Nearly one in three adults in the United States has high blood pressure, also called hypertension. High blood pressure is dangerous because it increases the risk of stroke, heart attack, heart failure, kidney failure, death.

“High blood pressure is often called the ‘silent killer’ because it usually has no symptoms until it causes damage to the body,” says Douglas Throckmorton, M.D., Deputy Director of FDA’s Center for Drug Evaluation and Research. Many studies have shown that lowering the blood pressure with drugs decreases that damage.

A Lifelong Condition

Blood is carried from the heart to all parts of the body in vessels called arteries. Blood pressure is the force of the blood pushing forward through the body and against the walls of the arteries. The higher the blood pressure, the greater the risk of stroke, heart attack, heart failure, kidney failure, and death.

Blood pressure is made up of two numbers:

  • The “top” number is the systolic blood pressure—the pressure while the heart is pumping blood out. According to the National Institutes of Health (NIH), this number should be less than 120 to be in the normal range.
  • The “bottom” number is the diastolic blood pressure—the pressure while the heart is filling up with blood, getting ready to pump again. According to NIH, this number should be less than 80 to be in the normal range.

It was once believed that only diastolic pressure (the “bottom” number) was important, but this is not true. Elevated systolic pressure alone, particularly common in older people, is just as dangerous as elevations of both systolic and diastolic pressure.

Blood pressure is elevated for two main reasons:

  • too high blood volume
  • too narrow blood vessels.

Most of the time, the cause of a person’s high blood pressure is unknown. Once it develops, high blood pressure usually lasts the rest of the person’s life. But it is treatable.

Some people can lower blood pressure by losing weight, limiting salt intake, and exercising, but for most people, these steps are not enough. Most people need medication for blood pressure control, and will probably need it all their lives.

Types of Medications

FDA has approved many medications to treat high blood pressure, including

  • Diuretics, or “water pills,” which help the kidneys flush extra water and salt from your body and decrease blood volume
  • Angiotensin converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs), reduce blood pressure by relaxing blood vessels
  • Beta blockers, which also cause the heart to beat with less force
  • Drugs that directly relax the blood vessels. These include calcium channel blockers (CCBs) and other direct dilators (relaxers) of blood vessels
  • Alpha blockers, which reduce nerve impulses that tighten blood vessels
  • Nervous system inhibitors, which control nerve impulses from the brain to relax blood vessels

Many people with high blood pressure may need more than one medication to reach their goal blood pressure. Your health care provider can tell you if you should be on medication and, if so, which drug(s) may be best for you.

Tips for Consumers

Controlling your blood pressure is a lifelong task. Blood pressure is only one of a number of factors that increase your risk of heart attack, stroke, and death. High cholesterol and diabetes are other risk factors. Lifestyle changes—such as weight loss, a healthy diet, and physical activity—can affect all three risk factors, but many people will also need medications.

Take your medicines and monitor your blood pressure. Take the medications prescribed for you regularly and don’t stop them except on the advice of your health care provider. Hypertension tends to worsen with age and you cannot tell if you have high blood pressure by the way you feel, so have your health care provider measure your blood pressure periodically. You may also want to buy a home blood pressure monitor, available in many drug stores, to measure your blood pressure more frequently. Your health care provider or pharmacist can help you choose the right device. Many drug stores also have blood pressure measuring devices you can use in the store.

Tell your health care provider about any side effects you are having. Some side effects may go away over time, others may be avoided by adjusting the dosage or switching to a different medication.

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Scientific evidence shows that taking an aspirin daily can help prevent a heart attack or stroke in some people, but not in everyone. It also can cause unwanted side effects.

According to Robert Temple, M.D., deputy director for clinical science at the Food and Drug Administration (FDA), one thing is certain: You should use daily aspirin therapy only after first talking to your health care professional, who can weigh the benefits and risks.

Who Can Benefit?

“Since the 1990s, clinical data have shown that in people who have experienced a heart attack, stroke or who have a disease of the blood vessels in the heart, a daily low dose of aspirin can help prevent a reoccurrence,” Temple says. (A dose ranges from the 80 milligrams (mg) in a low-dose tablet to the 325 mg in a regular strength tablet.) This use is known as “secondary prevention.”

However, after carefully examining scientific data from major studies, FDA has concluded that the data do not support the use of aspirin as a preventive medication by people who have not had a heart attack, stroke or cardiovascular problems, a use that is called “primary prevention.” In such people, the benefit has not been established but risks—such as dangerous bleeding into the brain or stomach—are still present.

Caution Needed With Other Blood Thinners

When you have a heart attack, it’s because one of the coronary arteries (which provide blood to the heart), has developed a clot that obstructs the flow of blood and oxygen to the heart. Aspirin works by interfering with your blood’s clotting action.

Care is needed when using aspirin with other blood thinners, such as warfarin, dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixiban (Eliquis).

What about people who have not had heart problems or a stroke but who, due to family history or showing other evidence of arterial disease are at increased risk? Is an aspirin a day a safe and effective strategy for them?

Again, Temple emphasizes, the clinical data do not show a benefit in such people.

He adds, however, that there are a number of ongoing, large-scale clinical studies continuing to investigate the use of aspirin in primary prevention of heart attack or stroke. FDA is monitoring these studies and will continue to examine the evidence as it emerges.

Surgery to remove a cataract is one of the ways to get rid of a cataract. This surgery works well and helps people see better. But surgery is often not needed or can be delayed for months or years. Many people with cataracts get along very well with the help of eyeglasses, contacts, and natural cataract treatment products.

Because of fear of blindness or loss of independence, older adults may think they need to have surgery even when their cataracts do not affect their quality of life. In many cases, wearing eyeglasses or contacts and using other options to treat cataracts without surgery might be appropriate and just as effective without any of the risks of surgery.

Doctors will often tell you that there is no cure for cataracts and that your only options are to either have surgery or treat the symptoms. The truth is that cataracts can often be reversed and even eliminated with natural cataract treatments.