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High blood pressure
is the most common reason for physician visits in our population.
The prevalence increases with obesity, diabetes, and ageing. Complications
of uncontrolled BP include strokes, heart disease, kidney disease,
and hardening of the arteries.
In the past few years we have changed
our ideas about hypertension. We used to emphasize the diastolic
(lower) BP as being most important. Today, it is the systolic
(highest) that we monitor most carefully. Some evidence suggests
a low diastolic BP may be a problem, as measured by a high pulse
pressure-the difference between the systolic and the diastolic
pressures.
Currently, recommendations are to keep the systolic BP below 140
mm mercury, and in diabetics, even lower-130.
New drugs have made this possible. When FDR was president, he
had his BP checked daily by his personal physician. I do not know
what his pressure was, but it was high. The only drug treatment
at this time was phenobarbital, which was not effective. He died
of a stroke because of poor BP control. Today we have many options,
and the drugs have much less side effects.
To adequately control BP, most patients
will need 2-3 medications. One is rarely enough, and using a combination
allows lower doses of the drugs. Our current lists of drugs are
as follows:
ACE inhibitor - either of these classes can be
used as the primary drug. Lotensin, Capotin, Accupril, etc are
the ACE inhibitors I generally start with. All are probably the
same, so we go with the lowest price drugs. If the drug is not
tolerated-cough especially, I substitute a calcium channel blocker.
Diuretics - these were originally developed as
diuretics, but today we use low doses that do not cause urinary
problems at night. These are generic and are very inexpensive.
They help control BP, allowing lesser doses of the more expensive
ACE inhibitors. In low doses, potassium loss is seldom a problem.
If BP is not adequately controlled with these 2 medications, we
have other options, including a calcium channel antagonist, a
beta blocker like atenolol, or one of the new and expensive ARB’s
(angiotensin receptor blockers).
Other drugs are available for special circumstances, the above
is the program used by most physicians.
More links about Hypertension:
http://hyper.ahajournals.org/
www.americanheart.org
www.ash-us.org
www.lifeclinic.com
Written
& edited by Robert E. Dyer, MD
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