I have not see this for years
I'm not good in this blog activities

You didn't understand what I wanted to say
After these years I still think I'm right and that early treatment with drugs may abort the Hypertension process whatever the original ischemia was known or not.
I believe that Essential HT is very heterogenous
I'm with life style + pharmacologic therapy + correction of hyperuricemia all from the start
in this way pharmacologic therapy would have to be stopped after may be a year and the HT would be cured.
it is the same like the cure of DM type 2 by early life style changes

Now I'm ID specialist

Paradoxically lower recumbant than sitting blood pressure reading

It is physiologically normal to find a difference in BP reading between the sitting and recumbent position. The recumbent systole is more than the sitting systole by usually a net 10mmHg.

In my general internal medicine clinic I usually have ~50% of cases having HT, about 10% of these have a recumbent BP reading lower than the sitting one, what I call a reversed response to gravity or body position.

This was found to have no relation to whether the patient is diabetic or not and is frequently found in hyertensive or normotensive patient not using any blood pressure lowering medication.

This phenomenon is related to a positive family history of HT even if the patient is not hypertensive himself at the time of consultation.

This normotensive cases of paradoxical BP reading may be more susceptible to develop HT in the future than those with a family history of HT but no paradoxical BP reading phenomenon.

The blood pressure should always be measured in the sitting left arm and the recumbent right one for every patient (right and left would make it less likely to miss this phenomenon)

Type 2 diabetes mellitus on top of type 1

Long standing cases of IDDM live in the same pathologic environement resulting in obesity and related disorders or the metabolic syndrome. This patients usually develop insulin resistance and progressively need larger doses of insulin which would aggravate weight gain.

The use of insulin sensitizers like metformin and thiazolidinediones may have important roles to ameliorate this situation.

Note that thiazolidinediones have salutary resluts only in black subjects.

It is not yet clear if Avandia really have a tendency for the induction of IHD although a shift to Actos may be wise.

Patient usually do not realize the imporance of a cheap durg like Metformin.

The talk about the early use of drugs for essential hypertension

The public statement in guidelines used to be (use non-pharmcologic measures for six months before deciding on medication). Some authorities are questioning this point. I'm with this and I want to make a simple reasoning for early pharmacologic therapy.

To start with, know that Essential hypertesion have a cause whether the exact mechanism is known or not and I think the term essential would favor keeping it unknown.

Whatever the cause may be, if the BP stayed high for a while it may soon produce a damage in some part of the arterial system. This would result in subclinical ischemic changes somewhere, not necessarily the kidneys. Autoregulation would automatically lead to an increase in the BP in order to normalize the blood flow to this as yet still unknown arterial bed. Now we have already two causes for the hypertension. If the BP stayed high for a while further a third cause would eventually result. In ohter word a vicious circle would have been created.

So my opinion is to start pharmacologic treatment fully complying with guidelines side by side with a low salt DASH diet and always check and keep serum uric acid below 5.5mg/dl.

In Egypt there is a misbelief among patients that we should all fight to change, that is "if I started taking medicine for hypertension I will take it for life, so I will not take it. I will wait until I'm sure the doctor have right" By so doing the doctor will certainly have right.

I'm sure that if we treated essential hypertension early with drugs doctors may not have right. I have seen in many cases the hypertension cured.