High Blood Pressure

[ThaiPauly]

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?

Hi Sheryl,

Again I must give thanks for the lengths you have gone to in your post.

I do have a problem with cholesterol...the Overall Value was 262...top end should be 200

My HDL Value on my last check-up were 57 (within target I think)

LDL 202 ( well above normal unfortunatley.)

I am also a type 2 diabetic so that does not really help much does it?

Thanks for your help...everybody's imput is really appreciated

TP

[Prakanong]

TP

Nothing to add except say my BP has recently been diagnosed as hypertension and have started medication for it - just over a month now and while still on the high side will give it another month before asking to try another med.

When I presented my BP was 200/150 - the Dr's words "You should not even be walking here"

Since then I have had a full medical workout as detailed elsewhere on this board with pretty good results. This includede a good cardiac treadmill result with BP not so bad under this test and good return to resting.

My Kidney tests and everything else was fine too.

Just to put your mind to rest I would consider going for one of the full health screenings like they have at Bumrungrad - i did mine at Raffles in Singapore and was worth every penny even if i am not paying.

I do need to exercise more and to live a healthier lifestyle. i will not turn into a monk but I will be more responsible - as i write this the food blender just bought is beside me for my daily intake of fresh fruit smoothies and the like. I will also be cutting right down on the beer and the fatty food.

Good luck - catching it and treating it is the main thing - i work with research Dr's and they have all told me the same thing as have the GP and the hospitsal Dr's

[ThaiPauly]

Just to put your mind to rest I would consider going for one of the full health screenings like they have at Bumrungrad -

I have had 2 health screeings within the last 5 months at Burungrad and Samitivej........ and i live in Chiang Mai..its not as if I am not taking it seriously or anything however my last reading was showing the same as my 23 year old's Son..within acceptable limits..but it just seems to go up and down so much..I am definatley gonna cut down my caffine intake from tomorrow

I HAVE spent a lot of money..because its no good to me if I am dead. Insurance companies will not touch me with a bargepole...they will only insure me against accidents !!

I have e-mailed the heart specialist up here this morning...but am still waiting for a reply as to how soon I can get to see him.

Thank for your imput Prakanong...PS I am in the process of purchasing a Condo in Suk 69 Which will be ready at the end of April so I can be closer to the best hospitals in Thailand, I wont live there full time but I feel I need to be closer to the best healthcare possible...when I need it

Edited due to spelling errors

Edited January 4, 2007 by ThaiPauly

[Prakanong]

Hi

Mine is up and down as well - taking it tonight after getting back from the supermarket it reads quite high at moderate hypertension levels.

An hour later after relaxing and resting its well within "Normal" range - there are just so many variables in this as many Dr's have pointed out to me including "White Coat Hypertension".

Just before taking it a pal rang me who is a radiologist to ask about my recent Thailand trip as he is going up for the weekend tomorrow. He enquired about my BP as well to see if I was compliant with the medication etc. This was because they had a women in today he was asked to look at due to her wild swings in BP which they could not control - he was issuing me with a cautionary note I know but I am compliant.

I can not raise my insurance money payout either without medical notes - do not want to at the moment but those at work assure me it will be OK with just the BP

[Old Man River]

Nothing to add except say my BP has recently been diagnosed as hypertension and have started medication for it - just over a month now and while still on the high side will give it another month before asking to try another med.

I just started taking meds 1 1/2 weeks ago. It was 165/102. I travelled from Bangkok to the US and had it taken just before I left. It was 130/87, but due to the time differences, I skipped taking the pill for 12 hours to get back on schedule of taking them in the morning. I had the BP taken a few days after arriving in the US, and it was back up to 162/100. The nurse told me never to miss a dose and if I have to adjust to different times, to take one at my normal time and another at the new time (12 hours difference). If you are going to be travelling and are under meds, best to discuss this with your Dr. prior to leaving. I didn't.

I had the BP taken again two days ago and it was down to 146/96, which is still high, but headed in the right direction. It is reassuring that after a month yours is still high so that I won't panic if mine stays high for awhile also. The Dr. (Bangkok Nursing Home) said that my blood pressure should return to 120/80, but she was not specific as to when.

[georgebkk]

Watch the salt intake.

[Prakanong]

Nothing to add except say my BP has recently been diagnosed as hypertension and have started medication for it - just over a month now and while still on the high side will give it another month before asking to try another med.

I just started taking meds 1 1/2 weeks ago. It was 165/102. I travelled from Bangkok to the US and had it taken just before I left. It was 130/87, but due to the time differences, I skipped taking the pill for 12 hours to get back on schedule of taking them in the morning. I had the BP taken a few days after arriving in the US, and it was back up to 162/100. The nurse told me never to miss a dose and if I have to adjust to different times, to take one at my normal time and another at the new time (12 hours difference). If you are going to be travelling and are under meds, best to discuss this with your Dr. prior to leaving. I didn't.

I had the BP taken again two days ago and it was down to 146/96, which is still high, but headed in the right direction. It is reassuring that after a month yours is still high so that I won't panic if mine stays high for awhile also. The Dr. (Bangkok Nursing Home) said that my blood pressure should return to 120/80, but she was not specific as to when.

The Dr's I have spoken to about this say it may well be up to 6 weeks of regular compliance before it settles down. My BP depends on where I am and at rest and relaxing is OK. I did party a bit in BKK over Christmas so that would not have helped. Booze while initially lowering the BP then causes it to be raised even more in me afterwards.

My dose of Hyzaar may need to be upped or even a 3rd therapy added but we are just monitoring it for the next month or so as things settle down.

It may even be a completely different type of therapy is required for me. I also need to start my exercise regimen too - my diet has already changed a lot.

[Old Man River]

The Dr's I have spoken to about this say it may well be up to 6 weeks of regular compliance before it settles down.

That explains why my Dr. had me make an appointment 6 weeks hence. I am new to this and have to admit that I find it hard to not constantly think about it despite knowing this isn't good. I exercise a lot, stay thin and don't overeat. Last checked (recently), my cholesteral was below 160 with the LDL below 70. Finding out I have high blood pressure has really shocked me, especially since my lifestyle would be considered boring by normal TV standards. I guess I am lucky I found out before it got out of control.

[Gary A]

I too have hypertension. I was working in the USA several years ago and suffered a stroke. Fortunately it was a mild stroke and I have only minor residual symptoms. The doctor in California had me on three different drugs. I really felt bad every day. After I returned to Thailand a friend of mine was concerned because I felt bad every day. He suggested that he take me to see his doctor. We went to Bangkok Pattaya hospital where I had a brief check up and a long talk with his Thai doctor. My blood pressure wasn't under control. When the doctor asked me what I was taking. I showed him the drugs. His eyebrows raised but he said nothing. He advised me to throw those drugs away and prescribed an ACE inhibitor called Enaril. He recommended that I take one 20mg tablet and one 60mg Aspent-M (aspirin) a day. He wanted to monitor my blood pressure for a couple of weeks after that. The last time I saw him, my blood pressure was indeed under control and I felt great. He told me that I would live forever. I have a Lumiscope home monitor and check once a week or so. My readings are normally around 133/80. Seldom higher and often lower. I buy the Enaril in boxes of 100 tablets. The last box cost 350 baht for 100 foil wrapped tablets.

[Prakanong]

The Dr's I have spoken to about this say it may well be up to 6 weeks of regular compliance before it settles down.

That explains why my Dr. had me make an appointment 6 weeks hence. I am new to this and have to admit that I find it hard to not constantly think about it despite knowing this isn't good. I exercise a lot, stay thin and don't overeat. Last checked (recently), my cholesteral was below 160 with the LDL below 70. Finding out I have high blood pressure has really shocked me, especially since my lifestyle would be considered boring by normal TV standards. I guess I am lucky I found out before it got out of control.

I totally understand your concern and while my lifestyle is probably not as healthy as yours i would be considered a saint by many I know outside my holidays. Like you my cholesteroletc are fine as is most other things except a high Uric acid score which others would have gout every week with but I seem to have tolerence.

It is a shock having to come to terms with the fact that you may have to be on medication the rest of your life when you have been as fit as the butchers dog before that - its only natural. The Dr as well as knowing medication can take time to settle in will know you will worry about this so maybe another reason for 6 weeks. If he was worried he would have you in daily - I had to promise mine to completely rest the whole weekend and not do anything for myself and then to have Dr's at my work monitor my BP daily.

I am hoping my BP improves with exercise etc and better eating but will not wager the house on it - we will see.

I work with Dr's and am sitting not 2 metres from one now - I value their opinion and their views seems to be control it by medication or improved lifestyle and there will be no problems.

[Old Man River]

Prakanong, thanks for the info.

I have two questions which I would think would be similar questions most with high BP would want to know:

1) Does there have to be an underlying cause to high BP, or can it just be part of the aging process? My Dr. said that she will want to find the underlying cause when I next see her (in 6 weeks). Can't you just acquire high BP without having anything specifically wrong?

2) Alcohol - I normally enjoy two to three glasses of red wine per day (no more than approx. 1/2 bottle per day). Since I was diagnosed with high BP, I have not had a drop for fear I might exacerbate the problem. Still, at least one or two glasses of red wine per day are considered healthy. Any thoughts?

Normally, I would have asked these questions to the Dr., but she did me a favor and saw me on a holiday, limiting the time I had for questions.

[PeaceBlondie]

Old Man River, why not just drink red grape juice, or buy red grapes? That way, you leave out the poison. I'm serious. It still amazes me that a doctor of medicine would 'prescribe' a known toxin - the chemical that has killed more humans than anything else except warfare - as if it's good medicine.

[Mossfinn]

- try atenolol

I urge caution here.

I had been on Atenolol for some time and it was excellent in bringing down my BP.

But it has recently been taken off the approved list of BP meds in the UK and I have been taken off it, I cannot remember the reason why it has come off the list.

No doubting its effectiveness, once off it the BP went thru the roof again.

I am presently on Ramapril, Amlodopine and Bendroflumethiazide and that just about keeps it under control, it is exacerbated by other meds mind.

Personally if I could get away with Atenolol I would continue to use it, personal choice and advice I guess.

Good Luck TP

Moss

BTW, you sure it has nothing to do with Reading doing so well.

Edited January 6, 2007 by Mossfinn

[Mighty Mouse]

The following article is printed in today's edition of the Sun- Herald. (Jan 7 - Sydney)

Men with high blood pressure who drink moderate amounts of alcohol may have a lower risk of heart attack, a new long-term study has found.

Researchers at the Harvard School of Public Health found moderate consumption of alcohol - up to one to two drinks a day - was associated with a decreased risk of cardiovascular disease and death in men with hypertension.

Drinking more than two drinks a day, however, may increase the risk.

The study authors said it might be unnecessary to counsel hypertensive men not to drink at all.

Take it for what it is worth.

Edited January 6, 2007 by Mighty Mouse

[lopburi3]

- try atenolol

I urge caution here.

I had been on Atenolol for some time and it was excellent in bringing down my BP.

But it has recently been taken off the approved list of BP meds in the UK and I have been taken off it, I cannot remember the reason why it has come off the list.

No doubting its effectiveness, once off it the BP went thru the roof again.

I am presently on Ramapril, Amlodopine and Bendroflumethiazide and that just about keeps it under control, it is exacerbated by other meds mind.

Personally if I could get away with Atenolol I would continue to use it, personal choice and advice I guess.

Good Luck TP

Moss

BTW, you sure it has nothing to do with Reading doing so well.

Can you please provide a source for saying Atenolol has been taken of the approved list of BP meds as Google seems to have missed that news. Are you sure this is not a case of your doctor or medical unit? I understand there are studies that paint it as less than ideal as a one drug treatment in that it may increase chance of sugar or lipid level increase but under monitor (perhaps they don't want to monitor your blood?) that would not be a reason to stop use as it is known to work for BP reduction. I find it very hard to believe what is probably the number one used BP medication in the world has been outright banned in the UK without press reports available to Google.

[rak sa_ngop]

The following article is printed in today's edition of the Sun- Herald. (Jan 7 - Sydney)

Men with high blood pressure who drink moderate amounts of alcohol may have a lower risk of heart attack, a new long-term study has found.

Researchers at the Harvard School of Public Health found moderate consumption of alcohol - up to one to two drinks a day - was associated with a decreased risk of cardiovascular disease and death in men with hypertension.

Drinking more than two drinks a day, however, may increase the risk.

The study authors said it might be unnecessary to counsel hypertensive men not to drink at all.

Take it for what it is worth.

As I mentioned in an earlier reply, my BP always drops when drinking alcohol.

Last night after drinking a moderate amount of alcohol units my BP dropped to 107/65 (usually 135/85). I do not know whether this is something I should be pleased about or not.

Self monitoring with a reputable wrist monitor over a period of time may be a useful way to learm more about yourself and how your BP varies over the course of a day etc.

[BigSnake]

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

Yes, get it check regular.

[Prakanong]

Prakanong, thanks for the info.

I have two questions which I would think would be similar questions most with high BP would want to know:

1) Does there have to be an underlying cause to high BP, or can it just be part of the aging process? My Dr. said that she will want to find the underlying cause when I next see her (in 6 weeks). Can't you just acquire high BP without having anything specifically wrong?

2) Alcohol - I normally enjoy two to three glasses of red wine per day (no more than approx. 1/2 bottle per day). Since I was diagnosed with high BP, I have not had a drop for fear I might exacerbate the problem. Still, at least one or two glasses of red wine per day are considered healthy. Any thoughts?

Normally, I would have asked these questions to the Dr., but she did me a favor and saw me on a holiday, limiting the time I had for questions.

From what Dr's have told me there can be no underlying cause. Of cause it could be current stress etc but in many cases including mine there is no thought of underying cause

Booze - I like a bevvy too - A few Beer's or wine but I do know it increases BP. I am not going to stop and only drink on weekends but will take care. A couple of glasses of wine a day is supposed to be good for you - well every couple of days.

I am not a clinician so ask your Dr - remember though that Dr's are not expert in every single condition - they have breadth of knowledge as GP's ans specialties and Consultants etc. It is possible for a non-clinician to know more than a Dr about one particular condition. Do your own research and even point out the literature to your Dr in a polite way ;-))))

[Mossfinn]

- try atenolol

I urge caution here.

I had been on Atenolol for some time and it was excellent in bringing down my BP.

But it has recently been taken off the approved list of BP meds in the UK and I have been taken off it, I cannot remember the reason why it has come off the list.

No doubting its effectiveness, once off it the BP went thru the roof again.

I am presently on Ramapril, Amlodopine and Bendroflumethiazide and that just about keeps it under control, it is exacerbated by other meds mind.

Personally if I could get away with Atenolol I would continue to use it, personal choice and advice I guess.

Good Luck TP

Moss

BTW, you sure it has nothing to do with Reading doing so well.

Can you please provide a source for saying Atenolol has been taken of the approved list of BP meds as Google seems to have missed that news. Are you sure this is not a case of your doctor or medical unit? I understand there are studies that paint it as less than ideal as a one drug treatment in that it may increase chance of sugar or lipid level increase but under monitor (perhaps they don't want to monitor your blood?) that would not be a reason to stop use as it is known to work for BP reduction. I find it very hard to believe what is probably the number one used BP medication in the world has been outright banned in the UK without press reports available to Google.

My source was the GP, Lopburi.

It was about 2/3 months ago there was a scare regarding certain beta blockers, had to see the Doc soon after and was taken straight of it. I remember that Diclofenac anti-inflammatory pain killers was taken off at the same time.

I may have got the terminology wrong here Lop, it may have been taken off as first choice and not used when there is another alternative, it may be that it is used where it has the best effect and there is no viable alternative.

Let me check the reason and I will get back and confirm.

Cheers

Moss

[Mossfinn]

http://news.bbc.co.uk/1/hi/health/3981935.stm

Lop, I have just done a very quick search and found this.

It may now be very clear that I may have done Atenolol a dis-service in saying it has been taken off as an approved drug, but it clearly states it is a fourth choice.

I was seriously under the impression that there was a danger involved with the drug as well as it being ineffective.

I will continue to search.

Good Luck

Moss

[Big Guy]

Went to the doctor in Aus 4 mnths ago after a blood pressure reading of 184/120 during a medical for work. Doctor didn't want to medicate, after testing bloods and ecg etc' recommended lifestyle changes and diet changes to try to control it first as medication should be the last resort. At present have dropped 10 kilos and blood pressure is readind 124/74 as I write this, so glad I made a few lifestyle changes rather than being medicated for the rest of my life.

[Sheryl]

TP -- I had forgotten you were diabetic. That puts an even greater urgency on your getting your BP under control (as you are already at above average risk of heart & kidney problems) but it also makes it more advisable that you consult a competent internist regarding choice of drugs, as some are more advisable for diabetics than others.

Old Man River: High blood pressure is usually not due to another condition ("primary hypertension") but in some cases it is caused by another disease process ("secondary hypertension") and some of those are quite serious. Some docs prefer to screen all new cases of high BP for possible underlying causes, others do so only if the onset is really abrupt, or the BP quite high, or the patient is unusually young and lacks a family history of hypertension. Certainly checking for rare but serious underlying causes is the safest and most conservative course of action.

[lopburi3]

http://news.bbc.co.uk/1/hi/health/3981935.stm

Lop, I have just done a very quick search and found this.

It may now be very clear that I may have done Atenolol a dis-service in saying it has been taken off as an approved drug, but it clearly states it is a fourth choice.

I was seriously under the impression that there was a danger involved with the drug as well as it being ineffective.

I will continue to search.

Good Luck

Moss

I also read that and find no mention of anything but deaths from heart attacks - nothing about number of strokes, eye troubles and such, which is a major concern I would think for those with high blood pressure. Although I do not usually take the pharmacy "money talks" too seriously wonder if the fact this medication patent expired 15 years ago and is now very cheap might have a significance. The test does not seem to address blood pressure control but only number of heart attack deaths. Hopefully my baby aspirin (also a much maligned drug) will help in that regard. As for blood pressure it most surly does lower pressure for me.

[Mossfinn]

http://news.bbc.co.uk/1/hi/health/3981935.stm

Lop, I have just done a very quick search and found this.

It may now be very clear that I may have done Atenolol a dis-service in saying it has been taken off as an approved drug, but it clearly states it is a fourth choice.

I was seriously under the impression that there was a danger involved with the drug as well as it being ineffective.

I will continue to search.

Good Luck

Moss

I also read that and find no mention of anything but deaths from heart attacks - nothing about number of strokes, eye troubles and such, which is a major concern I would think for those with high blood pressure. Although I do not usually take the pharmacy "money talks" too seriously wonder if the fact this medication patent expired 15 years ago and is now very cheap might have a significance. The test does not seem to address blood pressure control but only number of heart attack deaths. Hopefully my baby aspirin (also a much maligned drug) will help in that regard. As for blood pressure it most surly does lower pressure for me.

Not sure what you mean here.

I have actually stated it was excellent in controlling my blood pressure and went on to say it went thru the roof again once taken off it.

It is a BBC report, so hopefully Good Old Aunty is not too influenced by any any political wrangling or manilla envelopes.

I am convinced that it has other effects relating to being a beta-blocker and is certainly not used as first line med, in usual circumstances, as the report states, but I need to find more info to actually prove that.

Not that I need to of course, I was only trying to help.

Good Luck

Moss

[ThaiPauly]

TP -- I had forgotten you were diabetic. That puts an even greater urgency on your getting your BP under control (as you are already at above average risk of heart & kidney problems) but it also makes it more advisable that you consult a competent internist regarding choice of drugs, as some are more advisable for diabetics than others.

Thanks Sheryl...and everyone else that has contributed their thoughts to this thread.

it is so confusing as to the right WHO is? (No not Dr.Who)!!!

WHO is the BEST Doctor??

I have been given a waggon load of advice for which I am very grateful ...but out here(LOS) it seems a bit of a lottery getting lucky and finding someone who has a genuine interest in your health....somebody that does not just see Dollar signs flashing before their eyes when they see you walking towards them...this may be rather cynical but I have been to see the best ...and I am now in fear for my life.

I e-mailed a Doctor recommended to me up here as I could not contact him by phone ..explained my situation and 4 days later still no reply...so the BP is still up and down like a darn yo-yo..

Oh dear...what to do ..where to go

Tomorrow I will just walk into the local hospital and see where I go from there

Thanks for all your help folks..it is very much appreciated..you guys are probably saving lives if you only knew it!!!

[Mossfinn]

TP -- I had forgotten you were diabetic. That puts an even greater urgency on your getting your BP under control (as you are already at above average risk of heart & kidney problems) but it also makes it more advisable that you consult a competent internist regarding choice of drugs, as some are more advisable for diabetics than others.

Thanks Sheryl...and everyone else that has contributed their thoughts to this thread.

it is so confusing as to the right WHO is? (No not Dr.Who)!!!

WHO is the BEST Doctor??

I have been given a waggon load of advice for which I am very grateful ...but out here(LOS) it seems a bit of a lottery getting lucky and finding someone who has a genuine interest in your health....somebody that does not just see Dollar signs flashing before their eyes when they see you walking towards them...this may be rather cynical but I have been to see the best ...and I am now in fear for my life.

I e-mailed a Doctor recommended to me up here as I could not contact him by phone ..explained my situation and 4 days later still no reply...so the BP is still up and down like a darn yo-yo..

Oh dear...what to do ..where to go

Tomorrow I will just walk into the local hospital and see where I go from there

Thanks for all your help folks..it is very much appreciated..you guys are probably saving lives if you only knew it!!!

Hi TP,

It can be a lottery wherever you are.

I hope you get sorted because it is high.

Whether it is life style or meds I hope you find the answer.

Good Luck

Moss

Edited January 7, 2007 by Mossfinn

[ProThaiExpat]

http://news.bbc.co.uk/1/hi/health/3981935.stm

Lop, I have just done a very quick search and found this.

It may now be very clear that I may have done Atenolol a dis-service in saying it has been taken off as an approved drug, but it clearly states it is a fourth choice.

I was seriously under the impression that there was a danger involved with the drug as well as it being ineffective.

I will continue to search.

Good Luck

Moss

I also read that and find no mention of anything but deaths from heart attacks - nothing about number of strokes, eye troubles and such, which is a major concern I would think for those with high blood pressure. Although I do not usually take the pharmacy "money talks" too seriously wonder if the fact this medication patent expired 15 years ago and is now very cheap might have a significance. The test does not seem to address blood pressure control but only number of heart attack deaths. Hopefully my baby aspirin (also a much maligned drug) will help in that regard. As for blood pressure it most surly does lower pressure for me.

I have been on Atenolol for the five years I have been in Thailand and with no side effects and excellent diastolic control.

Doctors are not immune to drug company influence. They are also not pharmacologists. Most of them are just too busy to stay up on the chemistry of drugs, even if they were ever up on them. They depend on literature and drug company reps for their information.

As an aside, I have read a lot about protease inhibitors and it seems that many physicians are prescribing them as a drug of first choice. Sheryl, lopburi3, care to weigh in on this question?

At least, some posters have indicated they were put on them first and they worked fine.

[lopburi3]

Mossfinn:

Was not taking issue with you at all and sorry you took it that way. In fact I do thank you for providing the link. What I do take issue with is the report itself as it did not mention other factors and believe it is the duty of reporters to point that out. I also know that doctors often jump the start line when new drugs come to market under the intense pressures of business and that tests, just as polls, can often result in what the source wants to hear. I have a lot of respect for the BBC but I do not believe they are infallible, by any means. What they reported was "a study" and that is a part of the jigsaw puzzle - but there are many other pieces and they failed to mention that. Obviously if this report was conclusive nobody would use the drug as it is the same a sugar pill. But, I submit, that is not the case.

[leisurely]

Hope you get it sorted out quickly TP. I am alarmed at some of the suggestions of 'try this one, no this one is better........'.the OP is in a situation that really ought to be managed by a cardiologist IMHO and, please don't be offended, not by some unqualified (though undoubtedly well meaning) amateurs.

[Sheryl]

TP: as to who, my general guideline is to look check out the qualifications of English speaking docs on the websites of the various int'l hosps (Bumrungrad, Samitivej, Bangkok General etc) looking for:

- Board certification and/or a fellowship in a western country

- special interest or sub-specialty in your particular problem

In your case I would click on "internal medicine" and English speaking then look for the qualification above and special interest or training in Diabetes and hypertension.

Sorry to have to say Bkk but the distribution of good docs is quite inequitable in Thailand.

Also -- be awre that Asians and westerners respond somewhat differently to anyihypertensive drugs, and for that reason alone it is best to have a doc who spent a significant amount of time in the west. Also, they are more likely to be willing to explain things and involve you in the choices, having learned that westerners expect this.

Re the atenolol flap -- indeed, the fact that it is off patent is I suspect a factor. Beta blockers in general recently took a knocking from a study published in Lancet in liong-term effect on the incidence of heart disease but they have not been dis-approved anywhere that I know of and are still a mainstay of treatment for patients with hypertension and no history of cardiac disease.

Someone else said proteases inhibitors?? Never heard of them being used for hypertension..????