EDITORIAL
Physician heal thyself: adventures in hypertension I am a 55-year-old White man, with a family history of hypertension and cardiovascular disease. There is no known family history of diabetes mellitus. My body mass index is 27 kg/m2. Although my fasting blood glucose levels have ventured into high normal/ borderline territory, my cholesterol and triglyceride levels have always been exemplary. I last consulted a physician 7 years earlier, and aside from a somewhat enlarged prostate, I was free of any remarkable physical findings. While waiting at the pharmacy for my spouse’s prescription to be filled, I spotted the automated blood pressure monitoring kiosk, and on a lark, I gave it a try. When the digital readout informed me that my blood pressure was 160/110 mmHg, I casually mentioned to the pharmacist that the machine required recalibration, to which he gave me a puzzled look and replied that recent readings had been accurate. You can guess the rest of the story – frantic checking and re-checking the blood pressure at home (no shortage of sphygmomanometers and stethoscopes in a dual-physician home), appointment hurriedly made to see the internist, sheepish admission that ‘no, I haven’t had my blood pressure checked in 7 years,’ physical examination, blood tests, electrocardiogram (yes, that right bundle branch block is new) and echocardiogram scheduled. I now have joined the ranks of the millions (or billions) of people taking antihypertensive medications (I am prescribed two, including one that my dog used to take with cream cheese twice daily). In the Prospective Urban Rural Epidemiology cross-sectional study of 153,996 adults, aged
References 1 Chow CK, Teo KK, Rangarajan S et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013; 310: 959– 68. 2 Houle SK, Tsuyuki RT. Public-use blood pressure machines in pharmacies for identification of undetected hypertension in the community. J Clin Hypertens (Greenwich) 2013; 15: 302. 3 Ross KL, Bhasin S, Wilson MP, Stewart SA, Wilson TW. Accuracy of drug store blood pressure monitors:
ª 2014 John Wiley & Sons Ltd Int J Clin Pract, November 2014, 68, 11, 1283–1285
35–70 years, from 628 diverse communities in 17 different countries, 40.8% of participants had hypertension (≥ 140/90 mmHg) but only about half were aware of the diagnosis (1). I got ‘lucky’ – my hypertension was detected by a publically available blood pressure machine at my local pharmacy (2). My initial concerns over the machine’s accuracy were unfounded (3,4). It is well known that untreated hypertension is a significant risk factor for death, stroke and myocardial infarction. The benefits of treating hypertension can be quantified using number needed to treat (NNT), and vary according to severity of hypertension, age and formally estimated cardiovascular risk level (5). When antihypertensive medications are used to treat severe diastolic hypertension (115– 129 mmHg), NNT for 5 years to prevent one event of death, stroke or myocardial infarction is 3 (5). For mild or moderate diastolic hypertension (90– 109 mmHg), the applicable NNT is 141; although a NNT of 141 is generally considered to be a ‘weak’ effect size (6), the consequences of death, stroke or myocardial infarction are compelling reasons to treat. For older persons, NNT to avoid stroke is as robust as 34. For persons with a clinically relevant 10-year coronary heart disease risk level, NNT to avoid a cardiovascular event is as robust as 20. Are you walking around in blissful ignorance with a blood pressure of 160/110 mm Hg?
Are you walking around in blissful ignorance with a blood pressure of 160/110 mmHg?
L. Citrome New York Medical College, Valhalla, NY, USA Email: [email protected]
an observational study. Blood Press Monit 2013; 18: 339–41. 4 Chambers LW, Kaczorowski J, O’Rielly S, Ignagni S, Hearps SJ. Comparison of blood pressure measurements using an automated blood pressure device in community pharmacies and family physicians’ offices: a randomized controlled trial. CMAJ Open 2013; 1: E37–42. 5 A’Court C. 10-minute consultation. Newly diagnosed hypertension. BMJ 2002; 324: 1375. 6 Citrome L, Ketter TA. When does a difference make a difference? Interpretation of number needed
to treat, number needed to harm, and likelihood to be helped or harmed. Int J Clin Pract 2013; 67: 407–11.
Disclosures No relevant disclosures other than feeling like an idiot for not having had a routine medical check-up in 7 years. doi: 10.1111/ijcp.12571
1283
Physician heal thyself: adventures in hypertension I am a 55-year-old White man, with a family history of hypertension and cardiovascular disease. There is no known family history of diabetes mellitus. My body mass index is 27 kg/m2. Although my fasting blood glucose levels have ventured into high normal/ borderline territory, my cholesterol and triglyceride levels have always been exemplary. I last consulted a physician 7 years earlier, and aside from a somewhat enlarged prostate, I was free of any remarkable physical findings. While waiting at the pharmacy for my spouse’s prescription to be filled, I spotted the automated blood pressure monitoring kiosk, and on a lark, I gave it a try. When the digital readout informed me that my blood pressure was 160/110 mmHg, I casually mentioned to the pharmacist that the machine required recalibration, to which he gave me a puzzled look and replied that recent readings had been accurate. You can guess the rest of the story – frantic checking and re-checking the blood pressure at home (no shortage of sphygmomanometers and stethoscopes in a dual-physician home), appointment hurriedly made to see the internist, sheepish admission that ‘no, I haven’t had my blood pressure checked in 7 years,’ physical examination, blood tests, electrocardiogram (yes, that right bundle branch block is new) and echocardiogram scheduled. I now have joined the ranks of the millions (or billions) of people taking antihypertensive medications (I am prescribed two, including one that my dog used to take with cream cheese twice daily). In the Prospective Urban Rural Epidemiology cross-sectional study of 153,996 adults, aged
References 1 Chow CK, Teo KK, Rangarajan S et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013; 310: 959– 68. 2 Houle SK, Tsuyuki RT. Public-use blood pressure machines in pharmacies for identification of undetected hypertension in the community. J Clin Hypertens (Greenwich) 2013; 15: 302. 3 Ross KL, Bhasin S, Wilson MP, Stewart SA, Wilson TW. Accuracy of drug store blood pressure monitors:
ª 2014 John Wiley & Sons Ltd Int J Clin Pract, November 2014, 68, 11, 1283–1285
35–70 years, from 628 diverse communities in 17 different countries, 40.8% of participants had hypertension (≥ 140/90 mmHg) but only about half were aware of the diagnosis (1). I got ‘lucky’ – my hypertension was detected by a publically available blood pressure machine at my local pharmacy (2). My initial concerns over the machine’s accuracy were unfounded (3,4). It is well known that untreated hypertension is a significant risk factor for death, stroke and myocardial infarction. The benefits of treating hypertension can be quantified using number needed to treat (NNT), and vary according to severity of hypertension, age and formally estimated cardiovascular risk level (5). When antihypertensive medications are used to treat severe diastolic hypertension (115– 129 mmHg), NNT for 5 years to prevent one event of death, stroke or myocardial infarction is 3 (5). For mild or moderate diastolic hypertension (90– 109 mmHg), the applicable NNT is 141; although a NNT of 141 is generally considered to be a ‘weak’ effect size (6), the consequences of death, stroke or myocardial infarction are compelling reasons to treat. For older persons, NNT to avoid stroke is as robust as 34. For persons with a clinically relevant 10-year coronary heart disease risk level, NNT to avoid a cardiovascular event is as robust as 20. Are you walking around in blissful ignorance with a blood pressure of 160/110 mm Hg?
Are you walking around in blissful ignorance with a blood pressure of 160/110 mmHg?
L. Citrome New York Medical College, Valhalla, NY, USA Email: [email protected]
an observational study. Blood Press Monit 2013; 18: 339–41. 4 Chambers LW, Kaczorowski J, O’Rielly S, Ignagni S, Hearps SJ. Comparison of blood pressure measurements using an automated blood pressure device in community pharmacies and family physicians’ offices: a randomized controlled trial. CMAJ Open 2013; 1: E37–42. 5 A’Court C. 10-minute consultation. Newly diagnosed hypertension. BMJ 2002; 324: 1375. 6 Citrome L, Ketter TA. When does a difference make a difference? Interpretation of number needed
to treat, number needed to harm, and likelihood to be helped or harmed. Int J Clin Pract 2013; 67: 407–11.
Disclosures No relevant disclosures other than feeling like an idiot for not having had a routine medical check-up in 7 years. doi: 10.1111/ijcp.12571
1283
