Do I need stress test

[julier]

I am 50 y o female, with hx HTN for 5 yrs. 170/120 when dx. It is now stable with HCTZ 12.5 & Zestril 10. 120-140/76-90. I had carotid US when Dr thought he heard heart murmer. No murmer, but carotids < than 50% occluded. Cholesterol levels always wnl. Homocystene 6. something. CRP not done as Dr says no point as I obviously have disase. St next app in July, he plans to start beta-blocker because of some new research he read. Says he wants my BP 110/60. I do exercise every day as have gym at work. I am approx 15 lbs overweight & am trying to reduce. Avoid fats/salt. Never smoked. Strong family hx for MI/stroke. What else can I do? Thanks!

[CCF-M.D.-RCJ]

julier,

I would take hbp702 comments with a grain of salt.  The statements are too bold.  Most cardiologists and hypertension esxperts agree that diuretics are first-line agents for hypertension, period.  Beta-blockers and ACE-inhhibitors are second-line agents after that. But every patient is different, and so hypertension therapy must be individualized.  Remember, neither I nor hbp702 has ever seen you, and all we know about you is 1 paragraph!  Establishing a relationship with a trusted health professional will be key to the success of your medical care.

Good luck.

[hbp702]

Beta blockers can make it hard (or damn near impossible) to exercise (or even to do the activities of daily living, such as walking to one's car in a parking lot). I know from experience. Doctors hope that you won't have a side effect. They don't gamble and lose, they gamble, and you lose. :(

If you exercise, ask your doctor to give you something that won't kill your exercise tolerance. Beta blockers are very bad, diuretics are bad, and AT2 inhibitors, ACE inhibitors, and Calcium Channel Blockers are good. Alpha blockers are supposed to be good for active patients, but they can cause dizziness, and I've heard they don't actually work all that well. There are other types of HTN drugs, but your doctor will very likely not prescribe them, and they have a lot of side effects (centrally acting agents, direct vasodilators, etc).

Make sure your doctor has EXTREMELY compelling (e.g. "ALLHAT says so" doesn't cut it, especially since studies often contradict each other (see the Australian HBP study), and nothing in medicine is certain) reasons to put you on specifically a beta blocker or diuretic in spite of the fact you wish to maintain an active lifestyle.

I'm not a doctor, but I am a patient. I have learned a lot from research and experience. I have learned because I HAD to. Had I trusted the doctors 100% I would likely be very damaged or DEAD.

[CCF-M.D.-RCJ]

julier,

Thanks for the question.

From what you have told me thus far, it make sense to continue to lose weight and to maintain an exercise regimen that your doctor approves.  Aggressive blood pressure control also makes sense.  I'm not sure what research you are referring to with t he beta-blocker.  

The current guidelines would not support the use of a "statin", based on what information you gave, but many patients are choosing to begin these medicines anyway.  The decision to have a stress test depends on a history and physical and cannot be reliable recommended or discouraged via the internet.

Hope that helps.