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A Matter of Pressure

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

A similar article appeared on page 19 in the February 7-8, 2004 issue of
The Mississauga News under the feature: Health & Wellness, Doctor's Corner.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

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 is to quit smoking.

When I diagnose hypertension in someone, I usually begin by looking at and trying to modify their risk factors. At some point, I might consider advising them to begin using 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. Trouble is that you don't feel much different when we do, and sometimes even experience unwanted effects. Prevention and decrease of risk is a difficult concept to accept, and this 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 that no ideal agent has yet been discovered, 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The answer to the question seems to be that for some people, medication can be withdrawn when they successfully change lifestyle factors.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 for a short period to carefully monitor your condition while temporarily suspend a medication. I would strongly dissuade anyone from attempting discontinuation of their medication without appropriate medical advice.

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