August 26, 2013 I published this article last year. Since then, the diagnosis and treatment of hypertension have been remarkably improved through the use of a new, non-invasive, in-office device. Stay tuned for more info and find out how you can improve your cardiovascular health. In an article published in USA Today entitled,
August 26, 2013
I published this article last year. Since then, the diagnosis and treatment of hypertension have been remarkably improved through the use of a new, non-invasive, in-office device. Stay tuned for more info and find out how you can improve your cardiovascular health.
In an article published in USA Today entitled,Millions don’t have their blood pressure under control , written by Nanci Hellmich, the author addresses the fact that 67 million people with hypertension do not have the disease under adequate control.
There are a multitude of reasons why so many patients with known high blood pressure walk around with poorly controlled BP and an increased risk of cardiovascular and/or renal/kidney disease. In my experience, the number one reason is my patient’s belief that his elevated BP is the result of the stress of being in his physician’s office.
“Doc, my BP at home is always normal. I’m always stressed when I visit the doc. I think I have white coat hypertension.”
Let’s dissect this response. If coming to my office stresses you enough to raise your BP, what does a bad day at the office do to your BP? What does having a fight with your daughter do to you? How about when you get pulled over for a speeding ticket or find yourself in the “ten items or less” line and the person in front of you has 20 items and coupons? Stress seems to be everywhere.
Most people who check their BP check it while at rest, in the morning, when they aren’t stressed. Even if you check your BP when you are stressed,
most of the studies involving the risk of high blood pressure are done on “in office” BP measurement.
Reason number two for the unacceptable number of patients with uncontrolled hypertension is failure to follow up with the physician. In “Your Doctor, The Master Chef,” I equate my medicines to the spices in my kitchen cabinet. When I make Linguine and Clam Sauce, I don’t just add a little garlic and serve it, I add a little garlic, let it simmer, repeating the process until it is perfect. Then I serve it. When it comes to the treatment of hypertension, the doc must add medications over time until the BP is perfectly controlled. A medical intervention is followed by a number of weeks during which the patient’s BP is monitored (simmering phase) followed by a check-up and adjustment of medications until the BP is well controlled.
The third reason for uncontrolled BP is that patient needs change as they age. The medication regimen that worked for years may all of a sudden stop working. If my patient and I become complacent with his treatment and fail to monitor his success, we miss an opportunity to adjust his medication and, perhaps, stop a heart attack or stroke.
Reason number four is my patient’s failure to do his part in the care of his elevated BP. I have written multiple articles about the positive effects of diet and exercise. I have extolled the success of many of my patients seeking to inspire others. There are a multitude of excuses for not dieting and exercising. All excuses pale in light of the chest pain you experience during your first heart attack.
There are lots of other reasons for 67 million hypertensives to go uncontrolled and at risk. Yes, medication is costly. A 4 day stay in the
cardiac intensive care unit is very expensive, as well. Denial is a major reason.
“Doc Segal, nobody in my family has ever had a heart attack or stroke. I’ll lose some weight and cut out salt. I’ll start exercising. I don’t want to take more medication.”
Mr. Denial, last year you promised that you would take better care of yourself. Instead, you gained 15 pounds over the last year. You don’t want to be the first in your family to meet the cardiovascular surgeon, do you? Let’s increase your medications and we can reduce it when you are healthier.”
If you have hypertension, get it under excellent control. Don’t do half a job. It may be your life that you save.