Hypertension, an abnormally high blood pressure, is often called the silent killer. As increased pressure causes wear and tear on organs, in many patients, there is no outward sign or symptom. The end can come quickly with a sudden stroke or heart attack. Conversely, the end may be more gradual from complications of kidney failure. Good treatment is important.

Regarding treatment, it is important to focus on how long a drug dosage will last. As it turns out, the best medicines are long-acting drugs. Unfortunately, not all medications measure up.

The goal for treatment is to keep blood pressure below 140/90 in patients with no risk factors, or below 130/80 for patients with diabetes and/or kidney disease.

The medical literature now refers to patients with a systolic blood pressure (the top number) between 120 to 139 or a diastolic blood pressure (the bottom number) between 80 to 89 as being pre-hypertensive and deserving of early intervention.

There is no doubt that lower is better. The question becomes, “What is the best therapy?”

While certain classes of drugs have become very popular (the ARBs, ACE inhibitors, beta-blockers, diuretics and calcium channel blockers) not all members of each class last for long periods.

There is a rule of thumb ??” drugs that act quickly wear off quickly. Conversely, drugs that take a long time to act last a long time. While many factors control drug activity, the main influence is the time it takes to clear a medication from the body.

Years ago, many medications controlled blood pressure for only six to eight hours. Toward the end of this time, another dose of the medication was needed.

This would leave a patient with gaps of time during which blood pressure would spike, especially if a dose was missed.

There is an increased risk for heart attack or stroke when blood pressure spikes. An example is the increased incidence of heart attack at 5 or 6 a.m. It is well known that the body produces a surge of adrenaline at about 5 a.m. in most people to awaken them for their day. Adrenaline, also known as epinephrine, increases blood pressure, heart rate and stress on the heart.

Fortunately, the pharmaceutical industry has developed medications that last 24 hours or longer. This allows hypertensive patients to use combinations of medications which provide even blood pressure control, usually with no more than twice-a-day dosing.

In order to prove such control to your satisfaction and your doctor’s, home blood pressure records are critical. I always ask patients to take blood pressures primarily in the mornings and to record them in a log. This can be taken to the doctor for perusal at checkup time and is a wonderful help when altering your medical regimen. I do not recommend the purchase and use of wrist blood pressure cuffs, which I often have found correlate poorly with cuffs used in the clinic setting.

Modern home blood pressure cuffs, for use on the arm, are cheap, automated and have a memory backup.

Remember that blood pressure control needs to be uniform, even and adequate over a 24-hour period. Medications should be prescribed to achieve this control while preventing dangerous spikes of hypertension. It is thought that reductions in heart attack and stroke rates over the years is directly attributable, in part, to better blood pressure regulation.

Visiting your doctor for regular checkups, taking medications as prescribed and monitoring your blood pressure at home can help you maintain your cardiovascular health.
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Dan Gold is a board-certified family physician who treats U.S. military veterans in Great Falls. E-mail him at

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