This article is in response to an email I received from a subscriber. ‘Doctor, I developed hypertension 10 years ago and I have been on medication since then. I want to know, when can I stop my hypertension medication?’
Before we get into the question, let’s just revise the basics about hypertension. According to the American Heart Association, your blood pressure is considered normal when it’s below 120/80. Yes you read right, below 120/80. When your blood pressure goes above 120/80 you are beginning to develop hypertension.
Stages of hypertension
Stage 1 hypertension is when your blood pressure is between 130-139/80- 89. This is an important stage where lifestyle modifications are required to reverse the trend. At this stage no medication is usually required however.
When your BP crosses 140/90, you are now in stage 2 Hypertension and must start antihypertensive medication(s). The risk of complications rises sharply in stage 2 hence the need to start medication alongside the lifestyle modification.
Unfortunately for many people their first diagnosis of hypertension is when they are already in stage 2 or higher. Many newly diagnosed hypertensives already have developed complications at the time of diagnosis and therefore most doctors are not willing to risk delaying the start of pharmacological intervention or stop the medication for that matter.
Hypertension is considered a lifelong condition.
It has no cure, however, it can be managed effectively, first with lifestyle modifications such as healthier diet and increased physical activity with the aim of maintaining a healthy weight especially if you are overweight or obese. Stage 1 hypertension, can be reversed with only these lifestyle modifications without a need for medication. But in stage 2, lifestyle modification alone will not be enough, and so long as your blood pressure remains above 140/90 you must remain on your medication.
Yes you can
This is to say that yes, you can go off your BP medication once your blood pressure remains consistently below 140/90, but you can never stop managing your blood pressure. In other words, the BP medication can end but the lifestyle modifications can never end. However, your healthcare provider will have to consider all other factors before helping you make that decision.
A few important factors about hypertension
1. Black people have a much higher risk of developing hypertension, and its cousin, diabetes.
2. Men have a much higher risk of developing hypertension. They develop it at an earlier age and are more likely to have complications at the time of diagnosis.
3. Hypertension has no symptoms, hence the nickname ‘Silent killer’. The symptoms you have are usually a result of the complications of the high BP and not the high BP itself. Early diagnosis is key in minimizing those complications.
4. There are many categories of blood pressure medications, some more tolerable than others. If one medication is not working for you or you are experiencing side effects, report to your healthcare provider so it can be changed. There is definitely medication that will be right for you.
5. In up to 95% of hypertension, no obvious cause can be identified. This hypertension is known as primary or essential hypertension. The remaining 5%, called secondary hypertension, may be as a result of other diseases or medication. When the disease or medication causing the hypertension is dealt with, the blood pressure returns to normal.
6. Pregnancy is a special cause of secondary hypertension and is given the special treatment it deserves, since you cannot just remove ‘the cause’.
7. Hypertension and its complications are responsible for 60 – 80% of premature deaths
