FEB 03 -
Even with a plethora of drugs available to normalise blood pressure
today, there are still many at increased risk of disease, disability and
premature death
Since the start of the 21st century, people all around the world have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease. But even with a plethora of drugs available to normalise blood pressure, there are still many at increased risk of disease, disability and premature death. Hypertension experts offer a few common, and correctable, reasons:
—Many affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.
—Of the rest who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.
—Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.
—Many others do little to change lifestyle factors, like obesity, lack of exercise and a high-salt diet.
Dr Samuel J Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of those with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages. Mann, author of Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure, says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.
Plus, he adds, it can be done with minimal side effects and at a reasonable cost. “For most people, no new drugs need to be developed,” Mann says. “What we need, in terms of medication, is already out there. We just need to use it better.” The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for the hypertension—salt-sensitive hypertension , hypertension driven by the kidney hormone rennin, or neurogenic hypertension.
According to Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he says.
One of Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Mann’s help.
After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, and she no longer feared she would die young of a heart attack or stroke.
But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Mann says. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.
Specialists, he says, are most useful for patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs and for those whose treatment is effective but causing distressing side effects. Hypertension often fails to respond to routine care, he notes, because it results from an underlying medical problem that needs to be addressed.
“Some patients are on a lot of blood pressure drugs—four or five—who probably don’t need so many, and if they do, the question is why,” Mann says.
Since the start of the 21st century, people all around the world have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease. But even with a plethora of drugs available to normalise blood pressure, there are still many at increased risk of disease, disability and premature death. Hypertension experts offer a few common, and correctable, reasons:
—Many affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.
—Of the rest who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.
—Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.
—Many others do little to change lifestyle factors, like obesity, lack of exercise and a high-salt diet.
Dr Samuel J Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of those with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages. Mann, author of Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure, says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.
Plus, he adds, it can be done with minimal side effects and at a reasonable cost. “For most people, no new drugs need to be developed,” Mann says. “What we need, in terms of medication, is already out there. We just need to use it better.” The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for the hypertension—salt-sensitive hypertension , hypertension driven by the kidney hormone rennin, or neurogenic hypertension.
According to Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he says.
One of Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Mann’s help.
After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, and she no longer feared she would die young of a heart attack or stroke.
But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Mann says. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.
Specialists, he says, are most useful for patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs and for those whose treatment is effective but causing distressing side effects. Hypertension often fails to respond to routine care, he notes, because it results from an underlying medical problem that needs to be addressed.
“Some patients are on a lot of blood pressure drugs—four or five—who probably don’t need so many, and if they do, the question is why,” Mann says.
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