Doctors Don’t Intervene Early Enough
“This is a common problem-physicians often don’t initiate therapy in patients with mild hypertension. They wait until the hypertension is worse. But this waiting game is considered a major public health concern by all the experts in this area;’ says William B. White, M.D., chief, section of hypertension at University of Connecticut Health Center, Farmington. The fact is, even mild hypertension increases your risk of stroke and heart attack. Stage 1 (mild) hypertension means that your systolic reading is between 140 and 159. And your diastolic pressure is between 90 and 99.
Dr. White thinks what happens is that doctors just fail to see mild hypertension as a significant problem in the vigorous person sitting across from them. “They think, ‘O.K., this person is 40 and pretty healthy otherwise with a blood pressure of 140/90;” says Dr. White. “And they think that this isn’t very serious. The patient thinks he or she is healthy because they don’t have something bad enough to get medicine for. But mildly elevated blood pressure is likely to become even higher over time. So the patient resurfaces five years later when his or her blood pressure is 160/110. During that interval, some damage has occurred, such as cardiac changes associated with blood-pressure elevation or some kidney problems.”
Dr. Gifford believes in very early intervention-when blood pressure is high-normal, 130-139/85-89. “But doctors don’t tend to make much fuss if blood pressure is 135 over 85. The message doesn’t come across that it might be risky. And that’s the time to get to it. There’s really good evidence you can prevent high blood pressure then, before it gets worse,” he says. Unless blood pressure is high-over 160/105, says Dr. Gifford-or it’s complicated by a condition like diabetes, prompt treatment of choice means initiating lifestyle changes. “Lifestyle changes are very important;’ says Dr. Gavras. “Your doctor should educate you to eat less sodium and lose weight and exercise with activities like walking. Just by decreasing sodium intake and losing weight, one-third of those with hypertension can control their blood pressure. But doctors seem more at ease with drugs than with eating or exercise regimens, says Dr. White. “We have a lot harder time educating patients about lifestyle changes. It’s hard to implement because physicians don’t have the time or the background information on how to educate patients during the short encounter they have with them,” he says. So when doctors finally nab blood pressure at Stage 1, they often do so with medication. “When a doctor doesn’t have time, it’s easy to just say to the patient, ‘you have high blood pressure-I’ll give you a prescription,’” says Dr. Sheps. If you find yourself in that position and your blood pressure is mild and uncomplicated, Dr. Sheps says: “Then it’s all right for you to say, ‘I’ve been reading that I might be able to help my blood pressure by losing TO pounds, and I’d like to try that first. Is it O.K.? If it doesn’t work in three months, I’ll consider medication.’”