by Stewart B. Segal, MD
SERVICE MANUAL – HYPERTENSION
Patients with high blood pressure require the same routine yearly preventative exams as those without high blood pressure. In addition, they require both daily home monitoring and quarterly to biannual office visits to maximize their care. Hypertension, if left untreated or poorly controlled, is associated with heart disease, stroke and renal failure. Like diabetes, hypertension is best controlled with a team approach. The most important member of the team is the patient.
Daily home maintenance is essential and not just restricted to blood pressure monitoring. Patients with hypertension should monitor their diets closely. Many patients with hypertension are sensitive to salt intake and a low salt diet is recommended. The D.A.S.H. diet (http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf) is also highly recommended. Weight control is essential. A daily exercise routine plays an equally important role in the management of hypertension. Probably the most difficult goal to accomplish is stress management. While stress plays a role in almost every disease process, its impact on patients with hypertension is marked.
Quarterly or biannual medical checkups (dependent on severity of blood pressure and medication requirements) should include a careful review of your home blood pressure measurements, office standardization of your home cuff by comparing your office blood pressure on both your home monitor and the office blood pressure monitor, an exam of your eyes, heart and lungs, and laboratory testing including kidney function testing and cholesterol level, as well as tests to monitor any medication you are taking.
When caught early and treated aggressively with diet, exercise and medication (when needed), many people with hypertension can reverse or markedly slow the progression of this disease and limit its effects on heart, kidney and brain. As demonstrated by the patient I wrote about on Tuesday, November 9,2010 living a medication free lifestyle is possible. However, even when blood pressure control is achieved, you have to adhere to the maintenance routine for life. You cannot go back to ignorance and assume you are cured.