High blood pressure (hypertension) afflicts nearly one-fourth of the adult population of the world. Yet, nearly half of them are not aware of their blood pressure. Of those who are aware of hypertension, less than half have an optimal blood pressure control. This issue has serious public health repercussions as hypertension is a major risk factor for heart attack, heart failure, stroke, and renal failure.
Hypertension is a huge problem but by and large, its management is simple. Uncomplicated hypertension is best treated by a primary care physician in great majority because of the need for frequent contact with the caregiver. So it is a mistake to rush to a specialist on first detection of high blood pressure.
Common mistakes
Inability to have a regular blood pressure check for early detection of hypertension by the apparently healthy. Hypertension is silent unless complicated. It can affect people at any age. Therefore, it is a good practice to have a blood pressure check at least once in six months.
To start medication at first indication of high blood pressure. Ordinarily, the diagnosis of hypertension should be made only after blood pressure is found to be consistently high during repeated measurements over a period of days to weeks. A single reading of high blood pressure may be due to stress, lack of sleep or incorrect measurement.
This so called ‘white coat hypertension’ is quite common. The downsides of home blood pressure monitors are that many of these are not standardised and some people go overboard and start checking their blood pressure twice or thrice in a day, which is quite unnecessary.
It is a mistake to expect blood pressure to normalise within a few hours or days. Most anti-hypertensive medication work slowly and their peak action is manifest by three-four weeks. So it is not a good idea to check blood pressure too soon after initiation of treatment and it is certainly not desirable to check the pressure morning and evening or hourly basis.
There is no fixed dose or drug combination that will control blood pressure in all cases. Therefore frequent changes in doses and medications may be required over several months before blood pressure comes under control.
Blood pressure should not be treated in isolation because the idea behind control of blood pressure is to reduce the risk of heart attack, heart failure, stroke, and renal failure. A more comprehensive effort should be directed against weight gain, high blood sugar and cholesterol in order to maximise risk reduction.
To add indigenous drugs or supplements to conventional treatment. Patients often do so, hoping to reduce or eliminate medication. If blood pressure comes under control as a result of this mocktail of medication, credit is given to indigenous treatment. But if there is any side effect, blame lies on conventional medication. It is best to refrain from a mixture of different systems of medicine simultaneously. People having faith on alternative medication should try that first and may switch over to conventional medication if it is not working.
To change dietary salt to low sodium variety without doctor’s notice. low sodium salts contain potassium chloride that may raise blood potassium levels to dangerous levels, particularly in patients who have been prescribed some anti-hypertensive medications that also retain potassium in the body or in those with renal dysfunction. It must be remembered that body is extremely sensitive to fluctuations in serum potassium levels and a seemingly minor rise may be dangerous enough to cause fatal rhythm disorders of the heart. Therefore, it is strongly advised that low sodium dietary salt, so easily available in the market be taken only after checking with treating physician. These preparations are available over the counter in departmental stores. Due to their potential side effects, these should ideally be dispensed by chemists on doctors’ prescription and treated like drugs. This is a regulatory issue worth noting by concerned authorities.
(The writer is Director Cardiology and Head, Department of Preventive Cardiology, Fortis-Escorts Heart Institute New Delhi)