The treatment of blood pressure almost needs a book on its own, because there are so many methods, and so many ways in which the doctor, patient and complementary therapist can join forces to help.

In a few cases, high blood pressure has a basic cause, and in these cases removing the underlying problem may bring the blood pressure down to normal. Underlying problems like this include obstruction of the arteries to the kidney; certain rare types of kidney disease; and various tumours (some benign, a few malignant) that secrete excess hormones which raise the blood pressure.

One of these hormone-producing tumours is called a phaechromocytoma and it’s a non-malignant growth of a type of tissue that normally forms part of the adrenal glands. It produces excess, uncontrolled quantities of adrenalin-like substances which can raise the blood pressure to very high levels. Finding and cutting out offending cells brings the blood pressure back to normal.

Other hormonal causes for raised blood pressure include tumours of the pituitary gland (a gland at the base of the brain) which secrete too much growth hormone and diabetes is associated with higher blood pressure. However, with the exception of diabetes, all these conditions are rare: most doctors are unlikely to meet even a single case in their whole lifetime.

Once we’ve eliminated these conditions, we’re left with what is called ‘essential’ hypertension, and this forms the majority of cases of high blood pressure. Many cases of essential hypertension are probably genetic, and at the moment there is very little that we can do to cure it. Just keep taking the tablets! On the other hand, there are many things that can make blood pressure worse, chief of which is being too fat. For every extra pound of fat you put on, your blood has to go through an extra mile of capillaries; the fatter you are the harder the heart has to work. Mild to moderate blood pressure frequently rises in those who are overweight, and often returns to normal if the patient goes on a diet and returns to normal size.

Exercise also helps, making the body more efficient in how it uses biochemical raw materials, and regular exercise reduces blood pressure in the long run.

Stress, too, is associated with blood pressure, though the relationship is far from precise. Undoubtedly, extra levels of stress put up the blood pressure over a short period of time; for example, frantically rushing to get to work on time puts up the blood, pressure transiently. Some people seem to get high blood pressure when stress is maintained for a long time, yet others don’t get a raised blood pressure in these situations.

There are many things that the orthodox practitioner can do to treat high blood pressure. These fall into four main sections: dealing with obesity; encouraging exercise; reducing stress; and, prescribing medicines.. However, we shouldn’t look at these four groups independently; they all interact one with the other. A little less stress, a few extra pounds off, a little more exercise and a mild diuretic may together bring the blood pressure down to normal levels, but it might require a far higher dose of medicines if the first three procedures aren’t undertaken.

Let’s look at each of these in turn:

Obesity. Without doubt, being fat causes your blood pressure to rise, and shedding those extra few pounds may make all the difference to your overall health and wellbeing.

Exercise. Firstly, exercise uses up the excess adrenalin that swills round the system when we are in a state of alertness as a result of a fright or stress. Secondly, the fit person who exercises is less likely to become obese. Thirdly, the body systems of fit people work in a slightly different way to those who are unfit.

Exercise promotes a greater sense of well-being, a sense of relaxation, and causes some significant but subtle changes to occur in the body, particularly in the way in which the cells of the body handle sugar.

•    Stress. Our bodies are good at responding to external stress; they do so by putting up the blood pressure transiently, which is useful if we need to run away quickly in the face of danger. However, if stress is applied for days and weeks on end, or if we don’t get any opportunity to relieve the stress, then our bodies become constantly over-stimulated, with adrenalin swimming around the system; no wonder the blood pressure goes up!

Anti-stress measures can be simple, but very effective in reducing the levels of stress within the body; and by reducing stress we may reduce blood pressure fairly quickly.

However, stress on its own is unlikely to be the entire cause of high blood pressure; it probably has an effect mainly on those with an underlying predisposition to high blood pressure.

•    Medication. There are five main groups of drugs to treat high blood pressure. 1. The thiazide diuretics. These are drugs which are often used to produce extra

urine and dry out the body.

Beta-blockers are drugs which block the effects of adrenalin and nor-adrenalin, and so reduce the contraction of the arteriolar muscles, reducing blood pressure. They also stop the heart over-exerting itself, in much the same way that putting a wooden block under the car’s accelerator pedal prevents you over-revving the engine.

Calcium channel blockers such as nifedipine (Adalat, Verapamil, Diltiazem, etc) block the movement of calcium ions across the outer membrane of muscle cells and, in doing so, reduce the force with which the involuntary muscles can act. As all the muscles controlling blood pressure are involuntary, these medicines are excellent for reducing blood pressure.

Drugs which act to block the transmission of nerve impulses, e.g. Alpha-methyldopa. After being absorbed in the body this is changed into an imitation transmitter chemical — one that doesn’t stimulate the nerves — so, effectively, the nerve starts firing blanks! As a result the nervous system can’t force the muscles to contract as strongly, so the blood pressure drops.

The group of blood pressure reducers called ACE-inhibitors (which stands for Angiotension Converting Enzyme Inhibitor). These block the effects of a hormone called angiotensin which when converted into its active form normally acts to constrict the muscle cells in the arterioles. Blocking the conversion reduces the stimulus on the muscle cells.

    In controlling your blood pressure your doctor may use one drug on its own, or several of them together. Often the control of blood pressure is easier using two different drugs that work in different ways. Diuretics and beta-blockers are often used together; but, in fact, most anti-hypertensive drugs can be combined usefully with one another. Some combinations of drug even come together in one capsule, for convenience and ease of administration.

Once your blood pressure is under control you’ll probably only need to see the doctor once every six months for a routine blood-pressure check.

Once drug treatment has started, it is usually for life. While it is often possible to bring down minor degrees of raised blood pressure by curbing obesity, instituting relaxation therapy, etc., if hypertension remains despite these measures, then permanent drug treatment is likely to be needed. High blood pressure like this doesn’t often come down of its own accord, and although the drugs currently used reduce the blood pressure directly, they don’t affect what causes the alteration in blood-pressure control. So, in effect, they are just ameliorating the effects of high blood pressure, rather than curing it so that it goes away.

Just occasionally the blood pressure does come down again, but this is either after some years have passed, or else after a major event such as a heart attack or a stroke. In these circumstances it may be possible to reduce the medication.

A problem with taking drugs is that occasionally they can give side-effects -dizziness, weakness, coughs, difficulty with erections, etc. As they are being given for a condition which is largely symptomless it’s often difficult to persuade the patient to continue taking the medication, because as far as he is concerned, he feels fine when he’s off the medication, and worse when he’s on it. It is vital to keep taking your blood pressure pills; if you don’t you run tin’ risk of an earlier stroke, which may reduce your life expectancy by several years, or paralyse you.


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