I was diagnosed with high blood pressure. Since then I have read everything I could find about the topic. Why is there no concrete answer as to the cause and cure? I read that there are over 100 different medications for this disease! Why? I feel that we are being experimented on. Help me understand this because it is causing grave anxiety for me.
High blood pressure is a major health problem in the industrialized world. You are correct that, in most cases, the cause is not known; but what we do know is that the pressure can be controlled by treatment, and that treatment reduces the complications of the disease. These complications include heart failure and arteriosclerosis, leading to heart attacks, strokes, and kidney failure.
Improved control of hypertension is thought to be a major factor in the decline in the rate of heart attack deaths over the past thirty years, and is a factor in the reduced rate of strokes as well. Despite this, only about half of the people with hypertension are being treated and only about a quarter have their pressure under control. Much death and disability could be prevented if we could get those figures higher.
The definition of hypertension has also changed over the years. When I was in medical school, a blood pressure of 160/85 in a 65-year-old person was not really considered hypertension, even though the cutoff for a younger person was 140/90, as it is today. We now realize that this systolic hypertension, that is having the first number higher than 140, is associated with increased mortality even in older people, and therefore deserves treatment.
Most hypertension is now thought to result from a complex interaction of genetic, environmental and demographic factors. I believe it’s unlikely that a single cause of the disease will ever be discovered. In a small percentage of cases, a cause can be found, usually in the kidneys or the adrenal glands, and these should certainly be sought and corrected if present. Most people with hypertension have a family history of the disease, many are overweight, and our national habit of eating too much salt also contributes.
I believe that most hypertensives, and certainly the doctors who treat them, are happy that there are so many effective treatments now available. The fact that there are over 100 drugs that can be used doesn’t mean to me that people are being experimented upon. It means that we have available different effective treatments to treat people with mild to severe hypertension, and to change their medications if one doesn’t work or they have a bad reaction to one. Everyone responds differently to treatments — what works for one person might not be effective for another. Therefore, your doctor will try a different medicine or combination before finding the right treatment with the least side effects. This is not experimentation — it is thoughtful medicine. Most hypertension, except the mildest cases, requires more than one drug for effective treatment: a diuretic to reduce the salt load in the body and a beta blocker to lower pressure are first-line treatments shown to work and to reduce mortality.
There are a number of things that people with hypertension can do to reduce their blood pressure without drugs. If overweight, even a modest weight loss of ten to fifteen pounds, will often bring the pressure down. Reducing alcohol intake if it is excessive will help. Exercise: at least thirty minutes of moderate intensity exercise three or more times per week will often reduce the pressure, and has many other benefits as well. Reducing salt and increasing potassium and calcium in the diet will benefit a hypertensive. Potassium can be safely increased by eating more fresh fruits and vegetables; and calcium can be raised by increasing low-fat dairy intake or by supplements, if dairy is not well-tolerated. People under 65 should shoot for an intake of at least 1000mg. of calcium per day, and those over 65 should be taking in 1500mg. per day. Increasing water intake is a natural way to increase the excretion of salt.
Stress management, caffeine restriction, magnesium supplements or eating garlic have not been shown to produce sustained reductions in blood pressure.
If these lifestyle changes do not bring the pressure under control, meaning below 140/90 and even lower for diabetics, then taking one of those hundred or so medications must be considered.
Because the positive benefits of controlling hypertension are so great, I hope that you will work closely with your doctor to bring your pressure under control, even if we don’t know what is causing it to be high — and even if a number of different medicines must be used.