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The excellent Canadian Hypertension Education Program update published in the July issue of the journal1 demands some comments:
In family practice, where we follow patients for many years, it seems that our choice of drugs in the treatment of hypertension is essentially a game of “spot the adverse drug reaction.” We choose drugs based on what remains after calcium channel blocker–related edema, angiotensin-converting enzyme inhibitor cough, β-blocker fatigue, and diuretic electrolyte disturbances have been recognized—a fairly easy exercise. The recommended use of combination drugs such as angiotensin-converting enzyme inhibitors and diuretics makes this more difficult, however, and offers little benefit.
I agree that home measurement of blood pressure (BP) is best, and I no longer make treatment decisions unless the patient brings me a 2-week home BP diary or a series of BP results taken in pharmacies. Blood pressure monitors can be purchased at discount stores for $75, a good investment if the patient is spared years of costly and unnecessary drugs and adverse drug reactions. Two inventive manufacturers of angiotensin receptor blockers currently offer “free” monitors if we prescribe their products.
The article’s list of cardiovascular risk factors might also include the use of female hormones and anti-inflammatory drugs.