Doctor, do I have to take this medication forever?
Some people have hypertension only at times of great stress. Monitoring your own blood pressure can help pinpoint when meds are needed, and when they re no longer necessary. (Fotolia.com / May 8, 2013)
Who would want to take a medication every day unless there was a very good reason to do so? Do we have alternatives that actually are effective? Can we take medications just until other measures become effective? These are important questions that are studied in carefully controlled clinical trials. The results allow us to answer many of these questions based on data (evidence-based medicine).
High blood pressure (hypertension), diabetes, heart rhythm problems, and congestive heart failure are examples of potentially deadly diseases that may best be treated with medications taken every day. Drugs to reduce high cholesterol levels or chronic aspirin therapy are examples of proven interventions that decrease the likelihood of damaging or fatal illnesses in some situations.
Luckily, evidence-based medicine also has shown that for some people there are effective ways to avoid medications or to phase out the need for medications. Here are some examples:
1. High Blood pressure (hypertension):
Sustained high blood pressure puts abnormal strain on your heart and arteries and can lead to heart attacks (myocardial infarction), heart failure, strokes, and kidney failure. Treatment can greatly reduce the risk of these problems. Most hypertension is caused by a genetic predisposition and /or stress. Hypertension often runs in families.
Our goal is to keep the blood pressure less than 140 (the peak pressure in your arteries after the heart contracts)/90 (the lowest blood pressure between cardiac contractions). Some reports indicate a systolic blood pressure reading (the top number of the reading and the measure of blood pressure when the heart is beating) of 130 may be pre-hypertension, but we're not yet certain if medications are needed.
Systolic blood pressure over 130 should make you aware and to begin to take steps to deal with your blood pressure. When it does come time to treat hypertension, several kinds of medication can be effective.
Often, there are generic drugs, relatively inexpensive, that are effective. You can monitor your own blood pressure at home to make certain the medication is effective. Since we have many choices for blood pressure medication, there usually are effective alternatives if you have troublesome side effects.
If your blood pressure is elevated, your doctor may recommend a medication to control it. Reducing salt in your diet can help. Losing weight, stress management, and exercise also will give you a chance to avoid or reduce the need for drugs. Some people have hypertension only at times of great stress, requiring treatment only for that brief stressful period. Monitoring your own blood pressure will help determine when medication is needed, as well as when medication no longer is necessary.
2. Diabetes (diabetes mellitus, high blood sugar)
Juvenile diabetes usually results from destruction of the beta cells in the pancreas that produce insulin. This can be a fatal illness unless insulin is given to control the blood sugar. Diabetes requiring insulin can occur at any age.
A more common form of diabetes is related to diet and being overweight. Your pancreas may begin to fail and not be able to produce enough insulin. When we start this group of patients on medication, they want to know if it's forever.
We can now reliably tell them that weight loss and exercise may restore normal blood sugar control. In fact, large scale studies involving thousands of patients have shown that lifestyle changes (diet, exercise) over time can be more effective than medication alone.
Medications usually can keep blood sugar at safe levels, but controlling sugar metabolism with diet and exercise is very important and may be sufficient to eliminate or avoid the need for medication.
3. High cholesterol
High levels of some forms of cholesterol in the blood increase the risk of damage to arteries and therefore the risk of vascular illnesses, such as heart attacks, strokes, and proper blood flow throughout the body. Studies have documented these risks, as well as decreased risk of vascular disease when the cholesterol is controlled.
When there's a strong family history of vascular disease, diabetes, or established vascular disease, regardless of the cholesterol level, you need a medication to lower your cholesterol level. In these cases, even if your cholesterol is in the normal range, it may be abnormal for you and the association of progressive vascular disease is much too high. Lifestyle change is still of great added benefit.
Diet, weight loss, and exercise can be very helpful or even can eliminate the need for medication in people with none of the serious risk factors.