HERE provided a fantastic review on hypertension therapy. He claims that 3.8 billion prescriptions are written in the United States each year, but that more than half of them are taken wrongly or not at all. It is obvious that successful hypertension treatment necessitates a shift in patient mindset rather than a new medical discovery. We have the tools, but we don't use them.
The American Heart Association recently released new guidelines that decrease the blood pressure treatment goal for most individuals to 130/80. The first step is to take an honest look at your diet and exercise routine in order to avoid being overweight or obese. If blood pressure remains high despite these efforts, medication is prescribed, as well as lab tests to rule out other possible causes. Doctors can follow a step-by-step protocol; typically, diuretics are prescribed first, followed by lisinopril, an ARB, or a calcium channel blocker like amlodipine. Three or even four medications may be required in the end. It's all extremely straightforward and effective. So, what exactly is the issue?
The skepticism of physicians is the first impediment to good therapy. According to what I've read, most patients don't trust and even despise their doctors. They continue to visit offices, but they have no intention of following instructions. They attend because their spouse or mother insists ongoing, or because "the last doctor was far worse." This mistrust can be a family or even a community issue. A doctor's icy demeanor or a sense of disinterest might sometimes set it off. The doctor may be sensitive or kind, but he or she is rushed and harried by an unreasonable schedule.
Another impediment is the fear of negative side effects. Men discuss the effects of blood pressure medications "on their sex." They tell stories about friends who have "lost their manhood." Without assistance, older women may be afraid of dizziness and a disastrous fall. "I've heard them make you fat or make your hair fall out," younger women may have heard. "Those drugs will develop hair on your pancreas," the internet says. "You should toss them out and take turmeric instead, or at the very least consult a naturopath." Regrettably, that alternative health care salesman is probably smoother and more convincing on the surface than your doctor.
It's also vital to consider the "sick role." High blood pressure is an illness that usually has no symptoms. The long-term implications are disastrous: stroke, congestive heart failure, and kidney failure. You must admit that you are "ill" if you agree to take a long-term drug. This is not the same as taking antibiotics for ten days to treat an ear infection. It's reasonable to wonder, "If I'm feeling OK, why do I need this pill?"
After four decades of practicing medicine, I've come to the conclusion that the decision not to take a drug is usually done very carefully, rather than due to forgetfulness or "simply being foolish." Because the financial expenses and health effects of untreated hypertension are overwhelming, a contract between doctor and patient is required to address this problem.
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