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Q: I am writing to you about my mother and her sister. Both are about 60 years old and in overall good health, but they have very high blood pressure. They are both taking medications and have side effects from them.

I would like to know more about high blood pressure and whether I have a greater chance of suffering from this condition when I get older?

- I.G., Bethlehem, Pa.

A: High blood pressure is not a disease. It is a sign of a problem. But even though high blood pressure is one of the most common abnormalities, 95 percent of the time the underlying cause is not known.

In only 5 percent of people with high blood pressure is an underlying cause found. For these people, treating the cause is the first, and maybe the only, step required. Various causes include: the use of drugs such as estrogens; kidney disease; endocrine diseases such as hyperthyroidism and Cushing's syndrome; and pregnancy.

A very common cause of high blood pressure readings is obesity. Many obese people do have high blood pressure. Some, however, have falsely elevated blood pressure readings simply because they have more fat tissue in their arms.

Some people are called "salt sensitive" because their blood pressure will be higher if they are eating a high, or even normal, amount of salt in their diet. The only way to find out if you are salt sensitive is to go on salt restriction and see what happens. Salt sensitivity can be an inherited tendency, so you should talk with your mother and sister about this.

Many people will have increased blood pressure if they consume alcohol excessively, smoke cigarettes, or take some anti-inflammatory drugs. Again, the only way to find out if these behaviors are to blame would be to stop them and track the difference.

Much has been written about stress and high blood pressure. Although stress, both psychological and physical, does increase blood pressure, it does not typically cause chronic increases in blood pressure.

When high blood pressure results from disease or an unhealthy lifestyle, treating the disease or altering behavior will yield greater health benefits than taking blood pressure medication. Stopping smoking, for example, improves your entire health, whereas drugs often have unhealthy side effects, as both your mother and sister have found out.

It's important to note that medical studies have shown that about one in five people who are taking high blood pressure medications will have normal blood pressure when taken off the drugs. From time to time it's worth working with a doctor to test the need for continuing.

It can be very confusing for doctors and patients to assess the benefits and risks of using drugs to treat high blood pressure, and deciding which one to use. There are more than 50 different drugs, falling into nine classes, to treat high blood pressure.

Two classes of drugs, diuretics and beta-blockers, have proved to be equally effective treating most people and are generally less expensive than the alternatives. For these reasons, and because doctors have had more experience with them, these drugs are generally recommended as the starting point of drug treatment for high blood pressure.