Despite widespread efforts to improve education and enhance public awareness, 30 million to 40 million of the approximately 60 million hypertensives in the United States remain undiagnosed or are inadequately treated (Table 78.1). Most have mild hypertension, and controversy still exists concerning the appropriate approach to these patients. Nonpharmacologic therapy is often the first choice, and this approach continues to evolve.1Of the 20 million to 30 million hypertensives who receive pharmacologic therapy, fewer than 50% adhere to their therapeutic regimen for more than 1 year, and 60% of these patients reduce the dosage of their drug owing to adverse effects. A negative impact on the patient’s quality of life may occur as a result of just making the diagnosis. Effects such as increased absenteeism, sickness behavior, hypochondria, and decreased self-esteem have been noted in cohorts of previously well individuals who have been told they were hypertensive.2A 1987 survey of physicians revealed that they regarded quality of life changes to be the primary impediment to effective pharmacologic treatment of hypertension.
KeywordsChronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Patient Total Peripheral Resistance Life Style Modification Step Care Approach
Unable to display preview. Download preview PDF.
- 1.The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. National High Blood Pressure Education. National Institutes of Health. National Heart, Lung and Blood Institute. NIH Publication No. 93–1088. January 1993.Google Scholar
- 2.Haynes RB, Sackett DL, Taylor DW, Gibson ES, Johnson AL. Increased absenteeism from work after detection and labeling of hypertensive patients. N Engl J Med 1915;291:l41–4.Google Scholar
- 6.Rose G, Stamler J. The Intersalt Study: background, methods and main results; Intersalt Cooperative Research Group. J Hum Hyper-tens 1989;3:283–8.Google Scholar
- 11.Patel C, Marmot MG. Stress management, blood pressure and quality of life. J Hypertens 1987;5 Suppl 1:521–8.Google Scholar
- 13.American Hospital Formulary Service Drug Information. Bethesda: American Society of Hospital Pharmacists, 1990:939.Google Scholar
- 14.Kaplan NM. Clinical hypertension. 5th ed. Baltimore: Williams & Wilkins, 1993.Google Scholar