Neil Chesanow has written a superb review of hypertension treatment. He reports that within the us, 3.8 billion prescriptions are written per annum but over 50% of them are taken incorrectly or not in the least. it’s very clear that successful hypertension treatment requires changing patient thinking, not making a replacement revolutionary breakthrough in medical aid. we’ve the tools but they’re not getting used.
New guidelines have recently been written by the American Heart Association that lower the goal for vital sign treatment to 130/80 for many patients. the primary step is an honest assessment of diet and exercise with the goal of preventing overweight or obesity. If vital sign remains high in spite of those measures then medication is ordered also as lab tests to seem for other associated conditions. A step by step guideline is out there for doctors to follow, generally they first prescribe diuretics then lisinopril, an ARB or a calcium channel blocker like amlodipine. Eventually three or maybe four drugs could also be necessary. it’s all cut and dry and works alright. So why is there a problem?
The first barrier to successful treatment is distrust of physicians. I even have read that the majority patients don’t trust and even may hate their doctor. They still make office visits but haven’t any intention of doing what they’re told. they are available because their spouse insists or because their mother goes there or because”the last doctor was even worse”. Sometimes this distrust may be a family or maybe community issue. Sometimes it’s triggered by a chilly attitude from the doctor or a way of disinterest. The doctor could also be very caring or compassionate, but rushed and harried by an impossible schedule.
Another barrier is fear of side effects. Men mention the impact of vital sign drugs “on their sex”. They share tales of friends who “lost their manhood”. Older women may fear dizziness and a disastrous fall without access to assist. younger ladies may have “heard those cause you to fat or make your hair fall out”. the web whispers that “those pills will grow hair on your pancreas”. “You should throw them away and take turmeric or a minimum of see a naturopath.” Sadly that alternative health care guy is perhaps smoother and more superficially convincing than your doctor.
The “sick role” is additionally important. High vital sign is usually a disease without symptoms. it’s the long-term consequences: stroke, congestive coronary failure and renal failure that are disastrous. By agreeing to require a long-term medication you want to accept that you simply are “sick”. this is often tons different from taking an antibiotic for ten days for an ear infection. it’s natural to ask:”I feel well why do i want this pill”.
I have concluded after four decades of doctoring that generally the choice to not take a medicine is formed very deliberately, not due to forgetting or “just being stupid”. A contract between doctor and patient is important to correct this example because the dollar costs and health consequences of untreated hypertension are staggering.