How to Manage High Blood Pressure When You Have MS

Here’s what people with MS should know about managing high blood pressure.

A blood pressure reading includes two numbers — your systolic blood pressure (the top or first number), measured during heartbeats, and your diastolic blood pressure (the bottom or second number), measured between heartbeats.

When you have high blood pressure, “A hallmark feature is accelerated aging of the nervous system,” says Christopher Orlando, MD, a neurologist and an MS specialist at Keck Medicine of the University of Southern California in Los Angeles. “This is a big deal in MS, because complications can occur at a younger age than they otherwise would.”

Dr. Orlando says that with faster brain shrinkage due to high blood pressure, “We experience that as things like more fatigue, more trouble focusing, trouble with our memory,” along with poorer walking scores in people with MS.

Managing high blood pressure typically involves the same goals and treatment strategies regardless of whether you have MS. “The recommendations are not different due to MS,” says Mary Rensel, MD, the director of pediatric multiple sclerosis and wellness at the Mellen Center of Cleveland Clinic in Ohio.

• Dietary changes, including reducing sodium (salt)
• Regular physical activity
• Enough sleep
• Weight loss
• Limiting alcohol
• Quitting tobacco

One especially helpful dietary approach, called the DASH diet, has been shown in studies to help lower blood pressure. What’s more, “This diet has been studied to lessen neurodegeneration, or brain damage,” says Dr. Rensel, which means it could be especially beneficial for people with MS.

“Which lifestyle measures are most effective, and which medications are best, are things that a physician would want to tailor to a person’s cardiovascular health and lifestyle,” says Orlando.

For example, Orlando says, someone with MS might not be able to exercise or even prepare meals in the same way as a person without MS. Some blood pressure drugs can also cause dizziness or fatigue as side effects, so if someone already has those problems because of MS, other drugs may be better options.

Your doctor may recommend that you take regular readings with a home blood pressure monitor. “The most accurate readings we get are actually when somebody does it in their home, as long as they’re doing it the right way,” says Orlando — so be sure to follow your doctor’s instructions for when and how to use your monitor.

In some cases, you might not be sure if the symptoms you’re experiencing are caused by your MS or high blood pressure — or both.

“MS symptoms are very similar to high blood pressure symptoms,” says Rensel. “Both can frequently cause fatigue, headaches, cognitive fogginess, and bladder symptoms.”

But often, Rensel says, high blood pressure has no immediate symptoms — fitting its reputation as a “silent killer.” Instead, you may develop symptoms only after many years of damage to tissues and blood vessels throughout your body.

• Dizziness
• Fatigue or tiredness
• Muscle cramps
• Frequent urination
• Constipation
• Sleep difficulties

Be sure to discuss any new or worsening symptoms you experience after starting or changing the dose of a blood pressure medication, Orlando says. If you feel like a medication is making your life harder, your doctor may prescribe a different drug or change your treatment approach.

When you have MS, there can be a lot to discuss with your neurologist at appointments. With all of your other concerns, “It’s hard for us to get to high blood pressure,” says Orlando. So it may be a good idea to discuss concerns related to high blood pressure with your primary care doctor, or a specialist like a cardiologist if you’re seeing one.

Some questions to consider asking your doctor include:

• What should my target blood pressure be?
• How often should we evaluate my treatment plan to see if it’s meeting my goals and needs?
• Could my MS treatments, including steroids, be contributing to high blood pressure?
• Are there blood pressure medications that are less likely to cause side effects like dizziness, fatigue, or frequent urination?
• What symptoms should I watch out for that could indicate worsening MS or an overlap of symptoms due to high blood pressure?

Don’t hesitate to discuss any aspect of your MS, or high blood pressure, with any type of doctor you’re seeing if you have questions or concerns. In some cases, Orlando says, your doctors may coordinate with one another to adjust your treatment — such as adding or adjusting a blood pressure medication to address a symptom like headaches.

For people with MS, “It takes an entire team — and primary care and sometimes cardiology are key members of that team,” says Orlando.

• Managing high blood pressure is critical for people with multiple sclerosis, as hypertension can lead to faster brain shrinkage and worsened symptoms like fatigue and memory trouble.
• Treatment strategies typically include lifestyle changes like the DASH diet, regular physical activity, and weight loss, though doctors may also prescribe medications to lower blood pressure.
• Since high blood pressure often has no immediate symptoms and increases the risk of heart attack or stroke, you should have your blood pressure checked regularly by a healthcare professional.