Endocrine Abstracts (2010) 22 P144

Clinical approach to hypertensive patients: matter of trust between doctor and patient

P Pavlovic1, Zoran Hajdukovic2, Dragana Bubanja3 & Aleksandra Jovelic4

1Clinic of Cardiology Military Medical Academy, Belgrade, Serbia; 2Clinic of Endocrinology Military Medical Academy, Belgrade, Serbia; 3Center of Endocrinology, Kragujevac, Serbia; 4Institute for Cardiovascular Diseases, Sremska Kamenica, Serbia.

What happens if the prescribed medication makes the patient ‘worse’ than he was before comint to the doctor? Putting aside the world wide accepted JNC clasiffication of hypertension, we colud consider the following:

The ‘cat-walk’ (moderate) hypertension (<150/95 mmHg) 2. Pts with serious hypertension with symptoms 3. Pts with seerious hypertension without symptoms.

Having moderate hypertension and no side effeects of the disease, pts from the first group wil listen to the doctor, take medications as prescribed, come to regular check-ups and feel fine, mostly because they having no symptoms at the first plase, except for the doctor’s conclusion that they condition is fine. The result: both sides satisfied.

Pts from the second group decide to come to the doctor and start prescribed therapy their dreadfull symptoms will be gone with normalised blood pressure. The result: both sides are satisefied.

Pts from the third group are most difficult to deal with. Over months/years, their cardiovascular system has got adopted to register abnormal blood pressure as ‘normal’ so they have no symptoms.Once starting taking prescribed medication the blood pressure will normalise and such pts will paradoxlly feel worse despite the fact that their blood pressure condition is improved. The result.: satisfied doctor and a very unsatisfied and still ‘ill’ patient. Also, these pts tend to not to take medications because that paradoxslly makes them feel ‘better’. The only solution for this ‘hard core’ group is to have extreme patience in persuading them, over and over, again, explaining that it takes some time for their body to recognise and adopt that the normal state is ‘really normal’. It takes a lot of time and perssuasion but the final result is: Both sides satisfied.

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