In the age of increasing complexity in medical care, it is in a patient's best interest to take a more active role in health maintenance. It is an irony that many patients have a better handle upon their finances than their own health status. Technological advances allow people to track their financial data, anticipate and make changes by logging onto a computer. Therefore, why shouldn’t a patient be able to track their own health metrics, anticipate, and make changes (with medical supervision) in between office visits? After all, without health and prevention, how can one ensure financial health for self and family?
Hypertension is a medical disease that can be effectively self-managed. Control of blood pressure is one of the most cost-effective ways to assure longevity and quality of life (without disease). Uncontrolled blood pressure is often a silent process. Unfortunately, disastrous consequences (stroke, heart attack, heart failure, kidney disease) can occur due to a lack of blood pressure control. Uncontrolled hypertension can therefore lead to excessive medical costs and financial strain.
An essential point to this blog is that patients know the definition of normal blood pressure. The optimal blood pressure, as defined by the American Heart Association, is a systolic blood pressure of 120 mmHg and a diastolic blood pressure of less than 80 mmHg. Consistent numbers above 120/80 should be a signal to patients that they may have undiagnosed hypertension. It is important that patient undergo annual blood pressure screenings by a physician to evaluate for the presence of hypertension.
Once hypertension has been diagnosed, it is not enough to make decisions based upon blood pressure readings obtained in-between doctor visits. Hypertension is an active disease, blood pressure fluctuates throughout the day, and I therefore encourage every patient to maintain a blood pressure diary until there is adequate and consistent blood pressure control. Most available home blood pressure cuffs are relatively inexpensive, require little expertise, and provide accurate readings. Many home blood pressure cuffs will, in fact, record blood pressure readings and track averages over time. There are computer-based and web-based applications that also allow patients to input and follow their blood pressure readings, as if they were reviewing a bank account.
I often find that, when a patient monitors his or her blood pressure, the act of data monitoring allows for a far greater understanding of what controls blood pressure and what causes blood pressure to elevate. This personal understanding of one’s self may result in greater changes in lifestyle (reducing salt, reducing stress, increasing exercise) that clearly improve hypertension.
It is my experience that home blood pressure diaries also help the physician make better decisions with respect to therapy. Adjustment of medical therapy may be made without an office visit. After all, multiple points of data within the span of one month are far more valuable to the physician than two points of data (from one office visit to the next).
It is important that patients become open minded to starting medical therapy. I will often counsel patients that medicines supplement lifestyle changes such as diet, weight loss, and exercise. This multifaceted approach most effectively maintains the blood pressure over time. Most antihypertensive medicines are safe, have been used for a number of years, and have no common side-effects. Most antihypertensive medicines are also cost-effective. I often educate patients that the many effective blood pressure medicines can also be found in a generic format. A patient need not take the “latest and greatest” blood pressure medicine in order to achieve maximal benefit.
I can not express enough the importance of a “lifestyle prescription.” Regular exercise can be a challenge for the busy person, yet is not impossible. Walking is a safe and effective way to incorporate effective exercise. Park at the farthest space away from your workplace, use the stairs, take neighborhood walks, and the benefits will follow. Be conscious of maintaining a healthy weight. An effective health diary should incorporate daily weights in addition to blood pressure readings. By tracking your health data, you will see that your lifestyle contribution to your health is actually working! Use computer based technology and track trends in your numbers over time. Some health systems may even allow the medical team to review this data before your office visit!
Smoking cessation goes without saying or further discussion. Alcohol, in excess, will increase blood pressure. Some over the counter medicines may raise blood pressure with chronic use. It is important to be keenly aware of things that are put into the body that may increase blood pressure.
I would urge all who have uncontrolled hypertension to take an active role in their hypertension management. The ultimate goal, like in successful investment strategies, is for long-term gains (life free of disease) by applying a little discipline, setting goals, and knowing your targets. The savings will be invaluable.
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