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THE TREATMENT OF HIGH BLOOD PRESSURE: LONG-RANGE DRUG THERAPY

A patient with high blood pressure is likely to ask the doctor how much his pressure has to go down before he can stop worrying, whether he can discontinue the medication once the pressure has been normalized, and whether he must take all the pills his doctor has prescribed.

The objective in the treatment of hypertension is to bring down the pressure—particularly the diastolic reading—to a level appropriate to the patient's age. Those patients who present problems usually show arteriosclerotic damage in one or more of the arteries leading to the vital organs. Bringing down the pressure too abruptly can interfere with the flow of blood to the brain, resulting in vertigo and dizziness, or interfere with the flow of blood to the kidneys. But most patients respond well to the lowering of the pressure if it is done gradually and carefully over a period of weeks rather than days. In serious cases with major arteriosclerotic complications— where the blood pressure cannot be brought down to the level appropriate to the patient's age it can usually be brought to somewhat less dangerous ranges. Hypertension that does not respond to treatment at all is extremely rare, a fact all those who suffer from the disease should find very reassuring.

Concerning the question of how long treatment must continue, the answer is: forever. Secondary hypertension which can be cured through surgery is rare. In all other treatment types of hypertension medication can only eliminate the symptoms; it cannot cure its underlying cause. The body apparently is not able to learn how to correct the chronic disturbance of the regulatory mechanism. The blood pressure cannot return to normal levels without outside help. Every interruption of the treatment therefore means an almost immediate rise in blood pressure. Medication becomes a lifelong companion in the maintenance of normal or tolerable pressure levels, like insulin in the case of diabetes or eyeglasses for people with poor vision. After all, taking pills regularly does not seem too high a price for the chance to lead an almost normal life.

The type and quantity of drugs prescribed in the treatment of hypertension vary from patient to patient. If the blood pressure is only moderately high the doctor may prescribe only a single drug, while in cases of serious hypertension he may prescribe a combination of drugs. These patients usually question both the number of pills they are told to take and the possible harmful side effects. The answer is that the prescription of two or more drugs serves a useful purpose. The drugs used in hypertension have to be "strong" to be effective, and in the long run such strong drugs may have undersirable side effects. If one would treat a severe case of hypertension with one single drug, one would by necessity have to increase its dosage. This could conceivably lead to a higher risk of side effects. However this can be avoided by utilizing a combination therapy regime. Several antihypertensive drugs may be used simultaneously, all with different modes of action and, therefore, with different side effects.

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