Hypertension treatment changing, but don't do it yourself

It is commonly known that the management of hypertension requires the concomitant control of other conditions which are present, such as high cholesterol and diabetes, and the prevention of stroke, heart failure and kidney disease.

The report highlighting the need to treat even normal blood pressure ("Stroke risk? 'Treat those with normal blood pressure'"; Dec 25, 2015), bringing it to 120/80 in those with high-risk ailments, seems to turn the table around.

It emphasises that doing so will reduce end-point complications, which include morbidity and mortality. This probably requires further studies and evaluation.

What is clear is that the treatment and management of hypertension is no longer as straightforward as before. Studies showing good control of blood pressure with various medications end up with different end-point results.

Also, it now seems more necessary to tailor the medication to the patients; for instance, patients with heart problems do better with certain medications.

It has become increasingly helpful to have combination drugs in the management of hypertension.

Hypertension may worsen with time as ageing affects the blood vessels. Medications may need to be adjusted accordingly.

Also, certain medications seem to positively affect the remodelling of the endothelium (the inner lining of the blood vessels) with better end-point results.

Unfortunately, not all patients find such medications suitable.

I have come across some patients who happily got their hypertension medications from across the Causeway and treated themselves with the same dosage over a long period of time without seeing a doctor or checking their lipid levels, kidney function, heart condition and other associated risks.

Some do not even monitor their blood pressure, thinking that the same dosage is adequate over a long period of time. 

Incidentally, the normal levels of cholesterol and triglycerides in normal non-hypertensive individuals may not be normal for patients with hypertension, diabetes, stroke and other cardiovascular illnesses.

Patients with such ailments are advised to have lower-than-normal levels in order to prevent further complications.

With all the above in mind, let us be mindful that it is not so simple to manage even a common ailment such as hypertension.

Self-treatment and diagnosis based on advice obtained from the Internet may seem advantageous in terms of saving money and appear to have other apparent benefits, but the problem can be more complex than that.

Quek Koh Choon (Dr)