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High Blood Pressure: The Invisible Health Risk

It has no symptoms, but kills 50,000 Americans a year.

Medical Treatment Options for High Blood Pressure continued...

Patients with diabetes, kidney disease, and some types of heart disease also appear to get greater cardiovascular protection from ACE inhibitors and ARBs than from other blood pressure-lowering drugs. "In individuals at high risk of heart attack and stroke, we've seen that these particular drugs provide additional protection," says Saunders. The National Kidney Foundation and the American Diabetes Association both now recommend either an ARB or an ACE inhibitor as the initial treatment of choice to reduce blood pressure for people with diabetes, kidney disease, or both.

As often happens with the latest and greatest drugs, ARBs are more expensive than ACE inhibitors, which have been around longer. But they have one advantage: Nearly 5% to 10% of patients taking ACE inhibitors will develop a cough. Since ARBs don't stimulate the chemicals in the body that's likely to cause the cough, your chance of that side effect is minimal. If you can't tolerate an ACE inhibitor for that reason, your doctor may recommend switching to an ARB.

Doctors have also learned that starting combination therapies early in treatment for hypertension is often the best approach. "Up until recently, we were teaching doctors to try one drug and then add on another, but studies have found that two-thirds of hypertensive patients require two drugs to get their blood pressure to go down," says Saunders. "So now, the recommendation is to consider using two drugs from the start."

The combination can include any two drugs that are compatible and that operate on different mechanisms; the most common combination would be an ACE inhibitor or an ARB with a diuretic, which helps the other drug to work more effectively.

But some combinations may pose a problem. Recent research from the large Women's Health Initiative study showed that diuretics combined with calcium channel blockers appeared to double the risk of heart attack in older women. Scientists caution that there are significant limitations to this study, and that more research is needed. In the meantime, be sure to ask your doctor what the best combination is for you.

What's Next in Treating High Blood Pressure?

Researchers are now studying different classes of drugs that might help reduce high blood pressure. "Blood pressure has multiple mechanisms, and most drugs that aim to reduce it either concentrate on dilating the blood vessels or on blocking salt and water retention," says Saunders. "Basic scientists are now experimenting with new compounds that target other elements of the cardiovascular system to help reduce blood pressure."

Many of these potential new targets, Saunders says, involve hormones -- not sex hormones like estrogen or testosterone, but hormones like renin and angiotensin, which play a role in helping to control blood pressure. "Scientists are looking at whether drugs that block these hormones will help to control the blood-regulating mechanisms that affect blood pressure," he says.

There are many health risk factors in your life that you can't control, but hypertension isn't one of them. With a combination of a healthy lifestyle and medication when needed, you can keep your blood pressure numbers in the safe zone and your cardiovascular system healthy.


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