Hypertension

Hypertension– The Scourge of our Existence? Aggressive reaction to elevated blood pressure is very important. Most people recognize the importance of lowering blood pressure in preventing disease and cardiovascular outcomes. I have been passionate with regards to the aggressive diagnosis and treatment of hypertensive patients. Perhaps this is due to the fact that hypertension affects 92 million Americans, 60% of those over the age of 50. Perhaps it is because we know that after 50, the lifetime likelihood of developing hypertension approaches 90%. For every 20/10 increase in blood pressure reading, risk of cardiovascular death increases by 50%, as does one’s risk of stroke. In other words, a one-point drop in blood pressure translates to a 4% decreased risk of major cardiovascular event. Unfortunately, physicians are traditionally poor at initiating and/or titrating medical therapy, a well-recognized phenomenon known as "clinical inertia". Clinical inertia can be a major obstacle in effective management of hypertension. It is a complex issue that is multi-factorial in origin. First and foremost, cost issues can often limit the addition of medications to a patient’s regimen. Now with the upstart of specific four-dollar generic pharmacy plans, cost may not be as prohibitive. Physicians may be concerned about polypharmacy (use of multiple meds) and possible interactions between agents. Finally, there may be a "good enough" mentality whereby a physician may ignore a 145/95 blood pressure and view it as acceptable. Reasons for this may include a tendency to blame "white coat hypertension" or the belief that a patient’s home readings are much lower. Many patients fail to monitor their own ambulatory blood pressure readings, and thus cloud the issue even further. Patients may have their own reservations about taking medication. Factors include cost, polypharmacy and complex dosing regimens (twice or three times a day meds). Furthermore, they may be perceived as non-compliant when they are unable to tolerate the medication due to side effects. Lastly, patients may be in denial about there disease and refuse to take pills in favor of lifestyle modifications (most of which never work or are never undertaken). Because of the dramatic impact on cardiovascular health, I encourage patients to work closely with their physicians in formulating an aggressive plan in treating their hypertension. It does no good to add a medication then follow-up in six months. Studies demonstrate that lower is better regardless of the medications used. There is no reason we can’t do better.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.