Marks Daily Apple
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7 Feb

High Blood Pressure and Follow-up Care

High blood pressure is a major public health threat and one of the leading causes of death in the U.S. An analysis of hospitalization and follow-up care for individuals with severe hypertension, however, shows gaping holes in the maintenance of care.

Granger and colleagues at nearly two dozen institutions around the country created a special registry to find out what happens to patients with acute, severe hypertension – those with blood pressure readings above 160/110 – when they come to an emergency department or critical care setting for treatment. They found that although 90 percent of them already had a diagnosis of high blood pressure, about a quarter of them were not taking the medicines they were supposed to. The researchers also found that extremely high blood pressure was related to high complication and death rates. Many of the patients already had major organ damage and over six percent of them died in the hospital. Upon discharge, most of the patients were given prescriptions for at least two medicines, but 41 percent had to be readmitted within three months.

via Medical News Today

Clearly, this is a sad scenario for these patients, but this part of the research summary really made our jaws drop:

“What may be most unsettling, however, is the fact that the investigators could not find any evidence in the discharge records of about 60 percent of the patients that there had been any attempt to schedule a follow-up appointment for them.”

No attempt to schedule a follow-up visit? Anyone who’s been to the emergency room before knows it’s not the place to go for detailed explanations of care strategies. It’s largely triage, by necessity. Clearly, there are many unfortunate reasons (no insurance and little money, etc.) someone may refuse to schedule a follow-up visit, but isn’t it the place of medical personnel to at least try?

Not only is a follow-up visit necessary (at some point) to get a refill on a prescription, more importantly a personal conversation with a medical professional should offer a discussion of lifestyle changes that can support the natural lowering of blood pressure as well as general health.

Every day your blood vessels have to work that much harder, you put yourself at increased risk for heart disease, stroke and kidney disease. High blood pressure is largely a disease initiated by unhealthy living choices and circumstances, and reversing unhealthy patterns should be a natural part of treatment. What kinds of simple advice did these patients miss out on that would have provided useful and free tips for managing their blood pressure? How about cutting sodium, caffeine and alcohol? How about stress management therapies? What about weight loss and smoking cessation counseling? What about increasing fruits and vegetables in the diet and incorporating garlic and fish oil? What about other tips like research out this week showing a daily glass of beet juice appears to be very effective in reducing blood pressure?

Reading tips is one thing, and we think it’s important, by the way! But for someone in medical crisis, individual follow-up can provide a level of support and personal planning that articles cannot. These patients deserved better.

Lifestyle changes should be a serious part of every medical plan. It’s true, you can lead a horse to water, but you can’t make it drink. Nonetheless, this report shows too many medical professionals don’t even make it that far.

cursedthing Flickr Photo (CC)

Further Reading:

Big Pharma: Bad Science and Bad Business

PharmaLot: Bob Jarvik Doesn’t Prescribe, And He Can’t Row

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You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. There’s probably as much “sodium doesn’t affect blood pressure” as there is “cholesterol doesn’t cause heart disease” literature out there. Another area where we have to choose between dueling scientist.

    DaveC wrote on February 7th, 2008
  2. This is one area that no one should ignore, but so many do. There is usually no pain, discomfort, limitation with high BP….at least until you get serious complications.

    Moderate elevations should be initially treated by lifestyle changes, diet (especially low carb!) and exercise and quitting smoking are excellent starts, but unfortunately too many will still need medications to keep their BP in healthy ranges.

    A few years back they lowered the threshold and I for one was glad they did. Everyone should be monitoring their BP and they should see their doc as soon as they find it elevated. If given meds they must be taken….if you don’t like the reaction, tell your doc for a different one, there are at least a dozen different meds out there and many are very effective with minimal side effects. IMHO the older drugs are much better and safer than the newer ones.

    I’m a RN and have seen so many unnecessary damage from ignored high BP. A 65 yr old newly retired man with a devastating stroke, an elderly woman with a fatal stroke, a 53 yr old woman with kidney damage from untreated high BP, a 30 yr old new with a ruptured aneurysm in his brain, and more.

    All the screaming about fat and cholesterol and we essentially ignore high BP! A real problem is ignored and a fake one is pushed and promoted. Makes no sense to me. People often do not understand just how dangerous high BP can be!

    Cindy Moore wrote on February 8th, 2008
  3. After years of being a rock-solid 120/80, I started showing elevated numbers from time-to-time on doctor’s office visits. I tried to blow it off as faulty automatic equipment or white-coat hypertension; however, my doctor finally insisted on putting me on medication. I hate the idea of HAVING to take a pill every day but fortunately I have no side effects from it. My paternal grandfather died from a stroke and my dad has been having TIA incidents (what some call a “mild” stroke but ain’t nuthin mild about it). So I take my pills, and my BP monitor lives on the same table with my laptop!!

    DaveC wrote on February 8th, 2008
  4. I found the Dr’s never explore alternatives, put you on meds, up the doses and add more meds and ignore complaints of often life threatening side effects (adverse reactions.) I got HBP from hormone injections and got sick on every class of med with little control. I’m going to a Dr. who has succeeded in lowering it with natural methods.
    Then again, mine was secondary; I’m slim, never smoked, don’t drink, have worked out for decades and have a good diet.

    wamylove wrote on February 8th, 2008
  5. Research published in the Archives of Internal Medicine shows that consuming cocoa reduces high blood pressure. News Target writes that researchers from Germany’s University Hospital of Cologne examined five studies on how cocoa affects blood pressure. The flavonoids in cocoa, procyanids, have been linked to reduction of cholesterol and blood clotting.

    Cure for High Blood Pressure wrote on January 16th, 2009
  6. You know Mark, I have had a personal experience like the ones that are cited. I also work in the healthcare industry on the giving end of things. I have to say that there are significant complications on either end.
    On the giving end, there seems to be so little real appreciation for any alternatives to what is dictated by Academia and the “health care business side of things”. I’ve heard it said by many that, in it’s current state, the healthcare industry is not interested in promoting health or preventing disease.
    On the receiving end of things, the majority of people, while well meaning and well intentioned have no idea of, the importance of, or, the need to, take responsibility of their own personal health.
    Much education is needed on either side.

    Bryan wrote on February 12th, 2011
  7. Just want to report my blood pressure since going primal.

    Before primal: 140 over 85ish, sometimes 90. (Diet included daily grains, store milk, processed sugars and seed oils for cooking)
    Blood oxygen 96%.

    After primal: 107 over 70 consistently. (Diet of NO grains and beans, NO processed sugars, RAW milk instead of store milk and butter/lard for cooking)

    Blood Oxygen 98% consistently at elevation of 4500 feet.

    So even though my blood pressure went down, oxygen levels climbed up, which probably blows like every scientists brains out right now because they can’t explain it.

    Arty wrote on October 1st, 2011

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