| Motivation
to fight blood pressure
There was an interesting article that appeared in the Journal of
the American Medical Association last year.
Written
by the Joint National Committee on Prevention, Detection, Evaluation
and Treatment of High Blood Pressure, the article (termed the JNC7
report) made the pertinent observation that the most important factor
in controlling high blood pressure is patient motivation. This was
shown to be even more important than the choice of blood pressure
lowering medication!
According
to the experts what is important is that you actually take your
tablets irrespective of the type of tablets. And paramount in this
regard is that people who have been diagnosed with high blood pressure
(or Hypertension) understand the importance of controlling blood
pressure, are aware of the dangers of uncontrolled blood pressure
(like heart attacks, strokes and organ damage) and appreciate the
need to take their medication.
Hypertension
Hypertension does not get better if you take tablets for
a short period, unlike a chest infection or a headache. Once you
have been diagnosed with the condition, treatment is usually for
life - whether the treatment is daily exercise or keeping your weight
down or regular meditation or daily tablets or a combination of
some or all of these. This is where the doctor can exert a major
influence on the success of the treatment plan for the patient.
Most doctors are trained to be able to diagnose high blood pressure,
and are sufficiently updated to be able to prescribe efficacious
drugs to lower elevated blood pressure.
Doctor-patient
rapport
But an important factor that influences whether a patient's
blood pressure stays under control is the rapport between doctor
and patient and the confidence the patient has in the doctor. Whether
it is your GP or your cardiologist or your general physician, there
is no point in having a clever doctor who can diagnose your high
blood pressure and prescribe the ideal tablets - if you are not
motivated enough to take your tablets on time, and if you don't
make sure you do not run out of tablets and have to go "tablet-less"
for several days!
Types
of blood pressure
Blood pressure is usually measured in two numbers - the
Systolic pressure (SBP) which is the maximum pressure in the system
when the heart contracts, and the Diastolic pressure (DBP) which
is the minimum pressure in the system when the heart relaxes. In
the past it used to be thought that DBP was the more important measure,
and doctors' efforts were focused on maintaining DBP at 85 or less,
while it was believed that allowing SBP to be of the order of "one
hundred plus one's age" was alright. Thus a 70-year-old person
thought to be normal if SBP was less than 170, while a 65-year-old
was thought to have "normal" blood pressure if their SBP
was 165 or less.
Latest
research
Today, we have sufficient research evidence to warrant
modifying these criteria. About ten years ago an important research
study called the SHEP Study (Systolic Hypertension in the Elderly
Program) was published in the Journal of the American Medical Association.
This showed that treating high blood pressure in the elderly, even
if only the systolic blood pressure was elevated, reduced deaths
due to strokes and heart attacks. And a well planned 1998-research
study from the UK by the UK Prospective Diabetes Study Group confirmed
that in people with Diabetes, tight control of blood pressure led
to a marked reduction in deaths related to diabetes as well as diabetic
blindness.
So
the message is that if you have blood pressure, you must make it
a priority to keep it under control - aiming for a systolic pressure
of less than 140 and a diastolic pressure of less than 85. If you
are diabetic, it is even more important to maintain normal blood
pressure. |
