09/05/2012 07:52 am ET Updated Nov 04, 2012

Hypertension Treatment: How to Best Manage Your Hypertension


At a time when 75 million Americans have hypertension, there are 50 million of them who are taking antihypertensive medications in the effort to bring their hypertension under control and reduce their risk of stroke and heart attack.

As a hypertension specialist, I advocate healthy diet, reduction of sodium intake, and exercise, as a means to avoid or reduce medication. However, most people end up requiring medication, which is helping millions live a longer and healthier life.

The good news is that we have a lot of terrific medications. The bad news: They are not being prescribed as well as they could be. As a result, blood pressure control is inadequate in 30 percent of patients who are currently taking medication, leaving millions of patients at increased cardiovascular risk, while also living with avoidable side effects and excessive medication expenses.

Can we do better? Absolutely.

As I discuss in Hypertension and You, there are many ways we can do better with the drugs we have: by getting away from the one-size-fits-all philosophy and selecting the drugs, dosage and drug combinations that are right for each individual. By selecting the drugs that match the mechanisms causing the person's hypertension, and eliminating drugs that don't. By using more of some terrific older drugs that are mostly forgotten in the midst of the promotion of the newer drugs that dominate research funding, the medical literature, and the market. And by avoiding the treatment or overtreatment of millions who need less medication than their doctors are prescribing for them.

Here are just a few examples of how the wrong medication can affect you, and what can be done:

  • I see many patients who are on medication that they don't need. There are many reasons: In many cases, blood pressure is measured incorrectly in doctor's offices, or is high only in the doctor's office. Erroneous readings are extremely common. Correct measurement is crucial and deserves more attention.
  • If you are taking medication and your blood pressure has been normal, your doctor should not increase your medication because one day in his office your blood pressure was elevated somewhat.
  • Many patients are on three or four medications simply because the diuretic (water pill) they are taking is not strong enough to do the job. It is my professional opinion that with the right diuretic dose or combination of diuretics, hypertension will come under control in half of people with so-called uncontrollable hypertension.
  • Beta-blockers are causing fatigue in millions. Worse, in many cases, the patient does not even need to be on the beta-blocker. Another rarely mentioned side effect is cognitive deficit: in some patients, particularly elderly patients, beta-blockers can affect memory and clarity of thinking. Some beta-blockers are more likely to do this than others, but few doctors take that into account when they prescribe a beta-blocker.
  • If hypertension is at least partially caused by emotional factors, a different set of drugs may work a lot better than the usual ones. In my research, the combination of an alpha- and beta-blocker is very effective when psychological factors are contributory; this combination is sometimes remarkably effective, yet is not widely prescribed.

In this blog I hope to convey some of the ways we can better cope with hypertension, and usually without increasing drug costs. I will discuss new and old drugs, the good ones and the bad ones. I will write about new developments in hypertension treatment, as well as about the drugs, given their central role in lowering blood pressure in so many millions, and their documented effectiveness in preventing strokes and heart attacks. I hope this blog will be informative and helpful.

For more by Samuel J. Mann, M.D., click here.

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