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An Overview of Hypertension and You

Many of the nearly 70 million Americans with hypertension (high blood pressure) would like to bring it under control through lifestyle changes such as losing weight, cutting back on salt, exercising, or reducing stress. But like it or not, most will require medication to get their blood pressure under control. The good news is that we have many excellent blood pressure medications, which, when prescribed wisely, can control hypertension in almost everyone. The bad news is that doctors are placing millions of people who have hypertension on medications, drug combinations, or doses that are wrong for them despite good intentions. The consequences: millions with hypertension that is not under control, millions suffering from side effects, most of which are avoidable, and health consequences including avoidable heart attacks, strokes, and lost productivity due to side effects. Since blood pressure medication currently governs how tens of millions feel, how well their blood pressure is controlled, and how long they will live, this is not a small problem.

Hypertension and You by Dr. Samuel Mann

Sadly, it is not just a few doctors who frequently prescribe blood pressure medication incorrectly. It is many doctors, who, although well-intentioned, don’t have the intimate knowledge of blood pressure medications needed to prescribe them optimally. These include not only general practitioners and internists but also most nephrologists and cardiologists.

Many are not knowledgeable enough about the drugs and are considerably influenced by pharmaceutical industry promotion of the newest, most expensive drugs, while excellent older drugs are widely overlooked. Worse, some of the newer medications are not the best options.

The management of hypertension is nowhere near as good as it could be. As a hypertension specialist, I see new patients week after week who don’t feel well on their medication, or whose blood pressure is uncontrolled even though they are taking two or three or even more drugs. I am certain that with today’s medications, hypertension can be controlled in almost everyone, and that very few need to tolerate the side effects that are currently affecting so many. I know we can do much better while reducing, rather than increasing, medication costs.

Here are a few typical cases that illustrate the importance of getting the medication right:

  • John, 54, was taking six blood pressure medications, yet his blood pressure was still 160/120. One of his medications was Coreg, a new, aggressively marketed alpha/beta-blocker. Few doctors know that Coreg won’t work in many patients because it is rapidly inactivated in the liver. When I replaced the Coreg with an older beta-blocker, betaxolol, and an alpha-blocker, doxazosin, his blood pressure promptly fell. I was able to eliminate three of his drugs.
  • Tom, 46, was taking four drugs for his hypertension, yet his blood pressure was still uncontrolled. He had a high salt intake. Increasing his diuretic to double the usual dose resulted in very normal blood pressure with no side effects. He now requires only two medications.
  • Mary, 81, whose blood pressure was perfectly controlled on Verapamil, a calcium channel blocker, did not have the energy she used to have. She attributed it to age. Switching her to a diuretic rejuvenated her.
  • Harry, 75, was taking Toprol, the most widely-prescribed beta-blocker, for his hypertension. He was seeing a neurologist because of memory impairment. After I substituted an older beta-blocker, his memory problem improved dramatically.

You can see how the wrong treatment can yield bad results while getting the medication right offers dramatic benefits. The good news is that fixing the problem doesn’t require costly adjustments or testing. Often, all we need to do is tweak what’s prescribed. Unfortunately for millions of people, that tweaking never happens.

Hypertension and You is the first book to make the case that something is terribly wrong with how doctors prescribe drugs for this condition (many patients suspect this, but don’t know enough to be sure). It shows readers – and through them, their doctors – better ways to use the medications and achieve better results.

Many books do discuss blood pressure medications, providing standard information on the drug classes, dosage range, list of side effects, etc. They recommend the usual menu of drugs, but they fail to communicate that there are problems with how the medications are prescribed. They don’t convey that different people do better with different drugs. They don’t teach readers about the wonderful, but old and forgotten, drugs that can control their hypertension without side effects and at a lower cost than the newest drugs. They don’t reveal which of the widely prescribed new drugs are good, and which are not.

Hypertension and You clarifies which are the good drugs, which are the bad ones, and why.
woman having her blood pressure checked

This Book:

  • Names the biggest offenders in terms of side effects and presents drugs to consider instead of them.
  • Describes the shortcomings of some of the new drugs, while also introducing readers to some excellent old drugs that are woefully underused because of the publicity blitz surrounding the new, expensive drugs
  • Emphasizes the importance of matching the medication and dosage to the individual
  • Explains the clues that can tell us who should be on which drug (even an excellent drug can be the wrong one if it is given to the wrong person or in the wrong dose)

The book will provide many ideas and approaches that will be new to readers and to most doctors, and which no other book has offered. Readers can discuss these approaches with their doctor and make changes right away that can help lower their blood pressure, reduce or eliminate side effects, and more often than not, reduce medication costs.

The recommendations, many of which are unique to this book, can, without question, alter the treatment of hypertension and improve the quality of life for many readers. I clearly identify problems and solutions in the book. Here are a few examples:

  • The most common physician error responsible for uncontrolled hypertension is the failure to use a diuretic, or a diuretic regimen that is strong enough, for those who need it. This error alone is responsible for millions of people having uncontrolled hypertension and ending up on many more drugs than they would otherwise need. On the other hand, in the wrong person, a high dose is harmful. I will describe the clues that can tell us who needs a high dose and who should avoid one. I also present strategies that minimize the risk of adverse effects when prescribing the higher dosage.
  • Doctors pay little attention to how much salt their patients ingest. The book explains how the diuretic dose can and should be adjusted according to a person’s usual salt intake. It also offers a novel and valuable strategy that I regularly recommend to patients, one that makes sense yet is not found in any previous book or in medical literature. I call it the “variable-dose diuretic.” I advise patients to take a higher dose when they are eating more salt than usual (e.g., while traveling or frequently eating out) and a lower dose when eating a lower salt diet at home. This solves the problems of side effects from a high daily dose and inadequate control from a low daily dose.
  • Beta-blockers are making so many millions of people tired that it is frankly scandalous. And the sad thing about it is that most people given a beta-blocker for their hypertension don’t really need to be on one. The book clarifies who needs a beta-blocker, who doesn’t, and which beta-blockers are the worst culprits when it comes to fatigue.

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