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.
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.