Charlton Heston received the unusual distinction of having his death recorded on the front of The Times with a photograph framed by a black border, in the manner of a Victorian mourning card.

Heston's performance as Ben-Hur in the famous chariot race imprinted his persona on the memory of cinemagoers from the late 1950s onwards, and his image was kept in the public eye by television repeats of the film and other roles in, for example, Planet of the Apes. His other career as a politician, initially a Democrat but latterly a Republican who promoted such diverse causes as the rights of ethnic minorities and the interests of gun owners, is less well known.

Five years ago Heston announced that early signs of dementia had been diagnosed in him. The most common causes of dementia are Alzheimer's, vascular dementia or, often, a mixed dementia with elements of both types. High blood pressure is a factor likely to be associated with both vascular and mixed dementia. In these cases, the multitude of small strokes that frequently have their genesis in under-treated high blood pressure could well have been significant.

It is less obvious why raised blood pressure should be a possible factor in Alzheimer's dementia - until it is accepted that any cause of brain damage could trigger this condition. The initial damage to the brain's tissue might have been the result of regularly heading a heavy, rain-soaked old leather football, damaging the skull as a steeplechase jockey - or the subjection of soft, vulnerable brain tissue to the daily pounding from hypertensive cerebral blood vessels.

A raised blood pressure is initially without any symptoms and, as such, doesn't excite the concern that it should in a patient. It is too often assumed that raised blood pressure is found only in the bloated, red-faced, hard-drinking despot - but it may also affect the thin athlete.

Though it is never too late to treat high blood pressure, the sooner it is treated the less likelihood there is of patients suffering strokes, heart attacks, heart and kidney failure. Professor Graham MacGregor, chairman of the Blood Pressure Association, says that poor blood pressure control causes about 125,000 unnecessary strokes and heart attacks every year in the UK, about half of which prove fatal.

The therapeutic inclinations of British doctors are conservative. When prescribing for early, symptom-free high blood pressure, their thoughts are almost welded to the established habit of treating it with a diuretic thiazide tablet - the water pill - with or without a beta blocker. This combination was revolutionary when it was introduced, and it remains the treatment of choice for patients with a history of heart attacks, heart failure or difficult, atypical angina. However, there are now better ways to treat newly diagnosed blood pressure that achieve better results with less risk of side-effects.

The drawbacks of thiazide diuretics are that they increase a patient's likelihood of developing type 2 diabetes, and both they and beta blockers may be factors in causing impotence in men. The British Blood Pressure Association has adapted the NICE guidelines to take into account the newer drugs that control blood pressure with fewer side-effects. Patients currently taking beta blockers with or without the thiazides should never stop taking beta blockers without talking to their doctor. However, in the opinion of Professor MacGregor, they would be advised to discuss with their doctor whether it would help them to change to the newer drugs.

The question of the benefits afforded by careful selection of drugs to treat high blood pressure was a talking point at the recent meeting of American cardiologists in Chicago. The standard treatment pattern for patients under 55 with high blood pressure is either an ACE inhibitor or an ARB. There had been doubts over which was the better one to prescribe. A survey comparing Micardis (telmisartan) and ARB with a standard ACE inhibitor suggested that those high-risk patients taking Micardis suffered fewer side-effects, without any loss of effectiveness.

The same trial, which included 25,600 people at high risk of a cardiovascular event, indicated that there was no advantage to taking both an ACE inhibitor and an ARB. Although a patient's blood pressure fell farther, the outcome was not improved and the side-effect profile was worse.

The other talking point at the Chicago meeting was a survey which suggested that elderly people - ie, the over-80s - with high blood pressure could still receive major benefits from having the condition treated, even if they had not done so in the past. With treatment, strokes were reduced by 30 per cent, heart failure by 64 per cent, and there was a 20 per cent reduction in death from all causes.

The Blood Pressure Association www.bpassoc.org.uk; 020-8772 4994