Taking your medicine.

Rob had a birthday last was a good time. as a party, complete with family, friends, gifts, and a cake with 41 candles. Rob felt great.

He had a routine checkup the day after his birthday. It was not a good time. He had a physical exam, complete with temperature, pulse, and blood pressure. And he did not feel good about the results.

Rob's blood pressure was 220/140!

The physician rechecked Rob's blood pressure several times. Noting no significant change, she immediately administered medication to reduce Rob's dangerously high blood pressure.

Rob was taken by surprise. He knew that his blood pressure had been a little elevated in the past, and he had even taken blood pressure medication for a period of time. But recently he had been exercising regularly, watching his diet, feeling good, .. and neglecting his medication.

Initial treatment for mild hypertension (high blood pressure) includes exercise, weight management, and reduction of dietary salt. When these important measures fail to normalize blood pressure, medication may be required.

A recent issue of The Medical Letter lists more than 50 separate drugs for treating hypertension. These drugs have tongue-twisting names like bisoprolol, betaxolol, diltiazem, amiodipine, hydrochlorothiazide, and benazepril. Fortunately, complete knowledge of every individual drug is not necessary for appropriate management. The most commonly used medications are grouped into four general drug classes with similar characteristics and mechanisms of action. Depending on the circumstances physicians select drugs from one, two, or more classes to provide effective control of hypertension.

Diuretics, commonly called "water pills," have been used for many years in the management of hypertension. Studies clearly show that hypertensive patients treated with diuretics have decreased mortality, that is, they are less likely than untreated patients to experience a fatal complication of the disease. A common side effect of diuretics is the loss of potassium from the body. This potential complication should be monitored by the physician and is easily managed by supplementation of potassium in the diet or from other sources. Diuretics are now prescribed in much smaller doses than previously with no apparent loss of efficacy, but with significant reduction in side effects.

Like diuretics, beta blockers have been shown to be effective in the treatment of hypertension and in decreasing mortality in hypertensive individuals. Beta blockers may be less effective in African-American patients, and have generally not been recommended for patients with other diseases such as diabetes, heart failure, and asthma.

ACE inhibitors, the third class of drugs, are effective and well tolerated for treatment of hypertension. A common complication of treatment is chronic coughing. Allergic reactions are far less common, but have been reported. ACE inhibitors are not recommended for treatment during pregnancy.

Calcium channel blockers work by relaxing the small blood vessels, thereby reducing the resistance to blood flow and lowering blood pressure. These medications may also affect the electrical pathways of the heart and should be used with caution in patients with heart disease. While both calcium channel blockers and ACE inhibitors are effective in lowering blood pressure, only diuretics and beta blockers have been shown to reduce mortality and prolong life.

The physician's challenge is to select the appropriate drug or combination of drugs to control blood pressure and minimize side effects. This requires an intimate understanding of each patient's health profile and careful ongoing observation of the response to treatment.

The responsibilities of hypertensive individuals are to maintain regular surveillance of blood pressure, including physician checkups, take medication as prescribed; and report side effects and complications promptly.

Rob is now on medication and his most recent blood pressure reading was 142 over 90. Initially he had some difficulty adjusting to the medication and to the reduction of his blood pressure, but is now feeling much better. He has made a personal commitment to watch his blood pressure more carefully and take his medication regularly. More important, he has made a critical investment in good health and happy birthdays.

RELATED ARTICLE: Keeping on Course With Your Medications

Although drugs can't cure high blood pressure, they can control it. The American Medical Association offers these tips to remember while taking hypertension medications. And remember, maintaining a healthy lifestyle may help reduce the amount of medication you need:

* Don't stop taking your medication without your doctor's advice, even if you feel fine or your blood pressure has returned to normal.

* Take your pills at the same time every day with some daily activity, like brushing your teeth.

* If you miss a dose, start back on Schedule with your next dose.

* Don't change the amount of medication you're taking without talking to your doctor.

* Check with your doctor before taking over-the-counter medications.

Ted Hamilton, M.D., is medical director Of Florida Hospital Centra Ca" in Orlando, Florida.