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It's a prescription that can work. The NHLBI promotes an eating plan called the DASH diet (for dietary approaches to stopping hypertension), with menus low in fats, salt, cholesterol, red meat and sweets and high in fruits, vegetables, grains, fish, poultry, nuts and low-fat dairy foods. Alcohol consumption should be limited, with men having two drinks or fewer a day and women--or men with small body mass--just one. In the very short term, alcohol may lower blood pressure; over time, however, it elevates it. Exercise is important, with aerobic activity--as little as 30 minutes of brisk walking--recommended for three or four days a week. Even though pressure briefly rises when you exercise, the workouts cause the heart and other muscles to become more efficient and require less oxygen. This reduces cardiovascular demands and lowers overall pressure.
For many people, lifestyle changes aren't enough. In such cases, drugs are the answer. There are five classes of blood-pressure medication, each of which works on a different link in the hypertension chain. Diuretics, which cause the body to excrete water and lower the load in the vessels, are the workhorse drugs with the longest history and the most direct effect. Diuretics work best in older patients, since younger metabolisms sense the change in fluid volume and react by activating the renin-angiotensin system to constrict vessels and boost pressure, negating the effects of the drugs.
The other categories of medications include beta-blockers, which moderate heart rate and the angiotensin system; calcium-channel blockers, which obstruct the tiny ducts in cells through which calcium ions must pass to constrict blood vessels; ACE inhibitors, which reduce the production of angiotensin and thus reduce constriction; and angiotensin-receptor blockers, which allow the protein to be produced but prevent some of it from being taken up by the cells. All four of these have the same goal--to unclench the tensed circulatory system--and they are often prescribed in combination.
If the drugs are going to work, patients must actually take them, and doctors find it maddeningly hard to ensure that they do. Many of the medications can have mild side effects, including fatigue, dry cough, and occasional erectile difficulties in men--not surprising, since you're manipulating the body's circulatory hydraulics. When people face a disease that causes no symptoms and a treatment that does, it's no surprise which one they sometimes choose. "You prescribe medication," says Weber, "and within a year, 50% of people quit taking it."
That's an exceedingly bad idea, not only because the alternative to medication may be early death but also because side effects can be easily minimized or eliminated, particularly with so many drug combinations to try. And while most people need to continue taking hypertension medications for life, that doesn't mean the dose can't be lowered. Says Rush University's Bakris: "I tell patients that if they reduce their grocery bill they can also reduce their medication bill."