It is not that high blood pressure is especially difficult to control. Today's doctors can prescribe a wide range of good, affordable drugs that will lower your blood pressure and help you live a longer, healthier life. The problem is many of them simply don't.
As recently as the end of World War II, there was wide disagreement about whether it was a good idea to attempt to lower a person's blood pressure. Some experts argued that raising blood pressure was the body's way of handling various circulatory problems. They thought that treatment might even be dangerous.
Unfortunately, the vast majority of Americans with the condition continue to go untreated. Possibly because many doctors do not take hypertension seriously as a health threat, this is true even for those who are diagnosed.
Medical thinking began to change when one scientific study after another established a clear association among heart disease, stroke, kidney disease and hypertension. The question that remained was whether hypertension was a cause, an effect or merely a condition associated with these health problems. In the 1960s, several large studies settled the question -- hypertension by itself shortens life.
Today we can diagnose and treat hypertension fairly easily. Unfortunately, the vast majority of Americans with the condition continue to go untreated. Possibly because many doctors do not take hypertension seriously as a health threat, this is true even for those who are diagnosed.
Under this definition, more than 50 million people in the U.S., or nearly one in four adults, are afflicted with hypertension. And as the large Baby Boom generation ages, these numbers will only get worse. That is because, as we get older, we become more and more susceptible to high blood pressure. 44% of Americans, aged 50 to 59, and 67% of those older than 70 years are hypertensive.
Part of the problem is skepticism about the seriousness of hypertension. This attitude is understandable because not everything about the relationship between health and high blood pressure is understood. Skeptics often cite the "French "Paradox" -- cardiovascular mortality is exceptionally low in France despite the fact that the French diet is quite high in animal fats and alcohol, and that French doctors do very little to treat hypertension.
These studies have consistently shown that blood pressure can be reduced in large groups of people and that when this is done, for example, the chance of getting a heart attack or dying from one fall dramatically.
There is much evidence from around the world, however, that hypertension has serious health consequences -- at least for the non-French -- and that modern antihypertension drugs work, both to lower hypertension and to prolong life. These studies have consistently shown that blood pressure can be reduced in large groups of people and that when this is done, for example, the chance of getting a heart attack or dying from one fall dramatically. In light of what we now know from these studies, there is no excuse for the fact that many doctors simply do not focus on treating their hypertensive patients.
Antihypertensive drugs range from so-called angiotensin converting enzyme inhibitors (ACE inhibitors) to calcium antagonists, angiotensin II receptor blockers (ARBs), beta blockers and low-dose diuretics, alone or in combination. Because they are easy on the heart and the kidneys, ACE inhibitors are a good place to start. For patients who respond slowly to these drugs or who experience bad side effects, the best second choice is a calcium blocker in sustained release form.
Whether to move on to beta blockers and/or diuretics is an individual decision that should be made together with your own doctor. The same goes for the issue of trying to lose weight or reduce the amount of sodium in your diet, which are helpful for some people.