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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

    High blood pressure can't always be completely controlled with a healthy lifestyle. And some people, especially those with additional complications, such as diabetes and kidney disease, urgently need to lower blood pressure to safe levels. That's where medication comes in.

    There's a long list of drugs that are commonly used to lower blood pressure and help prevent heart attack and stroke, including ACE inhibitors, beta-blockers, calcium channel blockers, and diuretics. Recently, they've been joined by the latest, and possibly most exciting, class of hypertension drugs: angiotensin receptor blockers, or ARBs. In early December, an international trial comparing blood pressure-lowering treatments was stopped early when patients taking an ARB combined with a calcium channel blocker showed significant cardiovascular benefits (such as reduced rates of heart attack and stroke) compared with those taking an older combination of a beta-blocker and a diuretic.

    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."

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