Last month, the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, released new guidelines on treatment. The biggest change is that diuretics ("water pills," "fluid pills") should be used in all high blood pressure patients unless there is a compelling reason to use a different drug.

Diuretics alone may control blood pressure adequately in many patients. Often, however, two (only occasionally three) medications may be required. After diuretics, beta-blockers are the second most common family of drugs prescribed. Other second-line drugs are angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and calcium channel blockers.

A high percentage of patients who require multiple drugs to achieve blood pressure goals can now be treated with generic drugs. Diuretics have long been available in generic form as have beta-blockers. Several ACE inhibitors that were available only as branded products in the 1990s are now also available in generic form.

Another important change in the guidelines is the recognition of a "prehypertensive" state. Patients with blood pressure between 120-139 over 80-89 are considered prehypertensive. Such patients should aggressively pursue health-promoting lifestyle modifications to prevent coronary artery disease, especially if they have other risk factors such as obesity, sedentary life-style, diabetes, elevated cholesterol or triglycerides, or nicotine habituation.

Prehypertensive patients should quit smoking, strive to achieve and maintain ideal body weight, walk two miles in thirty minutes three times weekly, and follow a prudent diet. The same measures are strongly recommended for those who are already hypertensive, even if they are already taking medication. Lifestyle modification will often decrease, and sometimes eliminate, the number and dosage of medications required.

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