Just come across this thread, I am a family doctor working in the UK National Health Service and with an interest in hypertension. My word, by international standards, you guys are overtreated. Treat people with a systolic over 135? not in the rest of the world. There is no absolute criteria, that varies with age and general health. At my age 60, slim, fit with no concurrent illnesses, I started treatment at 150/95, with a target of 135/85. Clinical trial evidence for treating lower than this is limited and side effects, particularly postural dizziness, start to rise exponentially.
I would agree that non drug treatments are first choice, more exercise, a natural diet with reduced salt in particular and weight loss are vital. In my 30 years experience, 7 to 10lbs weight loss will make a real difference to blood pressure.
Current accepted guidelines for treatment under 60 are diuretics such as HCT and ACE inhibitors like lisinopril, which I am on. Sorry guys, but ARB's, angiotensin reuptake blockers are not better, they avoid the dry cough suffered by 5 to 20% of ACE users, depending on the brand. That is the reason to use them. ACE inhibitors have been around longer and evidence for protecting end organs, particularly the kidneys, in diabetics, is stronger.
Over 60 I tend to use diuretics + calcium channel blockers like amlodipine, both are better at reducing systolic blood pressure which tends to be a problem in the older patient. Almost nowone uses Beta blockers first line, because of side effects and recent evidence that they fail to stop cardiovascular endpoints, a euphemism for strokes and heart attacks.
The National Health service may be Socialist medicine, but it is evidence based, protocol driven and audited. All English family doctors are computerised and anonymous data for how I treat patients is downloaded and I have to be able to justify it.
Sorry for the lecture, which I am sure you audiogon MDs will not agree with.
I would agree that non drug treatments are first choice, more exercise, a natural diet with reduced salt in particular and weight loss are vital. In my 30 years experience, 7 to 10lbs weight loss will make a real difference to blood pressure.
Current accepted guidelines for treatment under 60 are diuretics such as HCT and ACE inhibitors like lisinopril, which I am on. Sorry guys, but ARB's, angiotensin reuptake blockers are not better, they avoid the dry cough suffered by 5 to 20% of ACE users, depending on the brand. That is the reason to use them. ACE inhibitors have been around longer and evidence for protecting end organs, particularly the kidneys, in diabetics, is stronger.
Over 60 I tend to use diuretics + calcium channel blockers like amlodipine, both are better at reducing systolic blood pressure which tends to be a problem in the older patient. Almost nowone uses Beta blockers first line, because of side effects and recent evidence that they fail to stop cardiovascular endpoints, a euphemism for strokes and heart attacks.
The National Health service may be Socialist medicine, but it is evidence based, protocol driven and audited. All English family doctors are computerised and anonymous data for how I treat patients is downloaded and I have to be able to justify it.
Sorry for the lecture, which I am sure you audiogon MDs will not agree with.