High Blood Pressure Controversy: Wading Through the Muck

Finally, doctors don't really know if it matters how we lower blood pressure. It remains controversial if use of one class of blood pressure lowering drugs prevents heart attack and stroke more effectively than another. In other words is it how low you go or how you go low? We often hear that certain patient groups (for example the elderly or African-Americans) respond better to one class of anti-hypertensive agents than another. Is this real or marketing hype?

It's very confusing. Fortunately many of these controversies are being evaluated in large ongoing clinical trials and we'll be getting some answers in the next few years. In the meantime what can concerned patients do?

First and foremost is to know your blood pressure, preferably your blood pressure at home or at least away from the doctor's office. Second is to realize that like most vascular diseases, hypertension is a lifestyle disease and that one can impact their blood pressure by simply living well. Every pound you lose generally lowers your blood pressure by a millimeter. Following a so-called Mediterranean diet will lower your blood pressure. Regular exercise lowers your blood pressure. Limiting salt intake for most patients is a cornerstone of blood pressure management. Dietary calcium, potassium and magnesium intake affects blood pressure. A flurry of recent studies suggest that vitamin D deficiency is an important cause of not only hypertension but also other vascular diseases.

Blood pressure is one of several risk factors for heart attack and stroke and every patient with high blood pressure should know their cholesterol and blood sugar and manage it while they manage their hypertension. This concept is called global risk reduction. Finally, you need to work with a doctor knowledgeable in blood pressure management willing to work with you to help achieve your goals. It takes some effort but it's a very treatable disease.

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