Get Serious About High Blood Pressure!

Hypertension is boring. Although roughly one in three adults has high blood pressure, most people don't get very excited about it.

But they should. A new report from the prestigious Institute of Medicine (IOM) says that hypertension is one of the nation's leading causes of death. This organization of the country's leading health experts is tasked with making unbiased policy recommendations to improve the health of Americans.

The problem is that doctors and patients don't take elevated blood pressure seriously enough. Many doctors don't tell their patients that their blood pressure is too high and may not coach them on lifestyle changes that can lower blood pressure.

Doctors tell people to lose weight, exercise more and cut back on salt. But these general recommendations don't actually help many people implement such a program.

That's why many physicians rely on medication as their first line of defense. Drugs such as diuretics (like HCTZ/hydrochlorothiazide), beta blockers (including atenolol and metoprolol) and ACE inhibitors (such as lisinopril) are prescribed frequently.

These drugs can help lower blood pressure, but they have potential complications. Diuretics may deplete the body of minerals such as potassium and magnesium. Low levels of these electrolytes can upset heart rhythms. Diuretics can also raise blood sugar levels.

Beta blockers such as atenolol are controversial for treating hypertension. Experts have determined that such drugs should rarely be used as first-line therapy (Annals of Pharmacotherapy, Dec. 2009).

This older type of beta blocker may raise cholesterol and also make blood sugar harder to control (Current Medical Research and Opinion, March, 2010). Some data even suggest that atenolol is linked to an increased risk of stroke. Nevertheless, more than 40 million prescriptions were filled for atenolol last year.

ACE inhibitors like benazepril, enalapril, lisinopril and ramipril are unquestionably effective for controlling hypertension. If patients don't experience side effects, these medications are extremely beneficial. But a significant number of people develop a chronic cough while taking an ACE inhibitor. Such drugs may also cause dizziness or headache.

It should come as no surprise that patients are interested in natural approaches to blood pressure control. If physicians knew how effective diet and exercise could be, they might be more encouraging.

A recent study demonstrated dramatic results from combining the DASH diet (Dietary Approaches to Stop Hypertension) with weight management and exercise (Archives of Internal Medicine, Jan. 25, 2010). Reducing systolic blood pressure by 16 points was better than one would expect from most drugs.