Physicians should try to spend as much time as possible with patients to educate them on the importance of lifestyle modification, but its important not to waste too much time before beginning drug therapy. With some patients, preaching life-style change is a fruitless exercise, and damage is being done while they struggle to cut salt from their diet or lose weight, Neutel says.
The decision needs to be made fairly early on as to whether its worth pursuing nonpharmacological treatment or whether its in the best interest of the patient to start drug treatment, he says. The physician can always stop the drugs if some dramatic improvement happens. Hydrochlorothiazide 25mg The longer it takes physicians to get to goal, the more likely they are to have some obstacle that results in acceptance of inadequate control.
Some physicians are turning to the Internet for ways to help patients learn to manage their blood pressure. One resource is a Web site that allows patients to assess their risk for hypertension, track their vital signs on a graph that can be sent to the physician, and access tips on lifestyle changes and the latest published research in the field.
Patients can type in their own blood pressure levels as well as pulse, weight, and cholesterol, and information pops up showing normal levels and what action should be taken if the patient falls outside the norm. The site also offers a place to keep personal and family health records, a reminder service for taking medications and making appointments, and a locator service for blood pressure kiosks around the country.
This kind of site helps physicians because it provides basic information to patients that they may not have time to cover in an appointment, says Michael Ruddy, MD, FACP, associate professor of medicine and chief of the section of hypertension in the division of nephrology at the Robert Wood Johnson Medical School in New Brunswick, NJ. Ruddy serves on the clinical advisory board for Lifeclinic.com. This helps patients have an active role in managing their high blood pressure, and thats the only way it will ever get under control.
The onus for improving blood pressure doesnt fall solely on the patient. Physicians must be more aggressive in their care, says Pablo LaPuerta, MD, clinical assistant professor at the Robert Wood Johnson Medical School and director of outcomes research at the Bristol-Myers Squibb Pharmaceutical Research Institute in Princeton, NJ, triamterene hctz.
LaPuerta was one of the authors of a study published recently in the Journal of the American College of Cardiology that outlined a set of indicators for measuring process quality in hypertension..sup.2 The indicators, based on national guidelines, include screening patients yearly for blood pressure, evaluating newly diagnosed patients for kidney function and cholesterol, getting patients started on drug therapy, and stepping up therapy to get control. When the indicators were tested on about 700 hypertensive women, deficiencies were found in every area.
One of the most notable things we found was that when patients persisted with uncontrolled blood pressure of more than 160/90 mm Hg for six months or more, 50% of the time physicians didnt change their treatment, LaPuerta says.
Patients in the study who had blood pressure control passed more indicators, showing that physicians who are more aggressive do achieve better results. A lot of physicians may think that a lot of the problems with blood pressure are outside their control, such as patient noncompliance, LaPuerta says. But this study suggests physicians can do something to improve control, like stepping up care when the blood pressure remains elevated. They may need to add another medication or go to a full dose of the existing medication.