Blood pressure high? Ask your druggist to help
You can lower high blood pressure by losing weight, exercising, cutting down on salt, eating better or, if those lifestyle methods fail, taking drugs. But do we do it? Nooo.
High blood pressure was the second heart disease risk factor, after smoking, identified by the Framingham Heart Study. A host of medications on the market can lower it. It is the most common, reversible cardiovascular disease risk factor in the world, projected to affect 1.5 billion people around the globe by 2025.
The key word is "reversible." High blood pressure, also called hypertension, can come down, and lowering blood pressure substantially reduces the risk of heart attack or stroke. Hypertension is defined as 140/90 or higher, and for each drop of 10 in the top number, or systolic pressure, the average risk of heart attack and stroke goes down 30% and 40%, respectively.
"Only about one-third of patients with hypertension in the United States have their BP lowered to target goals," writes Dr. Daniel W. Jones and Dr. Eric D. Peterson in an editorial in today's Journal of the American Medical Assn.
It has frustrated doctors for decades. They have the tools to help lower risk, but have been unable to figure out how to make patients use the tools. Patients fall off diets, stop exercising and often don't take their prescriptions every day. Or they don't return to the doctor often enough to see if the medications are doing the trick, or if the doctor needs to tinker with a dose, or try a new drug.
A study in the same issue of JAMA finds that a pharmacist can help bring down high-risk numbers. Researchers from Group Health Center for Health Studies recruited 778 patients, all members of the Seattle-based HMO, who had uncontrolled hypertension. The patients also had Internet access. A third of them received the usual care, which was instruction from their doctors and educational pamphlets. Another third of the volunteers received usual care plus a home-monitoring blood pressure cuff and training in how to get information from a website.
The final third received all of that, plus personal monitoring via emails at least every two weeks from a pharmacist trained in blood pressure control. The pharmacist, also in contact with the patient's physician, reminded them to send in blood pressure readings, encouraged them to make lifestyle changes, and altered medications and doses if blood pressure wasn't coming down.
About one-third of patients in the first two groups were able to lower their blood pressure. But with the help of a pharmacist, 56% of patients in the third group got their blood pressure under control.
It could be that nagging helps. Those relentless messages in patients' inboxes from the druggist prodded people to remember to take their medications, or do their exercises.
--Susan Brink
Photo: Mel Melcon/Los Angeles Times
