Monday, 15 February 2010

fear of hypertension

A man in his forties comes to surgery today for a blood pressure check and to pick up a prescription for his meds. As usual, I have to engage in a complex dance around the issues he raises: why do I have high blood pressure? Is it only high because of my anxiety at having to come here? Do I have to take drugs to control it? Must I take them for the rest of my life?

The answers to these questions are first, there is no specific reason, no, it isn't your anxiety (or at least that's only a small component), yes, you need drugs to reduce the risk of premature heart attack and stroke and, lastly, yes, you do have to take them for life. But this man, and he is not alone, seems to see his diagnosis as some sort of moral judgement on him, some negative reflection on his character. As usual, it takes upwards of 20 minutes to finesse all these issues (the appointment time allotted is 10 minutes per patient)

The fact is (as I tell him for the fifth time in as many months) that ESSENTIAL hypertension, as it is called, is exactly that. It is ESSENTIALLY high blood pressure- an isolated condition that is not related to any others. And it depends much more on genetic factors than environmental ones. You can be young, fit, a non smoker, not overweight, even be a relaxed, phlegmatic personality type and still have essential hypertension. That's the way it is. God invented the damn thing, not me.

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