Which type of high blood pressure patient are you?
High blood pressure is a very common disease in Jamaica. Approximately half a million people between the ages of 15 and 74 years have it and, by the age of 50, it is present in just about one in every two persons. So, every day, without exception, I see many persons visiting my office with high blood pressure. But after checking and talking with them, I have discovered that they are not all the same. Here are the different groups of patients I have seen over the years.
'I HAD NO IDEA!'
John came in with his wife, who is having a migraine and sits in the other chair looking on and commenting as I deal with her problem. As they are about to leave, Mrs Smith asks me to check his pressure. I attach the cuff and start pumping. The mercury climbs all the way up to 200mm before I stop feeling the pulse at his wrist. I complete the reading and call my nurse to open a file for Mr Smith. He is one of many persons walking around with high blood pressure readings every day without a clue.
'I DON'T REALLY
TAKE MY TABLETS'
Although many patients do return for their check-ups, the sad reality is that most are not taking their medication consistently. In the Jamaica Health and Lifestyle survey of 2007-2008, only a half of persons with hypertension report taking their medications every day. And the cost of drugs is not the biggest factor, as the National Health Fund and The Jamaica Drug For the Elderly Programme have made a big difference with this area. A large number of persons either forget, run out of medication, worry about side effects or just can't be bothered. The end result is that the blood pressure is poorly controlled, and over time, their life gets more complicated as the disease takes a toll.
'DOC, I KNOW
WHY IT IS HIGH'
So I check it and, before I could take the stethoscope from my ear, they say, "Doc, I know, I know; I just had some salt mackerel for breakfast and those grandchildren at home really stressing me out," suggesting that no treatment is needed. Now, indeed, stress and salt can push that blood pressure up and do need to be addressed, but these patients on every visit give a reason as to why their blood pressure is high. Their 'admission' really amounts to denial that they have a problem in need of serious treatment.
WHAT TYPE OF
PATIENT ARE YOU?
Among the large number of patients that I see with high blood pressure, there are those who make good effort to manage their lifestyle and take their medication every day and who see me smiling as I take the cuff off their arm.
You must know your status by checking your reading regularly at home. Discuss it with your doctor and don't be satisfied until it is consistently normal. Set targets and goals with your doctor for your blood pressure, your medications, your check-ups and keep living longer and better to see those grandchildren!
- Dr Tomlin Paul is a family physician at Health Plus Associates in Kingston; email: firstname.lastname@example.org.