By Tedler D. Depaynos, MD
In several occasions I encountered old and new acquaintances seeking advice on their problem of hypertension (HPN) or in layman’s term “high blood”. It is not because I am a specialist in this area but because they were simply at ease with me in bringing out their medical problems. Our informal discussions mostly spontaneous were made not only in my clinic but mostly over unending cups of coffee and sometimes over extended lunch and rarely dinner.
Many of them are retirees and obviously much older than me both in looks and in age. Many of them also have their own personal doctors and were prescribed adequate medicines. What is mostly common to them however is that they do not return to their doctors for follow ups. Despite their various alibis which may sometimes appear silly, I routinely encourage them to fulfill their return visits to their personal doctors who are well known cardiologists and specialists in Internal Medicine.
Most doctors prescribe the medicines they think best based on their studies and fruitful experiences. Some medicines however work best in different patients with great success and no apparent side effects while in others, they do not. Hence, the importance of return visits for monitoring. The doctor may increase the dosage of the prescribed drugs or perhaps prescribe additional ones to prevent side effects of high dosages which may not be good to certain patients. In some cases a replacement drug may be prescribed.
After the initial visit, a return visit after a month is usually advised. But of course, in complicated cases more frequent visits are required.
A number of those seeking my advice argued that even if their blood pressure is more than 140/90, they do not feel anything. Hence, some discontinued their medications while some had reduced the dosage of their prescribed medicines on their own. Others even shifted to advertized “herbals” which they claim to be more effective describing proudly their good feeling and subjective increased stamina.
For those who simply shifted to cheaper “similar” medicines for financial reasons, it is understandable.
Above 140/90 blood pressure is the classical definition of HPN. However, most prescribing doctors prefer to start treating their patients at a lower one especially if they have other concomitant diseases to prevent future complications. Actually this is the main reason in treating hypertension early. To prevent complications! Once complications set in, they may not be reversible. It may be too late.
Complications may occur in the heart manifested early as chest pains which maybe mild or severe or in the brain manifested early by transient dizziness or weakness of one side of the body.
Because the heart is pumping against a high pressure, the muscles of the heart compensate by enlarging gradually. The O2 supply of the heart however is constant and sometimes reduced already because of cholesterol deposits along the insides of the blood vessels making their lumen small. With the pumping enlarged heart lacking O2 supply, ischemia occurs manifested by chest pains. Depending on the severity of ischemia a heart attack may occur.
Weakness on one side of the body may imply a frank stroke which is basically lack of O2 in a part of the brain. This may be due to a ruptured blood vessel in the brain because of high pressure and weakness in the walls of the blood vessel due to a congenital bulging called aneurysm. It may be due also to a clogging of a cerebral blood vessel due to a peeling off of cholesterol deposits in the inner walls of the blood vessel blocking the passage of blood. The blood vessel may also be blocked by blood clots formed and thrown by the heart to the brain arteries. Doctors call this embolism. Sometimes this unfortunate condition may be preceded by transient attacks of dizziness or severe headache due to severe vascular spasm caused by the HPN.
There are other hypertensive complications but in emphasizing the above, I try to scare those asking advice from me that follow up is a must. These serious and irreversible complications may hasten their pre-mature departure.
During one’s initial consultation, a laboratory work-up is usually recommended to determine if the patient has other diseases which may aggravate the elevated blood pressure or vice-versa. Most common is an unknown heart condition and diabetis mellitus which should concomitantly be treated. Even gouty or osteo – arthritis should be treated because they would lead patients to have a sedentary life.
A work-up for the probable causes of the HPN is also done. One of the most common is a kidney problem especially in younger hypertensive patients and those with very high blood pressure. And likewise a work-up of the probable cause of the kidney problem is also done. Due to busy schedule of some doctors these requirements may not be fully explained. But then since you are paying for your consultations, you should ask your doctors to explain the reasons for the work-up which may be expensive to some retirees.
Treating HPN is not limited in taking drugs. A change in lifestyle is a must and never too late. It may really be difficult but a lot of determination is required. The objectives why the lifestyle that we are used to should be modified, should always occupy our mind.
Aside from shying away from lots of carbohydrates and fatty foods in attempting to lose weight, avoidance of salt and foods high in uric acid is emphasized. Therapeutic books will just recommend severe reduction of alcohol intake with cessation of smoking. This is a must.
Of course a regular exercise habit should not be forgotten and it is good that some of those elderly patients who sought my advice walk around Burnham Park and even CJH in the morning at least 3 times per week. Their joining or forming a walking association made the habit more enjoyable. Presently “zumba” is the trend.
Some busy professionals who do not have time to join these walking groups walk from home to their offices especially during the “coding” of their vehicles or instead of taking the elevators in their high building they climb the stairs. An elderly friend hike the Baguio Cathedral steps nearly every morning for exercise and he was mistaken to have suddenly become a religious man visiting the church often probably atoning for some unfortunate mistakes. **
