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In late 1960s and early 1970s when treating hypertension became mandatory, there were very few medications that could reduce blood pressure. Some of the medications (diuretics or ‘water pills') that are still in use now were prescribed at very high doses in those days.
Certain medications were found to be more effective in patients with heart disease; other antihypertensive medications are more effective in patients with kidney disease. It is important that the anti-hypertensive regimen is personalized based on patient's history. Here is a list of medications that should preferably be prescribed in patients with specific diseases. Interestingly, the most common reason for uncontrolled hypertension was found to be inadequate therapy in several studies. It was found that physicians failed to increase the dose of medication or add a new antihypertensive medication when blood pressure remained elevated.
There is no data yet on the cut-off points for blood pressure control in patients who perform home blood pressure monitoring or who undergo 24 hour ambulatory blood pressure readings.
Most of the blood pressure lowering medications commonly used now a days are safe and have minimum side effects. But keep in mind these are chemicals, and like all chemicals have properties that may effect you adversely.

If you have hypertension, make sure you check your blood pressure regularly and take home blood pressure reading records with you. An EKG or an echocardiogram will detect thickening of heart muscle (LVH or left ventricular hypertrophy) and a simple blood test (serum creatinine level) and urine test (for protein) will indicate if kidneys are affected as a result of hypertension. Improve your knowledge about Hypertension: Learn from patient friendly resources about hypertension and how to control it.
Home blood pressure monitoring: Regularly (at least once a week – in the morning and at night) measure your blood pressure at home and keep a record, take it with you to your physician’s office for review.
Simplify your medication regimen: If you are on more than one medication, discuss with your physician if a fixed dose combination medication can be prescribed. Pill box: Arrange your daily medications in a pill box so that it is easily accessible at the time of taking medications.
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Since the whole field of hypertension therapy was in its infancy, we did not even know the right dose to effectively lower blood pressure.
Now we know that such high doses did not offer any extra benefit, instead they caused excess adverse effects and were probably harmfull to patients. Until recently, only 30% patients with hypertension in United States had blood pressure controlled to goal.

Generally, it is agreed that these values should be lower than those recommended for patients who only have hypertension.
It is important for patients with hypertension to periodically undergo screening test to detect early changes of uncontrolled hypertension on heart and kidneys. In such situation, it is important to review therapy and plan a more aggressive approach to control blood pressure. It will help you to actively participate with your physician in getting your blood pressure to goal. If you are on a medication that you have to take several times during the day, ask your physician if a long acting substitute is available for use instead. If you continue to take blood pressure lowering medications, it may further lower blood pressure to dangerous levels.

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