Hypertension 9 – Treatment and Compliance

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Hi everyone! I’m on time today. This is Dr. Louella checking in from the office. This ought to be our final post on hypertension but I feel the need to give a summary afterwards to draw all the essential points together. Let us finish up on treatment.

So, let’s say diet and exercise (as we discussed previously), fail. You ask what I mean by fail… well you just don’t do them or you make a half-hearted attempt to do so. Then they will fail. Or, better yet, say you do try, and get some results but not sufficient for your blood pressure to be called normal, what do we do?

It is obvious we turn to medication at this point. Antihypertensive medication is used to control but not to cure hypertension or high blood pressure. Some people’s blood pressures are so high that we have to put them on medication from the start, but this should be done in conjunction with diet and exercise.

Now I don’t need to go too much into the actual medications. There are many classes of antihypertensive drugs and several drugs in each class. One may work a bit better in an individual than another but none is clearly superior.

I do have a lot to say on “The Patient and the Taking of Antihypertensives” though. Oh my goodness! I have only dealt with patients from Trinidad but I am sure there are patients all over who behave similarly.

Many patients aren’t convinced of the diagnosis of hypertension. They say “so they say” but don’t own it for themselves. They are in denial. Others treat it like a minor irritation or joke. But I am usually quickly able to convince them of the diagnosis by giving them the normal range and showing where a number of their blood pressures, as recorded in the patient notes, are beyond that. Remember, if they were diagnosed based on one reading, they have a right to be skeptical.

I show them that antihypertensives work on everyone. If they do not have hypertension their blood pressures would run low if they took medication. Are their blood pressures running low? Or are they being maintained just normal, high normal or even too high? If your blood pressure is normal whilst on an antihypertensive, you need to continue on that treatment, or else it will go high.

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It is difficult to get hypertensive patients to take their medication because they don’t feel sick. This often leads them to rush to take a pill when they do feel something like a headache or neck pain. Recall that hypertension has no symptoms. I tell them if you are waiting to feel something, that’s when complications have already set in, and it will be too late.

A lot of our patient population think a water pill is to help them pass water and improve functioning of their kidneys, so they don’t take it because they pass water just fine. They are oblivious to the fact that it is a pill for treating hypertension, so I make this clear to them.

Many of them have their own regimen for taking medicines: once a day instead of twice, every other day, twice or three times a week, whenever they remember or whenever the blood pressure is high. No wonder the pills don’t work!!! I always ask why? What is your reasoning for this?

I will admit, years ago when I first discovered this deviant behavior I was shocked. I found out that we doctors increased the dosages of patient medication when needed but the patients themselves didn’t. So the notes may be saying as many as four tablets a day when the patient still routinely took one. My most gruesome discovery was bags and bags half-filled with medication at the homes of the elderly we visited in Cedros. I was upset and thought I was fighting a losing battle.

But I’m older and wiser now. I understand many of the reasons they don’t take their medicines as prescribed. I ask them point blank about it and spend some time on the topic. But even after explaining there is no guarantee they will follow comply. Most of our patients are unaware of the names of their medication and this makes it more difficult.

I explain to those that take their meds only when blood pressure is high is that they are doing more damage by allowing their pressures to go high and then taking a pill, as opposed to having it controlled at all times. If your blood pressure is good today it may be the pill you took yesterday. If you miss the pill today it will be high tomorrow or the next day. To decrease risk of complications blood pressure needs to be controlled at all times

Many patients are afraid of side effects. I try to explain that these side effects are only potential and nothing happens to most people. There is no automatic damage by the medication. And furthermore, the damage they will get from hypertension is more sure and worse than what the tabs will do.

For those who have decreased the dosages due to convenience, I explain to them that the drug only is effective in their system for a certain length of time and they need to take it as prescribed for it to work properly. It comes as though you’re wasting your time because the drug can’t work like that.

A few of them cannot read so I emphasise to them that I am changing the dose and ask them to refer to a relative or neighbor to read it for them. Sometimes for the elderly or mentally challenged I ask for them to bring a relative. I explain to that person and charge them with the responsibility.

That’s it folks!!! We just completed the series on hypertension. Only the summary is left. Thereafter I’ll be starting a new topic. Now if I left out anything or you don’t understand something, feel free to comment before we move on. I enjoyed this because it was like a refresher for me and as you can tell, I love to share my patient experiences. Enjoy the rest of the weekend and the incoming week!