Q:What are possible alternatives to drug treatment for (borderline) hyper tension and raised pressure in eyes, especially early middle age? Also, when drug treatment is necessary, how to minimize side effects and not worry? J. H., Switzerland.

A:A mildly high blood pressure is common and not a great cause for concern, particularly as blood pressure rises gradually with age. Despite what is usually published as a "high" level, a normal level for older people is somewhere around 140/90 mmHg (that is millimeters of mercury under pressure).The first number stands for the "systolic" pressure in the arteries as the heart contracts and pumps out blood. The second, the "diastolic" number, is the pressure in the arteries as the heart relaxes and fills up with blood again.

If you are over 50, some experts believe only a diastolic level of 100 mmHG and over and/or a systolic level of 180 mmHG and over should be treated.

The only reason to keep monitoring it is because it is linked with strokes, kidney disease and, surprisingly, to a lesser degree with heart attacks. Although no one knows what brings on high blood pressure, it does seem to be hereditary. Weight also plays a role; sometimes dieting is the most effective way to lower your blood pressure. (For cardiac patients told to stop smoking it's important that they take steps not to gain an inordinate amount of weight!)

According to nutritional expert Dr Stephen Davies in Nutritional Medicine, much high blood pressure can be controlled by diet whenever possible. Even some of the more conventional doctors agree on that.

The first and well established point is to exclude additional salt from your diet and avoid salty foods. What is less known is the role of potassium in helping to control high blood pressure. Much potassium naturally present in vegetables gets lost in the cooking water when they are boiled for long periods of time in a large pot of water.

For anyone with high blood pressure, it's a good idea to eat potassium rich foods (like bananas) and to steam or cook vegetables as minimally as possible.

There has also been some research into the role that calcium and magnesium play in hypertension. Some studies show a link between low levels of calcium and magnesium and raised blood pressure. Although no studies have been done about calcium supplements, some researchers have reported success with magnesium supplements, particularly when given to patients with hypertension on diuretics, which tend to deplete magnesium.

Other possible sources of high blood pressure could be a diet high in refined sugar, saturated fats and tea and coffee. Two to three cups of coffee a day can raise your blood pressure levels temporarily, although a long term association hasn't been proven.

Besides cutting down on coffee and tea, it's also a good idea to cut down on your intake of animal fats and to use quality polyunsaturated margarines and cooking oils whenever possible. It's also well to remember that in several studies, vegetarians had lower blood pressure than meat eaters. Some quarters also believe that a high fibre diet or more fruits, vegetables and whole grains can also lower blood pressure.

According to Davies, other substances which can raise blood pressure are The Pill, liquorice (!), toxic minerals like lead and cadmium, and some of the non steroidal, anti inflammatory (NSAIDs) drugs, used to treat arthritis.

Mild aerobic exercise and numerous methods of stress management such as yoga, meditation or Autogenic Training can help get your blood pressure under control. And although a little alcohol every day can actually lower your blood pressure, it's a good idea to restrict your intake to no more than one drink a day.

If you do plan to take supplements or change your diet in any way, it is vital that you do so through consultation with a specialist in this kind of area.

As for drugs, these are vastly overused and unnecessary for most mild cases of raised blood pressure. One study found almost half the patients over 50 taken off hypertensive drugs had normal blood pressure a year later.

They also carry the risk of a host of side effects. The most usual drugs for hypertension are beta blockers, diuretics, reserpine, methyldopa and clonidine. These can all cause depression, impotence and sexual dysfunction, loss of appetite, nausea, tiredness or hypotension ( dizziness from a sudden drop in blood pressure on standing up), resulting in falls and broken bones. Hypertensive drugs are a major cause of hip fractures in older adults.

Hydralazine hydrochloride used for more than six months can also lead to a lupus erythematosis like condition. Captopril, another blood pressure drug, can cause bone marrow depression. Many of these drugs are contraindicated if you have asthma or diabetes.

As there is no drug that you can take without running the risk of side effects, the best treatment is to start with the dietary regime. If your blood pressure continues to be raised to what are considered dangerous levels, then and only then should you contemplate a drug at half the standard starting dose, increasing only if absolutely necessary.

One thing to check is whether any other drugs you are taking could be the cause of raised blood pressure. Amphetamines and the tricyclic antidepressants, particularly when taken with decongestants or antihistamines, significantly elevate blood pressure.