Health

Hypertension: medical world under pressure

Brenda Rabkin November 20 1978
Health

Hypertension: medical world under pressure

Brenda Rabkin November 20 1978

Hypertension: medical world under pressure

Health

Paul Ormsby went to his physician for a routine checkup and found he was suffering from hypertension. He was placed on a course of drug therapy but, as he didn’t feel sick to begin with, he didn’t see much point in taking his pills and easily persuaded himself to discontinue treatment. Within the year the Winnipeg man was dead of a stroke at the age of 52. Ormsby’s condition and his reaction to it exemplify the enormity of the problem the medical world faces in the detection and treatment of hypertension—a mysterious, sometimes fatal high blood-pressure condition that is believed to afflict almost one Canadian in 10. Since it seems to be a symptom-free disorder, how can its victims be found? And if they are found, how can they be persuaded to undergo treatment, especially when the side effects of the prescribed diuretic drugs—

dizziness and depression—are often worse than the disorder?

The prognosis for people with hypertension isn’t good. A major study under way at the University of Manitoba shows that men with the disorder are 3'/2 times more likely to die during heart attack—and almost nine times more likely to die during stroke—than men with normal blood pressure. And medical researchers are worried that efforts to combat the growing affliction—it affects 20 per cent of the increasing proportion of Canadians over 50—are being hampered by a lack of awareness. Medical statistics bear out these fears, showing that of the more than 600,000 hypertensives in Ontario, half don’t know they have the disorder, half of those who do know aren’t being treated and half of those being treated don’t have their conditions under control In an attempt to reach as many Canadians as possible, medical authorities four years ago launched what became known as the shopping plaza screening program. Booths were set up in urban shopping centres across the country for anyone to have his blood pressure measured. But although the program attracted considerable public interest and turned up many sufferers who didn’t know they were hypertensive, it fizzled after

two years when it was found the numbers being

reached were small relative to the total populace, and the cost of teams and equipment was too high.

Finally, critics of the program put their finger on the nub of the problem: screening should be one of the routine checks carried out by the family physician—in view of the fact that 80 per cent of Canadians see their doctors at least once every two years—but too often it is omitted. The doctors’ checks were also recommended in 1977 by an Ontario task force on hypertension. One curious danger was also uncovered in the shopping plaza approach: that of labelling a person hypertensive.

Extensive studies conducted on Hamilton steelworkers since 1975 by Dr. Brian Haynes and a team from McMaster University have shown that once men found out they had high blood pressure, there was an immediate 80per-cent rise in their absenteeism rate. Interestingly, the men had elevated pressures for over a year before they were told, but the problems of absenteeism and dissatisfaction at home began only afterward. The ethical issue that must be confronted as a result of this research is the questionable benefit of the patient’s right to know. “The advantages of telling the patient about his condition far outweigh the disadvantages,” says Haynes. “Whatever the costs might be initially, once the patient reconciles himself to his condition and complies with treatment, then there is a good chance that he will lead a normal life.”

Dr. Haynes’s statement is supported by the results of his research. Those workers who took their medication regularly experienced no significant rise in absenteeism. Conversely, patients who stopped complying showed an immedi-

ate increase in absenteeism. Clearly, the researchers reasoned, the patient’s willingness to assume responsibility for his condition should play an important role in determining whether or not he would comply with treatment.

The long-term benefits of such treatment are worth fighting for. A Veterans Administration co-operative study in the U.S. has showed that the risk of developing complications over a fiveyear period as a result of extreme hypertension was reduced from 55 per cent in those who receive no treatment to 18 per cent in those treated. Complicating these results is the fact that no one knows what causes hypertension. Experiments have shown that factors as varied as salt intake, obesity, alcohol consumption, stress, soft drinking water, heredity and lifestyle may all play some role in hypertension. There are also some well recognized states that are associated with hypertension, such as kidney disease. More and more the approach that medical science is taking is that hypertension has no single cause.

Drugs are not the only method by which high blood pressure can be reduced. Within the last few years it has been shown that yoga, transcendental meditation, biofeedback or simple weight reduction can also lower blood pressure. In a recent study in Israel, overweight hypertensives were placed on a reducing diet; by merely losing weight, 75 per cent of the patients were able to lower their blood pressures to normal.

The future for hypertension research may be intriguing and promising but the present reality lies in its detection and control through compliance with conventional treatment. Even for this to happen, the individual must assume an active if not aggressive role in his own health care. And then there is the question of the family doctor’s co-operation. Says Dr. Haynes: “The next time you visit your doctor, make sure you get your blood pressure taken. Even if he doesn’t think of it, insist upon it.”

Brenda Rabkin