The Physician's Approach to Hypertension in the Office

The family physician must take a comprehensive approach to managing hypertension in the office, to prevent the cardiovascular complications of atherosclerosis. Many risk factors interact to produce the vascular damage which culminates in stroke, myocardial infarction and heart failure. With each patient all the risk factors must be assessed and a specific treatment plan developed. Reduction of elevated blood pressure alone has no consistent effect on the incidence of heart attacks. Pharmacological therapy is usually required for patients with persistently elevated diastolic pressure; this should not exclude the concurrent use of non-pharmacological interventions. As the side effects of hypotensive drugs are common and non-specific, step-down therapy should be considered in those patients whose blood pressure has been controlled for one year.