Who Cares? Another Drug To Treat Hypertension


BFP Magazine



Cardio-vascular Health

Healthy Rubber, Blood Vessels

Who Cares? Another Drug To Treat Hypertension

By Dr. W. Gifford Jones

May 15, 1999

What's the first essential to a long and healthy life? If I had to pick one I'd choose healthy arteries, or what Sir William Osler called, "healthy rubber".

Osler, a wise old owl, had great credentials. During his lifetime he was Professor of Medicine at McGill, John Hopkins and Oxford Universities. And Osler learned that lucky people who inherited "healthy rubber", didn't get hypertension.

But today millions of North Americans have hardened, atherosclerotic blood vessels. This condition triggers hypertension. The resulting increased pressure injures both heart and kidneys.

Unfortunately, we're not talking about a disease that is a minor killer. Hypertension is the third leading cause of death in the world after malnutrition and smoking. Breast cancer, tuberculosis, malaria and AIDS all rank lower as causes of death.

The good news is that numerous research studies have shown that treatment of hypertension can decrease death and sickness associated with high blood pressure.

But a great irony surrounds hypertension. High blood pressure is one of the easiest diseases to diagnose. All doctors need is a blood pressure cuff. So if it's such a killer why isn't it being diagnosed early and treated sooner?

The problem is that you can't treat a disease unless you know you have it. And hypertension is a silent killer. It's estimated that 50 percent of people with hypertension are unaware of its presence.

This results in a major roadblock. If you don't have a headache it's hard for anyone to convince you to take an Aspirin. It's even more difficult to persuade a patient who doesn't feel ill to take blood pressure medication for months or years. Many react to the old adage that advises, "if it ain't broke, don't fix it."

Today's negative talk about the side©effects of drugs doesn't help. People worry, sometimes justifiably, about what else drugs are doing to you.

This anxiety about drugs isn't helped by pharmacy handouts to patients. They are a mixed blessing. I agree that it's good to have informed patients. After all, if that 's not the case I should pack up my tent and steal away silently into the night. Ô 0*0*0* But pharmacy literature often outlines for patients every conceivable problem that may happen. This list, sometimes as long as your arm, certainly scares some of my patients. So it's small wonder that some patients are reluctant to take some medications.

Blood pressure medication poses another problem. Drugs available to treat hypertension have not been easy to take.

Diuretics (water pills) stimulate kidneys so patients are always worrying about the location of the next washroom.

Beta blockers, another type of medication, often cause a decrease in sexual drive, changes in sleep pattern and the ability to concentrate. And patients taking calcium channel blockers suffer from flushing and swelling. And some of these drugs must be taken several times a day.

Several studies reveal that only 14 percent of patients on these drugs continue them after one year.

But now a new group of drugs, such as "Avapro", is available to treat hypertension. They're called angiotensin II receptor blockers or what's known as "ARB's" for short.

Avapro and other ARB's effectively lower blood pressure without the side©effects associated with other medications. They don't induce as much cough or peripheral swelling. And the incidence of dizziness and fatigue is almost nonexistent.

As well, these drugs are once©a©day medications. So it's easier to remember taking and they're more convenient. Moreover the blood pressure lowering effect of Avapro is not decreased because of food in the stomach. This is an important point as most people prefer taking medication at mealtimes.

How do ARB's work? Everyone has a hormone in the body called angiotensin II, which regulates blood pressure. This hormone can make blood vessels constrict, and therefore plays an important role in blood pressure control. In patients with high blood pressure ARB's block the effects of angiotensin II, thereby causing blood vessels to dilate and reducing blood pressure.

Studies show that Avapro is well tolerated by the elderly. Since it's primarily excreted by the liver it can be given to patients with low kidney function.

My advice is to be sure you have "healthy rubber". There's one easy way. Get your pressure checked by your doctor. Life is full of risks so there's no sense in dying from a risk you can prevent.


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He's been a ship's surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: www.mydoctor.ca/gifford-jones. He can be reached at bfp@bogotafreeplanet.com

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