Window of Opportunity for High Blood Pressure Treatment Without Medication

En español | Diabetics who are newly diagnosed with high blood pressure may be able to safely put off using blood pressure medication for a year while they try diet and exercise first, a new study finds.

Researchers at the University of Chicago examined information about 150 patients between the ages of 50 and 59 who were newly diagnosed with Type 2 diabetes. They found that delaying medication for blood pressure for up to a year had little or no health consequences in most people. Longer delays, however, could lead to serious health problems.

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Get up and walk! It may prevent you from going on blood pressure medication. — Photo by Jeffrey Coolidge/Getty Images

But some doctors feel that a year's delay is too long and could lead to dangerous complications.

"My argument is to strike when the iron is hot, in the beginning, when blood pressure is easier to manage" says Robert Sherwin, M.D., professor and section chief of endocrinology at Yale School of Medicine.

Sherwin says he's willing to give patients three or four months to lower their blood pressure using diet and exercise, but after that he strongly advises that they take blood pressure medications.

Generally, if a patient's blood pressure spikes to 140/90 mmHg most doctors will prescribe medications right away, as high blood pressure raises the risk of serious health complications — including stroke, heart disease and kidney failure.

The American Diabetes Association recommends that people with diabetes keep their blood pressure below 130/80 mmHg, a target lower than for the general public. But two out of three adults with diabetes never reach that goal, largely because of limited access to health care or reluctance to change their lifestyle. What's more, at least 20 percent of patients with diabetes abandon their treatment.

“The question is, do we want to encourage taking medications or the right diet and exercise?” says study author Neda Laiteerapong, MD, instructor of medicine at the University of Chicago. She says that once patients lower their blood pressure with medications, doctors are less likely to encourage them to use lifestyle changes.

"It's important to give people time to adopt the lifestyle necessary to treat their high blood pressure," she says.

The study was published online Jan. 4  in the Journal of General Internal Medicine.

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Loren Stein is a freelance writer who lives in Washington, D.C.