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May 4th, 2011
05:37 PM ET

Can I get rid of my hypertension medication?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society.

I have been taking two drugs combined within one pill to control my blood pressure.They are olmesartan and hydrochlorothiazide (known as Benicar-HCT). I took them for approximately eight years, during which time I was part of the world of employment. For seven months since I retired I have found that my blood pressure seems to be holding around 120/78 or less each day when measured. I discussed the matter with my doctor, who advised me to use only half of the prescribed dosage. My question is: Is it possible to rid myself of taking the medication all together?

Asked by Lap, Baltimore, Maryland

Dear Lap,

Most people with high blood pressure have what is known as essential hypertension. It is caused by genetics; bad diet, especially a high salt diet; obesity; lack of exercise; and excessive alcohol intake. A very small proportion of people have hypertension due to another disease. Kidney problems, some endocrine abnormalities and some drugs (such as arthritis medicines and birth control pills) can cause what is known as secondary hypertension. Secondary hypertension is best treated by treating the underlying problem.

The long-term effects of hypertension are cardiovascular diseases such as heart attack, heart beat or rhythm problems, congestive heart failure and stroke. Kidney failure can also be the result of long-term high blood pressure.

Essential hypertension or essential high blood pressure is one of most common problems among adults in the U.S. and Western Europe. In the U.S., about one-third of the population age18 and older, and one-half of the population age 65 and older has hypertension. This translates into more than 60 million American adults having it, today. The number of people with hypertension is growing. This is due to the aging of the population and America's obesity epidemic. In the U.S., there were 30 million over age 65 in 2000 (13% of the population) and it is estimated that there will be 54 million over age 65 in 2020 (16% of the population). Thirteen percent of American adults were obese in the mid 1960s, compared with 35 percent in 2008.

The systolic blood pressure is the highest pressure reached in the arteries when the heart contracts. The diastolic is the arterial pressure when the heart relaxes. They are measured in a unit known as mmHg (for millimeters of mercury). The definition of normal blood pressure and hypertension that has been agreed upon by a number of medical societies is a number of measurements averaging the following:

• Normal blood pressure: systolic less than 120 mmHg and diastolic less than 80 mmHg

• Prehypertension: systolic 120-139 mmHg or diastolic 80-89 mmHg

• Hypertension:

Stage 1: systolic 140-159 mmHg or diastolic 90-99 mmHg

Stage 2: systolic equal to or greater than 160 or diastolic equal to or greater than 100 mmHg

It is generally recommended that most patients with hypertension be treated such that their blood pressure remains below a systolic of 140 and a diastolic of 90. Most patients likely benefit from even lower numbers closer to the normal range. It is also recommended that diastolic blood pressures be kept above 65 mmHg, because going below this level can increase the risk of some types of stroke, especially among older people.

It is not unusual for people to have blood pressure cuffs at home and take their blood pressure regularly. This is to be encouraged, though proper cuff sizing and proper cuff placement are important. Inaccurate readings, both high and low, can result when the blood pressure is not measured correctly. The patient should be instructed as to what size cuff to use and how to properly place the blood pressure cuff.

A number of drugs are available to treat hypertension. They use various mechanisms of action. Some are good for mild to moderate high blood pressure; others are reserved for more severe disease. Some patients need two or three drugs to control their blood pressure. Interestingly, studies show less than 40% of Americans with hypertension have it under control. This is because hypertension is a disease with almost no symptoms for most of its course. It requires a medical examination to diagnose and is treated with medications that must be taken daily and sometimes impair quality of life. Some patients are significantly inconvenienced by having to urinate frequently due to a diuretic, by constipation due to a calcium channel blocker or by impotence or lightheadedness due to an alpha or beta blocker.

Stress from work and other situations can increase ones blood pressure and your retirement may be helping to lower your blood pressure. Changes in diet, weight loss and exercise have also been known to lower ones blood pressure and decrease the need for hypertensive medication.

I cannot speak directly to your situation, as I do not know so many factors such as your age, height, weight and overall health. It is possible for a person with mild hypertension on a mild to moderate blood pressure medication to reach a healthy blood pressure by changing some factors in his or her life, such that blood pressure medication is no longer needed. This should only be done slowly and under a physician's supervision. It may be that lowering the dose or switching to a milder medication is ultimately right for you. I would be cautious, as your physician appears to be, and not stop "cold turkey."


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