To treat, or not to treat, that is the question. Some doctors believe that all patients with high blood pressure should be treated, even if their conditions are mild. Others disagree, pointing to the potential effects of diet and exercise alone, and citing data which show no particular therapeutic advantage to taking the drugs.

There’s no question, however, that hypertension is one of the major risk factors in heart disease and should be controlled in order to prevent future cardiac events. This is especially true for women, who do far worse following heart attack or bypass if their blood pressures are even slightly elevated. Blacks, too, are at increased risk when hypertension enters the equation.

Mild hypertension can be defined as a blood pressure of 140-160 systolic over 90-100 diastolic. This range describes 80 per cent of the hypertensive population.

Norman Kaplan, MD, chief of the hypertension division at the University of Texas Health Science Center in Dallas, voiced the concern of many in the medical community about the benefits of treating mild hypertension with drugs.

“The data on the treatment of mild hypertension and protection against coronary heart disease ate simply nonexistent,” he explained at a meeting of the American Heart Association. “In four of the nine studies conducted to compare hypertension treatment with nontreatment, the benefits were seen on the wrong side, that is the nontreatment side of the study. There has simply been no significant decrease in coronary mortality among the treated population of mild hypertensives. Lowering blood pressure to the lowest possible level simply may not be in the best interests of our patients.”

One of the most common ways to treat hypertension is with diuretic drugs. But diuretics may cause a rise in cholesterol levels. Moreover, diabetic patients may suffer owing to decreased glucose tolerance.

Moreover, even if one has been taking hypertension medications, is it necessary to remain on the drugs for life? Once it was believed that such therapy would need to be continued forever. Now some experts are saying that many patients can safely quit their medications or at least cut way back on the dosage.

But that’s possible only when the patient takes an active role in the management of blood pressure. And that means weight control, proper diet including salt and sodium restriction if sensitive to sodium, and regular physical exercise.

As you can probably tell, I believe in the least possible medication, relying as much as practical on diet and exercise. But there certainly are patients for whom drugs will be necessary even when doing their very best with non-drug methods. For those with very high blood pressure which does not entirely respond to diet and exercise, there are a wide variety of drugs the physician can choose to bring the condition under control.

Remember that regardless of the means used to achieve the end, control of hypertension is essential to prevent future cardiac events. Discuss these matters with your physician. Talk about the different drugs listed in the chart at the end of this chapter and listen to why one or another might be the choice for you. Then follow your doctor’s prescription exactly. Don’t forget that after a while you may be able to cut that dosage down through your program of weight control, diet and exercise. But do not alter your medication dosage without your physician’s prior permission.

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Cardio & Blood/ Cholesterol