By Paul Goldfinger, MD, FACC.
This post is from 2019, but it is still valid:
Almost all doctors believe in treating hypertension, but how many will be enthused about following the new guidelines? We’re talking about the American Heart Association/ American College of Cardiology 2017 guidelines for the diagnosis and treatment of high blood pressure.
If you were a doctor, would you spend hours going through piles of hypertension guidelines, looking at all the intricate details, and trying to resolve the controversies? Or would you just do whatever it is that you normally do to treat the most common cause of death in the US ?
And even if a physician were willing to wade into the weeds trying to figure all this out, he might emerge confused, because in the end, he will have to use his best judgement.
Guidelines are supposed to provide consistency not controversy. But when it comes to hypertension, knowledge has been evolving since the 19th century when a device to measure blood pressure was invented. And change is slow.
I have hypertension–it runs in my family. It also increases in frequency as we get older. My blood pressure was normal until I passed 50. As a cardiologist, I keep my finger on the pulse of advances in cardiology.
My own cardiologist is an eminent and respected doctor in this area. But he is fairly conservative, and when I press him about the new guidelines, he usually falls back on his own judgement which doesn’t try to push too hard on drugs. Last time I saw him, it appeared that he was beginning to adopt the new American guidelines, yet he didn’t change my treatment, although he might have.
However my biggest concern is that not only will physicians pay little attention to the guidelines, but probably half of their patients with high blood pressure are not under good control. And there are many people who are walking around despite high blood pressure. These people don’t often see doctors or go to health screenings. This disease is called “the silent killer” with good reason.
Now, in the new world of medical practice in America, we have new ways to practice, and that involves mid-level practitioners such as physician assistants and nurse practitioners. Also we have electronic medical records and fabulous new technologies to help accomplish our goals. And there is a welcomed trend to use home BP measurements to guide diagnosis and treatment.
The new corporate style of practice involves a team approach to try and improve the track record in hypertension. And when a patient is put into the hands of such “teams,” those teams will be forced to use the latest guidelines, taking it out of the hands of doctors.
And we know that perhaps up to 800 entities such as the Mayo Clinic, the Cleveland Clinic, Summit Medical Group, Monmouth Cardiology, etc. across the country have already established this new approach, and more will jump on the bandwagon.
Then, it is hoped that the success rates of hypertension care will become much better. But I am also suspicious of corporate motives in such circumstances. Insurance companies, healthcare entities, and Big Pharma are interested in this topic.
I am skeptical of turning over the care of our patients to corporate managers, bottom line oriented policies, mid-level medical teams, efficiency experts, and one-size-fits-all algorithms. It is a recipe for reduced quality of care, failure to properly evaluate patients, and higher risk of complications, malpractice, and missed diagnoses.
I would be more enthused if the system were returned to the control of physicians.
So, having expressed that concern, we will proceed with the nitty-gritty of providing successful care for the millions of hypertensives in America.
GOLDFRAPP. From the soundtrack of Jack Goes Boating——It’s “Eat Yourself”
If you don’t eat yourself
No doubt the pain will instead
If you don’t eat yourself
You will explode instead
I think this means to take good care of yourself. Have your blood pressure checked. And more–you decide what it means.