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Hypertension is a condition that for the most part, has no ongoing symptoms except in the rare emergency situation. It takes years to develop heart, kidney, eye and circulatory problems. Controlling hypertension is an intervention that produces the greatest reduction in stroke and heart attack risk. The only other intervention with greater impact on your risk factors is to quit smoking.
It usually takes about six months of repeated measurements and observing trends to make the diagnosis. After hypertension is diagnosed, we usually begin by looking at and trying to modify risk factors.
I challenge patients to start simple by adding a brief activity to their day such as parking further, climbing stairs, or doing a brisk reconnaissance loop of the supermarket before you start shopping. At some point, I might consider advising patients to commence the use of medication. Starting blood pressure medication is difficult to do and maintain since there is no obvious gains readily seen by the patient.
The goal of treatment is to lower the resting systolic-diastolic pressures to below 140-90, or more ideally, below 130-75. The only trouble is that patients don't feel much different when we do. Sometimes they even experience unwanted effects. The prevention and decrease of risk is a difficult concept to accept, and for that reason leads to non-compliance.
Blood pressure changes with the needs of the body. When we refer to blood pressure, we assume the measurement is made at rest in a relaxed atmosphere. Most patients refuse to apply that definition to my exam room, particularly with latex gloves, scales and pap slides lying about.
Starting medication is a difficult choice. At last count, there are over 200 different brand names and variations of blood pressure formulations available. This fact alone points to the conclusion, first of all, that no ideal agent has been discovered yet, and secondly, relying solely on medication without addressing other modifiable risk factors is foolish.
The answer to the question seems to be that for some people, medication can be withdrawn when they successfully change lifestyle factors. Drinking less alcohol, exercising regularly, attaining an ideal weight, quitting smoking, decreasing salt intake, controlling blood sugar and cholesterol can all combine to eliminate the need for medications.
Your doctor may try a short period of careful monitoring while temporarily suspending a medication. I would strongly dissuade anyone from attempting discontinuation of medication without appropriate medical advice.
I would like to congratulate all 9000 people who took part in the Heart and Stroke Ride on Sunday despite the inclement weather, and all those who took the time to sponsor a rider. Together, we make a significant impact on disease.
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