Thursday, May 03, 2012

THE CONFUSED WORLD OF ANTI-HYPERTENSIVE THERAPY

Let me see if writing medical updates will help get me over the depression in the aftermath of Bersih 3.0.
While we were walking in Jalan Sultan, some my colleagues were in London, still sleeping, before going to attend the European Society of Hypertension 2012 meeting. I have jjust been reading some of the things discussed.
What is most surprising is that, although we know so much about hypertension and we have so many drugs to treat hypertension, we are still very confused as to how to treat hypertension.
You will be surprised that we still do not know what the ideal BP is as a target for the different sets of clinical situation, diabetics, chronic renal disease, acute strokes, chronic cerebro vascular disease, chronic CAD, acute CAD, etc. This is further accentuated by the fact that these numbers that we are aiming for, is different, if we use clinic BP assessment, compared to ambulatory BP monitoring, compared to self home BP monitoring. There is also the issue of the J-curve phenomena, Then when we talk about therapy, the role of combo pills, as opposed to stepping up single pill to max doses before adding another, the issue of resistant hypertension, its definition and therapy. The role of Renal denervation, will it last and are there non-responders. Shall we start treating pre-hypertension aggressively with pills? And what about diabetics with pre-hypertension?
Well, well well. We know so much, yet we know so little and much more research needs to be done.
However,
We do know, and agree that all BP above 140/90, should be monitored closely and reduced to below 140/90 initially through life style modification, and then with drugs. We know that the working number is 140/90mmHg as a target and for diabetics 130/80mmHg, both for clinic assessment, 24 hr ambulatory monitoring and also home monitoring. At least with these, we can already help so many. With more research, maybe these numbers may change, but in the meantime, we need to help people with raise BP. We know that 24hr ambulatory monitoring is good, except that at the moment is raise cost and is also inconvenient. Self home monitoring is also good, except that it needs an educated and compliant patient or family.
There are so many drugs out there, and they are all so good and with few side effects, but they are expensive and will increase the country's healthcare budget.
At the end of the day, we can all agree that prevention is probably the best policy. It is cheap, effective, and effective. But alas, it does require discipline and ( except for those motivated ) the patient may it troublesome and restrictive. He loses his "Human right" to eat and do as he wishes.
Alas, there is not one solution fits all. we have to choose what is best for us.
Well at least here, in hypertension therapy, you have the freedom to choose, and you will have to live with your choice and the consequences of your choice.
How I wish our government will give us that same choice to.

2 comments:

maneesh said...

Webcam home monitoring is much cheaper than using a professional home security set-up, that could set you back by many hundred dollars. Once you have your webcams in place, a webcam software is extremely affordable and what's best, is that some of them like GotoCamera www.gotocamera.com even offer this service for free.

bharatbook said...

Your post so informative as well as helpful for my Antihypertensive Medicine Market 2012 Research and Development.