May 4, 2013

Can Caffeine Affect Blood Pressure?

I am 35 and believe I am developing high blood pressure. I am 5’5″, 125 pounds, in the gym five days a week, and eat a low-fat diet. Can caffeine affect blood pressure? Will caffeine cause it to be higher? I’m trying to get it down without medication. It usually runs 140/90.

Hypertension is a common problem seen in general medical practice, and many articles in the past few years have chastised doctors for not being aggressive enough in identifying and treating people with the condition. Therefore, I thought that today’s question would provide a good starting point for a discussion on hypertension.

Hypertension means high blood pressure; and the level of 140/90 is usually accepted as the dividing line between normal pressure, in which both the systolic pressure (the first number) and the diastolic pressure (the second number) are lower, and hypertension, in which one or both of the numbers are higher than that figure.

You write that your pressure runs 140/90, at best. To me this means that you frequently have readings above that. In that case, you definitely have hypertension, and should be seeing your doctor to get it worked up, and probably to start getting treatment.

The workup of someone with hypertension attempts to identify any other conditions that might be causing it — such as certain kidney diseases, or some tumors of the adrenal glands. No such cause is found in more than 90 percent of people with hypertension, who are then said to have essential hypertension. Essential hypertension is strongly inherited. You didn’t mention your family history, but I would not be surprised to hear that one or both parents, or some siblings also have hypertension.

The workup should also include checking for other conditions which might lead to more serious complications when present with hypertension. These include all the risk factors for coronary artery disease such as smoking, high cholesterol, diabetes and perhaps high homocysteine levels in the blood.(See my q/a on this recently recognized risk factor for heart disease.) An electrocardiogram (EKG) to see if the hypertension has caused any enlargement of the heart muscle, and tests to check on other organs may also be done.

Even if your workup is negative, meaning no cause is found for your hypertension and no other risk factors for heart disease are identified, you should still be treated with the goal of reducing your usual blood pressure to around 130/80, or lower. You are getting regular exercise, which is good, and you are not obese. People who are obese and hypertensive should make a determined effort to lose weight, since even a 10-pound weight loss will often result in much lower pressure. Caffeine is not considered a problem in someone who is hypertensive. You can stop drinking coffee and see, but I doubt that that will reduce your pressure. Lowering your salt intake may bring your pressure down somewhat, and will make it possible to treat you with lower doses of drugs should that be necessary. If you drink alcohol, you should try abstaining and see if that will lower your pressure.

Other non-medical ways of treating hypertension that have been investigated over the years include hypnosis and biofeedback. Neither has been shown to be consistently effective. I am also not aware of any consistently effective herbal remedies. There has been some evidence showing that a calcium supplement can lower blood pressure so you might try increasing your intake by taking two 600mg tablets of calcium carbonate daily with food. You are also getting to the age where this supplement is desirable, to reduce the development of osteoporosis.

However, if none of these non-medication steps produce results, then I would suggest that you begin treatment with drugs. There are now many choices among anti-hypertensives, and since your pressure is not very high, you may require only small doses, which have less likelihood of producing side effects. The treatment of hypertension is long-term, and it may be necessary to try several medications or combinations until the best treatment for your case is found. Increasing dosage may be necessary over time, since the blood pressure of people with hypertension does tend to rise with age.

Although this sounds like it will be a real pain, with frequent doctor visits and possible drug side effects, it is important for you to simply make up your mind that you are going to persevere in keeping your blood pressure under control. The benefits in terms of reduced mortality from heart disease, kidney disease and stroke are enormous; and we are seeing this in our national health statistics as deaths from heart attacks and strokes go down. Much of this decline can be attributed to our better control of hypertension, high cholesterol and cigarette smoking, but there are still too many people out there with hypertension or who have high-fat diets, smoke, and get little exercise. We need to be identifying them and getting them into treatment, and into a healthier lifestyle. This happens only one person at a time; but you can make the decision that you’ll be the next person to bring your blood pressure under control, whatever it takes.


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