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Hypertension 101 Maybe you're picking up this book because you've just been told you have high blood pressure and you're looking for some answers. Or maybe you were diagnosed a long time ago and you're just tired of taking all that medication. Or perhaps traditional medicine has failed to keep your blood pressure under control, and you're searching for a new approach. Well, my friend, whatever your reason for opening this book, I'm just glad you're here. High blood pressure is something you need to know about, and something you need to take seriously. I hope this book informs you and provides you with some new options. I've learned a lot about treating hypertension these last thirty years, and I've found some really novel approaches that have turned my patients' lives around, so I think I can help. It's hard to overstate the impact of high blood pressure on our health, but let's just start with the cold, hard facts: Fifty million Americans (one out of five) have high blood pressure. Hypertension is more common in men and in folks over sixty-five years of age. More than half of people over sixty-five are hypertensive. High blood pressure is more common in African Americans than in white Americans. Hypertension is serious because it places you at increased risk for blindness, kidney damage, heart disease, an enlarged heart, heart attack, and stroke. We spend more than $3 billion on antihypertensive prescription drugs, more than for medications for any other diagnosis. According to the National Heart, Lung, and Blood Institute, 26 percent of people on medication for hypertension still have unacceptably high blood pressure. Despite new drugs and diagnostic techniques, the death rate from hypertension has risen 36 percent in the past decade. Clearly, traditional drug and diet therapies for hypertension are falling far short of their intended goals. I believe that part of the problem is that, as physicians, we're taught to refer to the step-by-step process of a one-size-fits-all algorithm in designing a program of care for our hypertensive patients. What's an algorithm? Basically, it's a step-by-step protocol to be followed. In treating hypertension, the algorithm goes something like this: Step one is that we are to prescribe drug A. After a month or so, if treatment A doesn't work, then we are to prescribe drug B. If B worked somewhat but we didn't get the results we were seeking, then we add in drug C, possibly juggling the dose of A or B. A typical algorithm doctors follow for treating blood pressure includes the following: a diuretic first, followed by a beta blocker or calcium channel blocker, then an ACE inhibitor or angiotensin receptor blocker (ARB). This is a very structured, precise system . . . but that's just not how the human body functions. Now don't get me wrong. There is an appropriate place for algorithms. They work best in an emergency situation such as a hypertensive crisis or a heart attack, when time is critical and the physician may have just met the patient and knows little about him or her. Algorithms establish the standard of care that you receive, and that's a good thing. But once the crisis is over, you want to receive a more personalized treatment plan that takes into consideration your personal needs and your own physiology. Each of us is an individual, with a unique body chemistry and physiology. An algorithm can only work so far, for I have found that blood pressure control is really more of an art than a science. As a cardiologist, I need to tune in to each individual to design a hypertension reduction program that gets atSinatra, Stephen T. is the author of 'Lower Your Blood Pressure in Eight Weeks A Revolutionary New Program for a Longer, Healthier Life', published 2003 under ISBN 9780345448071 and ISBN 0345448073.
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