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HEART ATTACK OPTIONS: DRUGS IN THE TREATMENT OF CIRCULATORY DISEASE AND HIGH BLOOD PRESSURE (HYPERTENSION)
There are an estimated two million people in Britain with high blood pressure. A corresponding figure from America suggests that 40 million people have symptoms associated with arterial disease. Initially most of these will be treated with drugs.
There is no doubt that drugs have an important and useful role to play in the control and management of arterial disease and its many symptomatic manifestations, but to suggest that in any way they are curing the condition is inaccurate.
High Blood Pressure (Hypertension)-There are many purposes for which drugs are taken but this condition is by far the most common. Depending on what doctors believe is the underlying cause of the high blood pressure they may prescribe any of the following categories of drugs:
diuretics (drugs that increase the flow of urine and thus control the blood pressure by reducing fluid levels in the body
beta blockers (drugs that decrease the activity of the heart)
ACE inhibitors (drugs that act on the kidneys directly) Studies have shown that there are many side effects to all of these, some serious. For example, diuretics have been shown to elevate blood fat levels of the most dangerous fat categories, thus actually increasing the risk of arteriosclerosis. They also deplete the body of vital mineral potassium and therefore can actually be a precipitating factor in causing heart arrythmias since adequate potassium in the blood is necessary for controlling this aspect.
Diuretics can elevate uric acid levels too, predisposing to gout. They do reduce the effects of too much salt in the system, but a far safer and better way of doing this is to cut out salt.
Beta blockers can have many unpleasant side effects from impotence to affecting breathing function. They also appear to increase the mortality rate when compared to those with the same condition who are not taking them. However they have been shown to reduce the severity of second and third heart attacks and they do control another common symptom of
arteriosclerosis – angina.
ACE inhibitors are another part of the large drug armoury for controlling hypertension (high blood pressure) and of them it should perhaps be pointed out that anything that has a direct effect on the body’s key organs of elimination, the kidneys, is bound to have effects other than those desired.
In fact this is true of nearly every drug used in this broad area: the advantages must be balanced with the disadvantages, and decisions made based on individual experiences.
Aside from hypertension, the most common conditions which drugs seek to control are: heart pain (angina), palpitations (ar-rythmia), impaired circulation, sticky or viscous blood, high blood fat/cholesterol levels, and various” drugs prescribed for emergency conditions.
The main categories of such drugs are: nitrates (for sudden and severe chest pain), beta blockers (for hypertension and angina), calcium channel blockers (for hypertension or angina), vasodilators (to improve circulation in the extremities or in the brain), anticoagulants (for those whose blood tends to clot too easily), and antiarrhythmics (for those with palpitations or the reverse, a too-slow heart beat).
Each of these drugs has several trade names depending on what drug company manufactures them and each has a slightly different composition. It is very important that those who have to take drugs know in which category their drug falls, so that if it doesn’t suit, others in the same category can be tried.
Just as in any other branch of commerce, some products are better than others. As with commerce, price is very often a guide to quality and those who are prescribed drugs on the National Health may well suffer from restrictions imposed by the constraints of its drug budget.
What usually happens is that doctors are instructed to prescribe the most economical (or locally produced) drug to begin with and if that doesn’t suit, than and only then to prescribe one which is possibly superior and more expensive. Not all drugs are available on the National Health and is wise to get acquainted with what is available in your category, because if you are going to take something for the rest of your life (or a considerable time), you might as well try to take the safest most effective product and your doctor will co-operate in this if at all possible.
There is a very good American Publication called Worst Pills, Best Pills. There is also a publication in the UK called What Doctors Don’t Tell You and a small guide1 to the side effects of drugs.
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