The Periodical Fourth Issue, March 2004
|Editorial||SAGAS Objectives||SAGAS News||International Article|
|Hypertension Rx Guide||Hypertension & Life Style||The Periodical Quiz||The Periodical Case|
Hypertension, is it treated well?
Despite all the advancement in the field of medicine, hypertension remains one of the major contributing factors to the global mortality. The prevalence of hypertension world wide is about 20% and in the Kingdom it reaches 26%.
The awareness of people about hypertension is about 69% and those who receive treatment is about 58% however those who are controlled is about 31% according to the latest report from the National Health and Nutrition examination survey year 2000. One then might ask why is the control so low despite the current available treatment. There is no doubt the control of blood pressure will reduce the stroke incidence by 35-40%, myocardial infarction by 20-25% and heart failure by 50%. As well each increment of 20/10mm.Hg will double the risk of the cardiovascular disease across the entire blood pressure range starting from 115/75mm.Hg. The recent trials comparing different antihypertensive treatment have found that in order to control blood pressure the average no. of drugs to be used is 3-4 per patient . The role of diuretics compared to angiotensin converting enzyme inhibitor (ACE) and calcium channel blocker have been addressed in the Antihypertensive and Lipid lowering treatment to prevent Heart Attack Trial (ALLHAT JAMA-2002). The authors concluded the superiority of thiazide – type diuretics in preventing one or more major form of cardiovascular disease over the other two agents , yet the blood pressure control was not similar between the different groups that might account for the observed differences in the clinical outcomes. As well the second Australian National Blood Pressure study (NEJM 2003) comparing the outcomes with ACE inhibitor and diuretics for hypertension in elderly particularly men concluded that ACE inhibitor is better than diuretics despite similar reduction of blood pressure. There for despite the important role of diuretics in patients with hypertension other classes of antihypertensive have proved them selves to change outcome.
Hypertension is a chronic illness that requires full awareness by the patient about the risk of non-compliance . The development of Target organ damage or clinical cardiovascular disease indicate a worse prognosis.
Patient knowledge about the side effect of drug been used should be fully explained and assessed because it is one of the major causes of non- compliance. The drug prices as well is an important factor specially among low social class individuals who are more prone to hypertension. Finally continuous education programs supported by societies and groups are essential to improve the awareness, treatment and controlled.
Dr Mohammed Arafah