Do you take medication to control your high blood pressure? In this Health Alert, Johns Hopkins cardiologist Roger S. Blumenthal answers questions of concern to many of us.

Q. I am not averse to taking medication, but my doctor told me that once I start with a hypertension medication, I would have to take it forever. I am only 51 years old, so "forever" seems like a real long time. What if I were able to stop smoking, and to lose the 40 to 50 pounds the doctor recommends? Would I still need the high blood pressure drugs? Oxford, MI

Dr. Blumenthal answers: Weight loss is highly beneficial in terms of dropping blood pressure for most people. Exercise can also be very helpful in reducing blood pressure in individuals with mild to moderate levels of hypertension. Moderate intensity aerobic exercise has been shown to drop systolic (top number) pressure by 10 to 11 mmHg, and diastolic (bottom number) pressure by 7–8 mmHg.

But the answer to your question about medication depends on the degree of your high blood pressure. It is certainly possible that if your blood pressure is only mildly elevated, a combination of weight loss, exercise, and smoking cessation could lower your blood pressure to the point where medication is not needed. In general, though, most people with high blood pressure tend to remain on their antihypertensive medication for life and often require additional medication to control blood pressure as they age.

Q. My doctor recently started me on hypertension medication. He said my blood pressure was slightly elevated and had not gone down since my exam last year. If my blood pressure is really not that high, is there a risk that the drug will lower my blood pressure too much? Hanover, NH

Dr. Blumenthal answers: It is possible that an antihypertensive medication can work "too well," and cause someone to become hypotensive, that is, for their blood pressure to drop too low.

Physicians typically try to prevent this adverse effect by starting with a low dose of medication and slowly increasing the dosage until optimal blood pressure is achieved. Occasionally, a patient may be more sensitive than expected to a hypertension drug, and sometimes interactions with other medications may enhance the drug's action.

Given that your blood pressure is only "slightly elevated," it is likely that your doctor has prescribed a low dose of medication. If you monitor your blood pressure regularly after starting on the drug, you should be able to avoid hypotension.