Neil Chesanov wrote an excellent review of the treatment of hypertension. He reports that in the United States, 3.8 billion prescriptions are recorded annually, but more than 50% of them are not accepted correctly or are not accepted at all. It is clear that successful treatment of hypertension requires a change in the patient’s thinking, and not a new revolutionary breakthrough in medical care. We have tools, but they are not used.
New guidelines have recently been written by the American Heart Association, which reduce the goal of treating blood pressure 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, then medication is ordered, as well as laboratory tests to look for other related conditions. A step-by-step guide is available for doctors to follow, as a rule, they first prescribe diuretics, and then lisinopril, ARB or a calcium channel blocker such as amlodipine. Sometimes it may take three or even four drugs. Everything is cut and dry and works very well. So why the problem?
The first obstacle to successful treatment is distrust of doctors. I read that most patients do not trust and may even hate their doctor. They continue to visit offices, but do not intend to do what they are told. They come because their spouse insists either because their mother goes there or because "the last doctor was even worse." Sometimes this distrust is a problem of the family or even the community. Sometimes this is caused by a cold attitude from a doctor or a feeling of disinterest. The doctor may be very caring or compassionate, but he rushed and exhausted by an impossible schedule.
Another barrier is the fear of side effects. Men talk about the effect of blood pressure drugs on their gender. They talk about friends who "have lost their virility." Older women may fear dizziness and a catastrophic fall without access to help. Younger women may have "Hear that you make you fat or make your hair fall out." The Internet whispers that "these pills will grow on your pancreas." "You have to throw them away and take turmeric, or at least see a naturopath." Unfortunately, the alternative medical professional is probably smoother and more convincing than your doctor.
The important role is the “sick role”. High blood pressure is usually a symptom without symptoms. These are long-term consequences: stroke, congestive heart failure and renal failure are catastrophic. By agreeing to long-term treatment, you must recognize that you are “sick.” This is very different from taking an antibiotic for ten days for an ear infection. It is natural to ask: "I feel good, why do I need this pill."
I finished after four decades of doctor, that in general, the decision not to take medicine is done very kindly, and not because of forgetting or “just being stupid”. The contract between the physician and the patient is important to correct this situation, because the dollar costs and health consequences of untreated hypertension fluctuate.
