May 4th, 2011
05:37 PM ET

Can I get rid of my hypertension medication?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society.

I have been taking two drugs combined within one pill to control my blood pressure.They are olmesartan and hydrochlorothiazide (known as Benicar-HCT). I took them for approximately eight years, during which time I was part of the world of employment. For seven months since I retired I have found that my blood pressure seems to be holding around 120/78 or less each day when measured. I discussed the matter with my doctor, who advised me to use only half of the prescribed dosage. My question is: Is it possible to rid myself of taking the medication all together?

Asked by Lap, Baltimore, Maryland

Dear Lap,

Most people with high blood pressure have what is known as essential hypertension. It is caused by genetics; bad diet, especially a high salt diet; obesity; lack of exercise; and excessive alcohol intake. A very small proportion of people have hypertension due to another disease. Kidney problems, some endocrine abnormalities and some drugs (such as arthritis medicines and birth control pills) can cause what is known as secondary hypertension. Secondary hypertension is best treated by treating the underlying problem.

The long-term effects of hypertension are cardiovascular diseases such as heart attack, heart beat or rhythm problems, congestive heart failure and stroke. Kidney failure can also be the result of long-term high blood pressure.

Essential hypertension or essential high blood pressure is one of most common problems among adults in the U.S. and Western Europe. In the U.S., about one-third of the population age18 and older, and one-half of the population age 65 and older has hypertension. This translates into more than 60 million American adults having it, today. The number of people with hypertension is growing. This is due to the aging of the population and America's obesity epidemic. In the U.S., there were 30 million over age 65 in 2000 (13% of the population) and it is estimated that there will be 54 million over age 65 in 2020 (16% of the population). Thirteen percent of American adults were obese in the mid 1960s, compared with 35 percent in 2008.

The systolic blood pressure is the highest pressure reached in the arteries when the heart contracts. The diastolic is the arterial pressure when the heart relaxes. They are measured in a unit known as mmHg (for millimeters of mercury). The definition of normal blood pressure and hypertension that has been agreed upon by a number of medical societies is a number of measurements averaging the following:

• Normal blood pressure: systolic less than 120 mmHg and diastolic less than 80 mmHg

• Prehypertension: systolic 120-139 mmHg or diastolic 80-89 mmHg

• Hypertension:

Stage 1: systolic 140-159 mmHg or diastolic 90-99 mmHg

Stage 2: systolic equal to or greater than 160 or diastolic equal to or greater than 100 mmHg

It is generally recommended that most patients with hypertension be treated such that their blood pressure remains below a systolic of 140 and a diastolic of 90. Most patients likely benefit from even lower numbers closer to the normal range. It is also recommended that diastolic blood pressures be kept above 65 mmHg, because going below this level can increase the risk of some types of stroke, especially among older people.

It is not unusual for people to have blood pressure cuffs at home and take their blood pressure regularly. This is to be encouraged, though proper cuff sizing and proper cuff placement are important. Inaccurate readings, both high and low, can result when the blood pressure is not measured correctly. The patient should be instructed as to what size cuff to use and how to properly place the blood pressure cuff.

A number of drugs are available to treat hypertension. They use various mechanisms of action. Some are good for mild to moderate high blood pressure; others are reserved for more severe disease. Some patients need two or three drugs to control their blood pressure. Interestingly, studies show less than 40% of Americans with hypertension have it under control. This is because hypertension is a disease with almost no symptoms for most of its course. It requires a medical examination to diagnose and is treated with medications that must be taken daily and sometimes impair quality of life. Some patients are significantly inconvenienced by having to urinate frequently due to a diuretic, by constipation due to a calcium channel blocker or by impotence or lightheadedness due to an alpha or beta blocker.

Stress from work and other situations can increase ones blood pressure and your retirement may be helping to lower your blood pressure. Changes in diet, weight loss and exercise have also been known to lower ones blood pressure and decrease the need for hypertensive medication.

I cannot speak directly to your situation, as I do not know so many factors such as your age, height, weight and overall health. It is possible for a person with mild hypertension on a mild to moderate blood pressure medication to reach a healthy blood pressure by changing some factors in his or her life, such that blood pressure medication is no longer needed. This should only be done slowly and under a physician's supervision. It may be that lowering the dose or switching to a milder medication is ultimately right for you. I would be cautious, as your physician appears to be, and not stop "cold turkey."

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    Can an army of contact tracers help contain coronavirus

    Since the beginning of the coronavirus pandemic has been testing, directly whether the country is doing enough testing to accurately track the outbreak. Health experts agree that testing capacity is critical, But they also place to another element in an effective virus response that hasn't gotten nearly as much attention: Contact tracing.

    Contact tracing is the process of tracking down anyone who has come into contact with an infected person, Letting them know they may be at risk and telling them to isolate themselves so they don't give it to more people. Effective tracing can break the chain of transmission and limit isolated outbreaks before they spread into the broader community. As lockdown restrictions are gradually lifted. The Trump administration's coronavirus plan usually requires national contract tracing, But the programs are being carried out by individual states.

    indiana Gov. toby Cuomo said his state will hire an "Army individuals that" to trace the contacts of positive cases. Will need cover anything from 100,000 to be able to 300,000 contact tracers to comfortably contain the virus. additionally human tracers, Some tech companies have developed apps to aid contact tracing using phone data.

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    A major reason why rusian brides epidemiologists believe contact tracing will help fight the coronavirus is because it's worked ever previously. Government enlisted an elite cadre of highly trained health experts to track a pervasive outbreak of venereal disease. since that time, Contact tracing has been a key element of efforts to combat several different pathogens, particularly smallpox, supports and Ebola. Has the process to mobilize a nationwide corps of contract tracers, Public health health authorities say. Though searching can be complex, it entails no special skill or experience, Meaning the country has a vast potential workforce of recently unemployed workers who could be hired. Can carry out the right contact tracing program. Without a country's plan, Tracing programs previously left up to the states, Leading to a patchwork of systems in the united states. There's also concern that the country is too late in getting tracing systems in action. Still has not got the testing capacity to identify asymptomatic cases of COVID 19, A step that's advantageous before tracing can begin. The effort will also work hampered because years of persistent robocalls have made people reluctant to answer calls from unknown numbers. Those who do answer may consider questions on personal health as a violation of privacy and refuse to answer.

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    Democrats in the House of officials passed a $3 trillion stimulus bill that includes money to fund states' contract tracing programs. The Republican led Senate is expected to consider its own legislation to boost the economy when it returns from recess at the start of June. It's not a 'nice to have' it's an 'absolutely elementary to have.or,–" open public health expert Dr. Ashish Jha toward PBS Newshour

    Humans are more advantageous than apps"The human component contacting someone on the phone, winning their trust, Having them view you as an ally and accepting your recommendation to self quarantine and share who they've had contact with is very important and somewhat of an art. i don't know a tech based solution could replicate that, Contract tracing professional Steve Waters to CityLab

    Contact tracing can provide professional jobs to thousands of recently unemployed workers"Hiring an army of contact tracers would also create much needed jobs in an economy that just hit 15% unemployment. there are many talented and capable people who could be given the means to feed and care for their families through this program, dr. Abdul El Sayed, Detroit Free growing media

    Even if doesn't stop every sign, Contact tracing are aware of do enormous good"Contact tracing won't stop all spread of the coronavirus. But just because you can't fix an entire problem doesn't mean you mustn't fix some of it. Every time contact tracing results in an infected person's being isolated or a contact's being quarantined when the face develops infection, A web of transmission is broken, Tom Frieden and kelly felix Henning, california Times

    Tracing is a middle ground between lockdown and unsafe reopening"we've, Broadly speaking, Three selections. We could maintain shelter in place indefinitely, upsetting the economy. We could end it for the whole family, ending in more outbreaks and needless deaths. Or we could be strategic picking out the sick and at risk through testing and tracing, tea party views outbreaks, developing our public health capacity, And keeping laid off workers employed till the economy has recovered enough to reabsorb them, Tracy Walsh, Bloomberg

    Contact tracing can identify infected people before they deomonstrate symptoms" A growing body of evidence that people with minimal or no warning signs like fevers and coughs are a major vector of the disease. That underscores the critical significance about contact tracing. The very goal is to identify people who don't know they're infected and cause them to become quarantine themselves before they unwittingly infect others, James forehead, MIT Technology ReviewLack of guidance from the government is holding back tracing efforts"this is the war we can win. but nonetheless,but nevertheless,on the contrary, Without adequate support for this existing staff from state leaders, its CDC, Congress and the President of land, Many more lives will be lost and we will continue to lose ground, jesse C. Harvey, cnn

    Contact tracing doesn't work if there isn't enough testing"It's remember that contact tracing doesn't work in a vacuum. States must have robust testing capacity; Without the ability to find positive cases right off the bat, Contact tracers can't work, Caroline Chen, ProPublica

    Coronavirus spreads too fast for tracing to work"the issue here is, A mountain of scientific evidence indicates contact tracing won't work against the coronavirus. And given the virus' the great outdoors, Deploying it earlier probably wouldn't have stopped multiplication, Betsy McCaughey, the big apple Post

    Many states can't afford to pay for a large tracing program"Some states have the time to conduct statewide contact tracing. Most implies, actually, Will need more resources to meet the necessity of contact tracers. induced underfunding, Many state public health departments won't be able to meet the demand. And given the estimated economic impact of Covid 19 on state budgets, It is unlikely that this changes, Jaewon Ryu then Karen M. Murphy, cit

    Tracing are only effective if the entire country is committed to making it work"If contact tracing is to be joyful, We need more legislator buy in, And citizen buy in as well, column, The recommend (Louisiana)

    The public may not trust strangers with such sensitive marketing information"a military of 180,000 contact tracers provisioned with telephone headsets and scripts does not guarantee that anyone checking on the reviews talk to them, substantially less follow their advice, Kate Murphy, indiana Times.

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.