduces pressure inside the kidney's filtering units, helping reduce protein leakage into the urine. In people with type 2 diabetes and kidney disease, losartan has been shown to slow progression of kidney disease beyond what could be explained by lowering blood pressure alone.
Other conditions, including heart failure, diabetes, and vascular disease, may similarly make one blood pressure medication more attractive than another. Some antihypertensive medications also have evidence suggesting a positive influence on inflammatory pathways.
Long on Meds examines these differences in Check a Condition, where medications used for hypertension can be compared by their clinical evidence and their effects on inflammatory pathways.
The goal is not simply to add medications. It is to use the medications you need to control your blood pressure while obtaining as much additional health protection as reasonably possible.