Day against hypertension, why it is important to recognize it and how best to treat high blood pressure
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It attacks the heart, putting it at risk of a heart attack. He wears out the valves. She tires him, favoring the appearance of decompensation. Chapter brain and nervous system: increases the threat of stroke and makes you more susceptible to degeneration with the risk of dementia. Gradually, then, it reduces the functionality of the kidneys. Unfortunately, all of this happens in silence. Thus, we are exposed to the harm of hypertension, often without knowing it. And if we know, precisely because we have no symptoms, only one in three people get the desired results. These data were reported by the experts of the Italian Society of Arterial Hypertension (SIIA) on the occasion of World Hypertension Day, scheduled for 17 May. Numerous awareness-raising and screening events are planned in many Italian cities.
Blood pressure is checked (also) at the table
Three steps are needed to checkmate high blood pressure: knowing that you are hypertensive, getting yourself treated and following up on the treatments over time. Maybe even adapting the situation to the individual patient, modifying the treatments when necessary. In this sense goes a research conducted by the experts of the University of Uppsala coordinated by Johan Sundstrom appeared on JAMA. The study, involving 280 people, shows that patients treated with antihypertensives can improve control of the situation by more than doubling the dosage of the current drug. they may experience much greater improvements from a drug switch than from doubling the dose of their current medication.
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How important is it to personalize care
The research involved the use of four different drugs. The treatment effect was seen to vary widely between individuals over the course of a year, with the need for tailored treatments. “If we tailor each patient’s drugs, we can get a better effect than if we randomly choose a drug from one of these four drug groups,” he explains. In short: in the absence of a specific marker – we cannot predict the response to a single antihypertensive drug.
“But it must be remembered that, while not being able to predict its effectiveness, the clinician will still choose the most suitable molecule for that particular patient – he explains Claudio Ferri, professor of internal medicine at the University of L’Aquila and president of SIIA. In addition, while completely changing an antihypertensive molecule that has not worked may make sense, it discourages the patient, especially if asymptomatic, and increases the risk of drug discontinuation”. Finally, a minority of hypertensive patients must receive monotherapy as at least the initial choice: those with a modest elevation in blood pressure and an inconsistent cardiovascular risk, the very elderly and frail patients.” In the others, precisely in order not to run into the phenomenon well studied by Sundström, it is good to start ab initio with a cocktail of drugs – recalls the expert”.
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Adherence to therapies is essential
In four out of ten cases, according to research coordinated by Michael Burnier and announced by the European Society of Hypertension (ESH), treatment for high blood pressure stopped. And it is a problem, considering that it is necessary to achieve a pre-established and shared goal between the clinician and the patient, which is obviously difficult to achieve if the prescriptions are not followed.
“Already studies conducted by Joseph Mancha And John Corrao demonstrated clearly that the goal is more easily achieved if you start immediately with a fixed combination of antihypertensive drugs and that the chance that the patient abandons a fixed combination is almost half that of the same patient abandoning monotherapy – Ferri specifies. The reasons? Fewer tablets means greater adherence and persistence and more molecules in the same tablet or capsule translate into better blood pressure control”. For the rest, the patient adheres to the therapy if he exactly follows the doctor’s recommendations regarding doses, times and frequency of taking the drug for the entire duration of the treatment. The athletes of the Italian Jazz Team tell it, on the web, with the series “All for one – Grip is a team game“, information and awareness campaign on the subject.
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When to measure blood pressure and how to follow the treatments
First of all, some advice comes from the experts of the Italian Society of Hypertension. In the absence of a family member to help the patient if he is distracted or not very attentive, it is advisable first of all to “hook” the assumption of the therapy to a single obligatory act in everyday life, such as going to the bathroom in the morning, thus leaving the box of hypertensive in the bathroom. It is also useful to make the box clearly visible and to buy a weekly organizer at the pharmacy. Finally, remember to activate a reminder on your smartphone and, lastly, always leave a reserve of antihypertensive tablets in the workplace. And then, the watchword is control.
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“Persisting correctly in therapy is crucial, but even more is self-measuring one’s blood pressure, with automatic and validated instruments, always using the arm and not the wrist and remaining in a sitting position, in a calm and well-heated environment, two-three times the week at different times – concludes Ferri. It would be better still to measure it – at least four times a year – even in an upright position, after 1 and 3 minutes of getting up. This will allow us to avoid a sneaky enemy: orthostatic hypotension, common in the hypertensive elderly and in the patient with benign prostatic hypertrophy treated with alpha-lytics and not rare in the diabetic patient and/or with neurological pathologies, especially if treated with drugs such as anti-Parkinson’s”. For those who are not hypertensive, it is better not to run away from controls: everyone, absolutely everyone, even children, even if they are “healthy as fish” must measure their blood pressure at least once a year.
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