About half of patients diagnosed with high blood pressure will need their medication adjusted within the first year to address side effects or failure to control blood pressure properly, according to a recent study.

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If you’ve been diagnosed with high blood pressure (hypertension), you’ll probably be given a prescription for medication. When determining the medication that’s best for you, your physician will consider numerous factors, including your family and personal medical history, age, weight, lifestyle, and other health conditions.

“It is very important to individualize drug therapy for each patient,” says Samuel Mann, MD, a hypertension expert at Weill Cornell Medicine. “The same medication that works for you may not be effective for another patient.”

Choosing a Medication

There are several classes of medications used to treat high blood pressure; they include diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs). Your physician needs to understand what mechanism is causing your hypertension before he or she can decide what class of drugs will be most effective for treating your hypertension, since the drugs work in different ways. The mechanisms responsible for hypertension in most people include:

• Constriction (narrowing) of arteries caused by an increased blood volume due to sodium
• Constriction of arteries caused by angiotensin II, a hormone stimulated by an enzyme called renin
• The sympathetic nervous system, which increases heart rate and causes blood vessels to constrict.

In some cases, the mechanism is relatively easy to diagnose. “For example, swelling due to fluid retention, which occurs most commonly in the legs, indicates that a fluid volume mechanism is likely, and a diuretic will probably decrease blood pressure,” Dr. Mann says. “About 80 percent of people with hypertension will have their blood pressure controlled with drugs that address the sodium volume mechanism, the renin-angiotensin mechanism, or a drug combo that addresses both.”

More on Medication

When you start a new medication, your doctor may prescribe a low dose, and then increase the dose if necessary.

If your blood pressure is below 160/100 mm Hg, a single medication is usually prescribed. If the first drug is ineffective, a second drug can either be added or substituted, Dr. Mann says. If your blood pressure is higher than 160/100 mm Hg, guidelines recommend starting treatment with two drugs.

“Hypertension can be controlled in almost everyone if they’re given the right drugs,” Dr. Mann says.

Dr. Mann notes that weight loss, exercise, and, in many patients, lowering sodium (salt) intake can help reduce the number of medications needed to control blood pressure.

Lifestyle Strategies

For some patients, adopting a healthier lifestyle can lower blood pressure enough to eliminate the need for medication. If you eat a healthy diet, exercise regularly, and cut back on sodium, you can reduce your blood pressure by as much as 20 mm Hg—as much or more than some medications.

Choose a dietary pattern that contains whole grains, fruits, vegetables, lean proteins, and low-fat dairy. Focus on eating whole foods and avoid highly processed foods, which are often high in sodium, saturated fat, and empty calories.

Engaging in aerobic exercise—the type that requires continuous movement of major muscle groups—30 minutes a day for five or more days each week can lower your blood pressure by 4 to 9 mm Hg. Aerobic exercises include walking, jogging, cycling, swimming, and dancing. Strength training (using hand weights, exercise machines, resistance bands, or your own body weight) also can help reduce blood pressure, and it helps strengthen your bones.

If you’re overweight, eating a healthier diet and staying physically active will help you lose weight. If you have difficulty losing weight on your own, ask your doctor for a referral to a healthcare provider who specializes in weight loss.

The Role of Sodium

The effect of sodium consumption on blood pressure varies. However, the average American consumes more than 3,000 milligrams (mg) of sodium per day—far more than the recommended 2,300 mg maximum recommended for all adults, and more than double the 1,500 mg of sodium advised for adults over age 50, African Americans, and those who have high blood pressure, diabetes, or kidney disease.

Even if you don’t add salt to your food, you’re probably getting too much sodium if you frequently eat out or you eat prepared foods; see our “What You Can Do” sidebar for foods that are often high in sodium.

Eating foods that contain potassium will help counteract the effects of sodium; sodium causes fluid to exit cells and increase blood volume, while potassium causes fluid to enter cells and decrease blood volume. Good sources of potassium include spinach, Swiss chard, avocados, white and sweet potatoes, white and black beans, tomatoes, soybeans, raisins, dates, and bananas.