High Blood Pressure

[ThaiPauly]

OK, I know its the festive season and we al overdo it...but I have just checked my blood preesure and it is reading 164/96.

That is way higher than any previous reading I have taken

Is that level dangerous, or will it come down normally after I stop "overdoing it" as I am now with all my family here.

Thanks

TP

[BambinA]

your BP is higher than nomal (140/80)

Uncle Paul 'd restrict and escape from high calorie , cholesterol in food

and Uncle Pual 'd work out more

i had got 160's BP 4 year ago when i took anti obesity drug

(when i was in farangland i wa really pepite ...but when i 'm inLOS im pretty fat ..thats why i took that crappy drug and got yoyo effect later)

49>53>55>58>60>65 kg

now im 55 kg

(im 5.7")

Edited December 28, 2006 by BambinA

[endure]

OK, I know its the festive season and we al overdo it...but I have just checked my blood preesure and it is reading 164/96.

That is way higher than any previous reading I have taken

Is that level dangerous, or will it come down normally after I stop "overdoing it" as I am now with all my family here.

Thanks

TP

When did you check it? 3 minutes after you were bopping your heart out? Or 10 minutes after you sat down and relaxed? Blood pressure changes all the time. You really ought to find a quiet place and rest for 10 minutes before you take a reading.

[DrFisher]

Actually a systolic of 120 and a diastolic of 80 are considered normal (120/80) New studies show 115/75 to be perfect (though most people don't have that). Your blood pressure is high and dangerously so (unless you are Asian) Asian blood pressures tend to run higher. Left untreated it can lead to heart attack or stroke and causes undue stress on all or your organs. As endure mentioned when did you check your B.P. after activity or after relaxing? That does make a big difference. If you have any concerns I would check with a doctor. There are many quality and inexpensive drugs available in Thailand. One of the best drugs is Zestril it comes in 10 and 20 mg and costs about 700 B per month as opposed to the $175 the USA charges. The generic is Lisinopril and cost around 300 B per month it is just as effective however has some side effects on some people. Both of these drugs are considered safe for long term use and remove salt from your body (make you pee a lot) but can solve your problem in 30 minutes.

This is a suggestion and not a diagnosis seek proper medical attention to address your concern.

[BambinA]

Actually a systolic of 120 and a diastolic of 80 are considered normal (120/80)

yes .. its not 140/80

i did type wrong

[lopburi3]

As said check when relaxed at home and do a number of times. Physical activity will greatly affect the readings as will anxiety (worried about family?). Doctors advise is cheap here and there is a wide range of medications if required. But do take a number of readings at different times and record for doctor (as your office readings could be much higher than normal at home level).

[ThaiPauly]

Thanks for the replies folks.

I initialy checked it when I got up this morning.

I have just checked it again after the really strenous activity of throwing the ball for the dog to fetch and it is virtually the same !

rather worrying methinks?

[ProThaiExpat]

I have been blessed with high blood pressure since my early twenties. I was told many times I would have my first heart attack by age 40. Being a Friedman Type A personality just made it worse.

A blessing in disguise, as I have payed attention to my health with great care all these years and no heart attack yet, early seventies. No enlarged heart and with a diuretic and a beta blocker, three baht a day, generic and in quantity, my pressure is excellent.

Pauly, lopburi3 is right on as to how to take your pressure. We all assume you have a machine. For two hundred baht you can go to the hypertension clinic at Rama and they will coordinate your readings on your machine with theirs and you will know your getting accurate readings. They can point you to the meds as well.

I take my blood pressure continuously until it levels off. Usually takes three successive readings before it levels off and I get repeat readings. Only when the reading repeats do you know you have settled down. Also keeps me busy while waiting for pressure stabilizing. Lopburi3 also pointed to what is called "white coat syndrome" where the pressure is usually elevated when taken in the doctors office.

I make note of my readings and take them into the clinic to show the doctor, as lopburi3 suggests. I have dealt with my blood pressure for so many years that I am comfortable self medicating and the cardiologist, who reviewed my meds recently, made no changes to what is clearly working.

As many have posted before, blood pressure control involves what is termed "titration", that is experimenting with combinations of drugs until you reach an optimum "recipe". I believe in taking as few drugs as possible and of time tested drugs. Thus I started with the minimum dosage of a diuretic, Diazide, generic are many and Atenol, a beta blocker. Worked like a charm. When the chloesterol went too high, started on minimum dosage of Lipitor, a new brand, and it worked wonders. Am now onto the same generic chemical group but generic, thanks to lopburi3. Savings per day, 40 Baht.

One of the blessings of Thailand, in my view, is that doctors do not control medications and you can buy most of what you need for these types of ailments over the counter in most pharmacies, and can bargain the price down as well. Many of us remember well the doctors who refuse to give a prescription or order a blood test without an office visit.

With the internet, one can educate oneself as to most medications and get comfortable and knowledgeable about ones own conditions. No, I am not talking about heart defects or the like, buy surely chloresterol control, blood pressure control, diabetes control and the like can well be managed by yourself, after guidance from a physician.

I recently returned from Australia where prescriptions are needed for almost everything, although better than the U.S., and no lab will even do a chloesterol check without a doctors order, minimum clinic visit to get such an order is over 2000 Baht.

You can expect your pressure to be higher in the morning and that is why I take my meds in the mid-evening. Since diuretics cause your body to dehydrate and thus lessen the water in the blood, thus lessening the pressure, you will have more night toilet calls, but since the pressure is highest in the morning, I choose to have the maximum effect of my diuretic at work then.

Diuretics are usually the first medication tried by physicians, although many of the younger doctors are prescribing very new drugs that are supposed to control your pressure with one pill. There are side effects with the newer drugs, though.

Good luck, with a little effort, you will get your blood pressure under control and can stop worrying.

By the way, it is proven than ones anxiety level can cause increases in blood pressure and it is further documented that alcohol injestion will, in and of itself, raise anxiety levels. Example, if your at an anxiety level of 4 when you start to drink to "relax", when the alcohol effect dissappates, your anxiety level with be higher, 5 or 6 on the same scale. There are studies that support a glass of while a day for those with heart conditions, not those with blood pressure problems.

[Kaojai]

When did you check it? 3 minutes after you were bopping your heart out? Or 10 minutes after you sat down and relaxed? Blood pressure changes all the time. You really ought to find a quiet place and rest for 10 minutes before you take a reading.

On the other hand, if your blood pressure is elevated most of the day due to your typical stress levels, physical activities, eating and drinking habits, etc., then that's the pressure which is being placed on your arteries and organs.

If you only consider the pressure when you stop your regular activities and sit quietly for awhile (and take several readings until you find one that you like), you are fooling yourself. The potential damage is being done if your blood pressure is too high much of the day even if it looks better when you sit still and think pleasant thoughts.

[Kaojai]

You can expect your pressure to be higher in the morning and that is why I take my meds in the mid-evening. Since diuretics cause your body to dehydrate and thus lessen the water in the blood, thus lessening the pressure, you will have more night toilet calls, but since the pressure is highest in the morning, I choose to have the maximum effect of my diuretic at work then.

Sounds logical, but more than one doctor that I've seen has told me I should take both Esidrex and Zestril, together, in the morning and low dosage aspirin (as a blood thinner) with lunch. What may seem obvious and logical may not always be correct. I won't pretend to know why taking it in the morning is preferred and admit I never bothere to ask (and I agree there are a lot of half-assed doctors out there dispensing half-assed advice), but if several doctors seem to insist on something I assume there must be a reason.

I also agree that the absolute control over every aspect of medical diagnosis and treatment by doctors in the US is ridiculous, but to go to the other extreme and assume that you can manage medical problems alone, or even be aware that they exist, is equally ridiculous. The Internet is a great source of information ( and misinformation) and I've used it to double-check drug side-effects and to explore the possible meaning of various symptoms, but it should not be assumed to be more than a tool to be used in conjunction with proper medical advice.

You should, for example, have periodic kidney function tests when taking Zestril. There are also issues of drug interactions which you may need to be aware of. A properly trained pharmacist who maintains records of all the drugs you are taking can give you support on some of these matters, but even Boots in Thailand maintains no records of what I've been buying from them ( or even who I am) and I've never been offered any advice concerning drugs I've bought from them.

[PeaceBlondie]

Paully, if you want a cardio specialist's name and number from Maharaj, PM me, especially if you won't go to Chiang Mai Ram. My condition is rather simple, but I still see an expert rather than self-medicate. If your medical condition is complex, that's all the more reson to see a good doctor.

[ProThaiExpat]

Its so interesting to see posts that misconstrue another post inorder to support their opinions. I did not post that I had no expert medical supervision, but alas, the internet is a free firezone and all we can judge about posters is what they post.

The bottom line in blood pressure control is "titration" and all "experts" follow that approach. They try a drug on you and if it works, fine. If not, they change it. They all have their favorite drugs for blood pressure control. If your "expert" has found a good drug or set of drugs that works for you, you can ask for nothing more.

As for me, I have found the proper mix of drugs for me, as posted, had them approved by a cardiologist and my last set of blood tests, which included kidney function, were just fine, thank you.

Having controlled my blood pressure most of my adult life, I do not have atherosclerosis, which many have in later life due to failure to control pressure early, and one can safely assume that their blood pressure control problems would not be the same as mine.

I would submit that the 140/80 blood pressure ideal. established by the medical profession. protocol specifies that that pressure is measured "at rest". Since pressure does elevate upon acitivity, a treadmill blood pressure test under medical supervision is the only accurate method of determining if you pressure goes too high upon exertion for safety, but more importantly, how quickly it returns to the ideal pressure upon rest.

I further submit that it is pure folly, to surrender your medical care to your choice of physician and trust all will be well. The ultimate responsibility for your own health care is with you and without an active role in your own healthcare, how are you to know if you have a competent physician for your problem. Emperical results is no measure of proper care.

[marshbags]

Hiya T.P.

Sorry to hear your B.P. is up so much.

The good thing is you are aware and monitoring it and are looking for sensible advice to lower it.

Please take a look at the following website provided by the U.K. Government.

http://www.eatwell.gov.uk/healthissues/

Look in the left hand column and take a look at this section for all important health issues.

For your particular problem go direct to:-

http://www.eatwell.gov.uk/healthissues/healthyheart/

Please remember you cannot continue with your present style of living if you don,t want something serious to happen.

Because it will and just maybe it will be to late to do anything about it.

I,d definitely go for a health check up as soon as possible to a reliable hospital as worrying about it will only make it worse.

Also it is important to go now and not wait for your Family / guests to go home.

( you cannot fool your body into waiting, especially if they are heart related )

You can do this discretely without worrying anyone, tell them you,ve got a bad stomach and want to watch what you eat / drink ect. for a few days and wait until you ascertain how serious it may or may not be.

High blood pressure CAN be controlled if you live accordingly so act NOW.

Be honest to yourself and listen to your body warnings that you have obviously had and heed them.

You obviously care about your family so do it for them as well as yourself.

Please don,t read this post as some sort of sermon as it is genuine advice to hopefully encourage you to get it sorted before it becomes to serious.

marshbags

I hope maybe others on T.Visa can make use of this website also as it,s full of well researched and sound professional advice and not commercially motivated.

Edited December 31, 2006 by marshbags

[DrFisher]

There is no "ideal" blood pressure reading. However, there is a range of "normal" blood pressure reading. Generally, a reading that is less than 120 over 80 indicates that you don't need to worry. If either or both numbers are equal to or greater than 120 over 80 for an extended period of time, you have high blood pressure, or hypertension.

Hypertension is dangerous because it causes the heart to work extra hard. This strain contributes to heart attacks and stroke. When the heart is forced to work extra hard for an extended period of time, it tends to enlarge. A slightly enlarged heart can function well, but a significantly enlarged heart cannot. High blood pressure also causes damage to the arteries, causing arterial disease.

Hypertension can be treated. Mild cases of hypertension can be treated through behavior modification like changing diet and increasing exercise. More severe cases of hypertension require medications like diuretics and beta blockers. Diuretics rid the body of excess fluids and salt. Beta blockers reduce the heart rate and the heart's output of blood.

http://www.ash-us.org/

American Society of Hypertension

Although in some European countries I understand 140/90 is acceptable I assure you it is not. The reason it is acceptable is because of social medicine and the bottom line. 140/90 will not affect most people that are non-smokers, not morbidly obese or under any pressure or stress, right away that is. Over time the organs in the body are subject to undo wear and stress resulting in stroke, heart attack or function failure. This is basic world standard medicine learned by first year nurses in most countries. Not to stress you but check the facts for yourself don't listen to anyone (not even me) about your health.

[ThaiPauly]

Thanks for all the replies and your genuine concern, and thank you Marshbags for the links.

Peace Blondie I will pm you soon to find out the name of the specialist you recommend. You are right I will not use the Ram becuase they do not want me as a patient and I don't want to be a patient of theirs or give them 1 satang of my money.

There is a lot to take in from the advice you have all so kindly proffered.

I accept that I need a complete change of lifestyle and there is no better time to start that than now..but I do need to see a specialist so that my sitaution can be monitored

Once again many thanks to you all.

TP

Edited January 1, 2007 by ThaiPauly

[marshbags]

Thanks for all the replies and your genuine concern, and thank you Marshbags for the links.

Peace Blondie I will pm you soon to find out the name of the specialist you recommend. You are right I will not use the Ram becuase they do not want me as a patient and I don't want to be a patient of theirs or give them 1 satang of my money.

There is a lot to take in from the advice you have all so kindly proffered.

I accept that I need a complete change of lifestyle and there is no better time to start that than now..but I do need to see a specialist so that my sitaution can be monitored

Once again many thanks to you all.

TP

Well done T.P., we,ve lost to many good guys / members already

On behalf of all.............................................................

Thai Visa Members

Edited January 1, 2007 by marshbags

[Mossfinn]

Hi TP,

Got nothing to add that hasn't been already said.

I take thee differing meds for blood pressure caused by a med for another problem.

Doc's will experiment until they get the right med/meds and dosage to suit you.

It is better to take successive readings to get an average and it is better to take your own readings separately to Doc's reading in case of 'White Coat Syndrome'.

I would not recommend self med'n but take advice from a professional.

My BP went wild recently something like 175/115 but they didn't panic and just proscibed something else to combat it.

It is right that High BP over a prolonged period will increase the probability of Stroke and Heart Attack, although I am not sure what will happen if it is high for a short period.

Please take PeaceBlondies advice and see the specialist he has suggested.

Good Luck Mate.

Moss

[Maestro]

ThaiPauly, if your latest measurements were with the same apparatus, with your arm in the same position as with previous measurements, you are right to be concerned about a sudden increase in your blood pressure.

You mention a certain degree of stress with your family visiting at the moment. I suggest you forget about your blood pressure for the moment and measure it again after they will have left. There is no immediate or short-term threat to your health with the values you indicate.

If in the end your pressure remains high and you consult a doctor, be prepared for him to pump you full of medicines, even if he is a specialist. This is a widely-used therapy for hypertension and I guess not much harm can come from it, although some medicines can have annoying side effects.

Knowing that mild hypertension can be treated successfully with some minor changes in the diet or even simply with a placebo (studies have shown an 80% efficacy rate for placebos in mild hypertension) I would not take any medicine at all.

The little gadgets for measuring your pressure yourself at home are not always very accurate. Therefore, if after the hectic period your pressure remains high, by all means see a doctor. If he does his job right, he will not only measure your pressure in your arm while you sit, but also with you lying down (recumbent blood pressure), and also in your leg (determination of the difference between recumbent pressure measurements in the arm and in the leg)

If a doctor were to prescribe me antihypertensive medication for a pressure of 140/90, I would ignore the prescription. At that level, medication is not necessary. See for example this summary of a scientific article.

--

Maestro

[ThaiPauly]

Thanks for the further responses.

Todays reading is 189/137........that is really concerning me.

I took it after I had been up for an hour and had just one cup of coffee !

Should I seek help asap?

TP

[lopburi3]

I am not a doctor but with it that high I would not waste time - although normal high pressure is a long term problem suspect pressures that high could be a problem for the weakest link if it continues. I am not sure what reading my doctor got the first time that he checked (was there for gout) but he looked as if he was going into cardiac arrest and immediately get medication under my tongue to lower it and have been on medications since (that was 17 years ago) and with the medications normal readings run 115-125/65-75 but still about 140/80 in front of the doctors.

[Phil Conners]

The human autonomic nervous system (ANS) which controls blood pressure (BP) is a highly sensitive machine. Doctors love to prescribe drugs against high BP but it is actually much much better to change your lifestyle - more exercise, better eating (and drinking) habits, cut smoking, etc. than to use drugs.

You should check that your heart and cholesterol levels are otherwise ok, quickly if you haven't already done so.

Anxiety can raise your BP quite dramatically; just worrying about your BP may easily push it up.

The body is made to have high BP under load, i.e. if you are doing sport, so it is not a problem in itself, but if you are at risk for heart attacks, have high cholesterol other other indications it may trigger other problems.

Doctors usually suggest taking a quart aspirin to prevent blood clots, you might want to consider taking one now if you think you are at risk.

[Tolley]

Thanks for the further responses.

Todays reading is 189/137........that is really concerning me.

I took it after I had been up for an hour and had just one cup of coffee !

Should I seek help asap?

TP

That sounds dangerously high so you need to take action and take whatever medications you need to lower it.

In the short term you will need to take medications if you have very high BP but long term i would be looking to make lifestyle changes that lowered your BP without the need for medications which all have some form of side effects. You may need to take the medications for life but it is always wiser to try to fix these sort of problems through lifestyle changes if possible.

[Kismet]

Hi ThaiPauly,

I have been taking high blood pressure drugs for the past 25 years.

As years go by, I have been changing so many types of drugs to

lower my blood pressure to the ideal level of 120/80. More or less.

I have been taking Beta Blockers, Calcium Blockers, Ace blocker,

(Angiotensin ll receptor) ..... the latest and most expensive.

And you name it and I have taken it.

As a retired Govt. servant, I am fortunate to receive these drugs

free of charge in Malaysia.

However, it does not mean an expensive drug could work on you.

Individual drugs work on individual people. For example, my friend,

who took a RM3.00 could not lower his blood pressure, but a RM0.40

drug did lower his pressure. For my case, I need a more expensive

drug, (Cozaar) to really lower my pressure.

Please consult a good doctor to give you the best advice.

Bty, your reading of 189/137 is not a good sign and may lead you to

suffer a stroke, and may damage your kidney in the long run.

Please seek medical treatment.

[ThaiPauly]

I have been prescibed EZETROL 10mg tablets.

I am rarther concerned that nobody has mentioned them

Does anyone have any expeience with this particular drug...

BP is still a bit high although I feel fine in myself. My BP has been high since I went to Bumrungrad in November for a check up which was when I prescribed this drug.... one would think that the best Doctors (???) in the Country know what they are doing?

When I had a full check up at Samitevej I had a BP of 140/82..if anything my lifestyle has improved since July..they also said my Electrocardiogram results were within normal limits.

I have been to what many would consider the best 2 hospitals in LOS..yet still my BP is still higher than what is considered normal, although I am a bit less concerned at present as it is now showing 153/98

I don't know if it may have been the binging over the Xmas /New Year period that caused it to rise...now things are getting back to some kind of normality ..the pressure is off, the rows with my Son's have stopped ..as they are gone now...drinking has stopped as has eating cr#p food.

Today is my Wife's birthday. PB gave me the number of a good heart doctor here in CM ..but as it has come down I do not want us to spend the day at yet another hospital if it was just the over indulgence that pushed it so high.

If it goes up again then I will go.

Things are very peaceful and calm in my household right now.

Any opinions on my self-assesment would be more than welcome

Many thanks

TP

Edited January 4, 2007 by ThaiPauly

[rak sa_ngop]

By the way, it is proven than ones anxiety level can cause increases in blood pressure and it is further documented that alcohol injestion will, in and of itself, raise anxiety levels. Example, if your at an anxiety level of 4 when you start to drink to "relax", when the alcohol effect dissappates, your anxiety level with be higher, 5 or 6 on the same scale. There are studies that support a glass of while a day for those with heart conditions, not those with blood pressure problems.

A few years ago I bought one of those wrist BP machines (after getting 'high' readings in doctors surgeries and waiting rooms) and found that over a month my readings were generally less than 140/90.

The 'worry' I have is that a few times I tested myself shortly after drinking alcohol (multiple units!) my readings dropped like a stone to approx. less than 100/75. Should I be worried about this? (My father has low blood pressure but is 90 years old).

[lopburi3]

Perhaps we have not mentioned them for good reason. They are not for blood pressure from my 30 sec Google. They are a new cholesterol lowering drug (by preventing absorption in intestinal tract). Strongly urge you to get that pressure lower and that will likely require some form of medication.

The low blood pressure mentioned in another post is probably not a problem if you have no symptoms, like feeling faint or dizzy when changing positions/getting up but have not read up on it too much (except when was over-medicated and had such symptoms).

[chingching]

Knowing that mild hypertension can be treated successfully with some minor changes in the diet or even simply with a placebo (studies have shown an 80% efficacy rate for placebos in mild hypertension) I would not take any medicine at all.

I'd agree with the above, high blood pressure is a symptom. Taking drugs to control symptoms might be o.k. for the short term, but for the long term you want to address the causes of high blood pressure. i.e. your weight, your diet, your exercise.

[ProThaiExpat]

thaipauly: Many of the posts regarding changing your lifestyle as a cure for hypertension, while well meaning and marginally effective, probably won't due the trick for you, IMHO.

Transitory emotional upset might affect your blood pressure on a transitory basis, but that is not what you should be concerned with. It is the hour by hour wear and tear on your vascular tree and the increased work load on your heart over time that is the real danger.

Up to a few years ago, diastolic pressure, the lower one, was the big emphasis and people with 150 over 80 were rarely treated. However, recent studies, particulary in older people, have revealed that systolic pressure is quite important.

Your report of normal diastolic but elevated systolic pressure readings should be of concern. As I have posted previously, "titration", the trying of different drugs and their combined effect, are what doctors due until they get it right. The one pill approach, while the latest in medical thinking, probably a protease inhibitor, doesn't always work. In your case it hasn't.

Diruretics to remove the volume of your blood by reducing the amount of water in your blood is a proven method of blood pressure control and it is often accompanied by a beta blocker drug that reduces your heart rate and the pumping effort.

I take both of these drugs, generic versions and in their minimum dosage and both of my pressures are fine.

I started with just the beta blocker, which has controlled my diastolic for 30 years or more, but with the emphasis on controlling systolic, I added the diruetic and now systolic is fine as well.

There was a post a while back in this thread that was right on in all respects regarding your need to educate yourself on your condition and the use of the above drugs in pressure control.

The underlying problem causing your elevated blood pressure has not been diagnosed and probably won't be as it is an expensive effort and doesn't really change the approach to control.

If your arteries have become clogged due to age, bad diet in the past or high chloesterol, all the lifesyle changes in the world won't open up your arteries.

Think of an old pipe where the minerals have adhered to the sides of the pipe so that the whole in the pipe has narrowed. That is what happens to your arteries when you have athroclerosis. Short of a rotor rooter surgery, your "pipes" have reduced passageways, medically the term is narrowing of the "lumen" or hole in the artery.

Basic physics tells us that when you narrow the apeture or hole of a pipe or other conduit, you increase the pressure. The heart works harder forcing the blood through these narrowed openings. It may get larger as a result and cause major problems for you.

Likewise, the passage of blood through your arterial system at a high pressure just plain wears them out in time.

Those who have suffered from essential hypertension for their entire life, as many have reported in this thread, were unsucessful in attaining normal pressure through lifestyle changes, as was the case with me. I was a virtual health Nazi for years with no effect on my high blood pressure.

I have been evaluated by top scientist and participated in an ongoing study of high blood pressure in young males, all to no avail. Meds have been my only course of effective treatment and I have been on them for over 40 years.

Today my health is excellent, no enlarged heart, pressure under control and haven't had any medical problems for years. Worry not about trying different drugs, under the supervision of a physician, until you get the right mix for you. Believe me, there is a combination that will work for you without any meaningful side effects, except perhaps loss of libido or erectile disfunction, for after all, blood pressure is a major component in that area.

[ThaiPauly]

Thank you for such a well worded and thought out post PTEP.

It is not the first time that you have been so helpful.

I guess a good place to start my re-habilitation would be to stop smoking...

Tomorrow I will see the specialist that Peace Blondie recommended to me and see where I go from there.

[Sheryl]

TP:

You are right to be concerned and should use medication to get your BP under control. If you are also able to make some life style changes, do so, and you may then be able to reduce or come off meds...but dio not wait for the rlifestyle eforms to solve it, you could have a stroke in the interim! Also some people, even with optimum life style adjustmentsd, still need medication. Varies with the individual.

Do you have high cholesterol? I am wondering based on what you say you have been prescribed. If so, do you know the HDL and LDL values?

It is true that it is best to be managed by a competent physician. But it is also true that many Thai docs are just going to toss pills at you without much thought going into it. I seem to recall you don't live near Bkk. Anyhow, if you can get under the care of a GOOD internist or cardiovascular speciialist, do so, but if not I would proceed as follows assuming there is no history of drug allergy, liver or kidney disease (you have already said no heart problem:

- try atenolol (generic name; available in many different brand names, locally made and cheap) 25 - 50 mg daily. Give it a week unless you experience side effects. (Headache is one that prevents some people from using this). It is a beta blocker. While the text books recommend a diuretic as the first choice, I personally am hesitant to suggest them in this climate...too much risk of fluid and electrolyte problems unless you are always in a/c and don't sweat much.Atenolol (or any other beta blocker) will cause you to have a slow pulse, can even be as slow as 42-50/min (usually will be between 50-55) and this is normal and not a cause for concern unless you experience dizziness.

- if atenolol either doesn't work or causes uncomfortable side effects, try enalapril (also generic, with many locally made brand names) 5-10 mg daily. This is in the class of drugs called ACE inhibitors.

Whichever you take, get a print out of possible adverse reactions (if this proves hard to find PM me and I'll send you) and drug incompatabilities.

Keep measuring your BP and aim for as close to 115-120/70-80 as you can get. Keep a record of the results.

With all BP meds, you may experience dizziness upon abruptly changing position. This may improve with time, meanwhile get up slowly (for example, sit up in bed a few minutes before standing up)

Try to reduce caffeine and if you need to, lose weight. Reducing sodium intake is also advisable. In some people that alone will do the trick...but easier said than done with Thai food!

Continue to have annual check-ups and go for the "executive" plan (with stress test) and be sure to tell them what meds you are taking for your BP.

Personally, I developed high BP about 1 1/2 yrs ago. I treated with atenolol first and then went to a detox/fast program, lost weight and redcued caffeine. I was then able to go off the medicatioon and BP is still fine (I've kept the weight off). But as mentioned, these life style changes while good for everyone do not always avoid the need for medication (some people just have a strong genetoic tendency to hypertension) and also should not be reason to delay treatment while waiting for them to do the job.