Hypertension: Take Those Pills Or Face The Consequences

Hypertension: Take Those Pills Or Face The Consequences

 Neil Chesanow wrote an excellent review on the treatment of hypertension. It states that 3.8 billion prescriptions are written in the United States each year, but more than 50% of them are filled incorrectly or not at all. It is abundantly clear that successful treatment of hypertension requires a change in the patient's mindset, not a revolutionary breakthrough in medical care. The American Heart Association recently wrote new guidelines that lower the goal for blood pressure treatment to 130/80 for most patients. The first step is an honest assessment of diet and exercise to prevent overweight or obesity. If blood pressure remains high despite these measures, medication and laboratory tests to look for other related conditions are ordered. Doctors have step-by-step instructions to follow, usually prescribing diuretics first, followed by lisinopril, an ARB, or a calcium channel blocker such as amlodipine. Eventually, three or even four medications may be necessary. It's all cut and dry and works very well. So why is there a problem? The first obstacle to successful treatment is distrust of doctors. I have read that most patients do not trust their doctor and may even hate him. They continue to visit the office but have no intention of doing as they are told. They come because their wife insists, or because their mother goes there, or because "the last doctor was even worse." Sometimes this mistrust is a family or even community problem. Sometimes it is caused by a cold attitude of the doctor or a feeling of disinterest. A doctor can be very caring or compassionate, but rushed and plagued by an impossible plan. Another obstacle is the fear of side effects. Men talk about the effect of blood pressure medication "on their gender." They share stories of friends who "lost their manhood." Elderly women may fear dizziness and a catastrophic fall without access to help. Younger women may have "heard they make you fat or make your hair fall out." The internet is buzzing that "those pills will make you grow hair on your pancreas." “You should throw them out and take turmeric or at least see a naturopath. Sadly, that alternative health practitioner is probably smoother and more superficially persuasive than your doctor. The "sick role" is also important. High blood pressure is generally a disease without symptoms. It's the long-term consequences: of stroke, congestive heart failure, and kidney failure that are catastrophic. By agreeing to long-term medication, you must accept that you are "sick". This is very different from taking antibiotics for ten days for an ear infection.  After four decades as a doctor, I have concluded that the decision not to take medication is generally made very deliberately, not because of forgetfulness or "plain stupidity". A doctor-patient contract is necessary to correct this situation, as the dollar cost and health consequences of untreated hypertension are staggering.