Unraveling the mysteries of pre-hypertension

WHEN confronted with an ailment particularly their own, doctors either become “neurotic” about the disease or rely on evidence from scientific and clinical researches to address it. This reality was revealed by UST cardiologist Dr. Albert A. Atilano, president of the Philippine Lipid and Atherosclerosis Society.

During the open forum of a lecture unravelling the mysteries of pre-hypertension (PHPN) by Dr. Joel Neutel from the Orange County Research Center during the 43rd Annual Convention and Scientific Meeting of the Philippine Heart Association (PHA) at the Crowne Plaza Manila Galleria in Quezon City this week, Atilano, one of the facilitators, said that when his body started exhibiting the symptoms of hypertension three years ago, he confronted his own disease not by being neurotic but by looking at evidence for its treatment.

Initially addressing his illness by non-pharmacologic treatment through lifestyle change and reduction of salt intake, Atilano eventually resorted to pharmacologic or drug intervention to address the problem because just like ordinary patients, he could not faithfully comply (proof that doctors are notoriously bad patients?) with lifestyle change, particularly doing exercises as well as reducing salt intake.

For three years, the cardiologist said he took an angiotensin-converting-enzyme (ACE) inhibitor to keep his BP at normal level but developed nasal drip so he shifted to an Angiotension Receptor Blocker (ARB) which prevents the small arteries from constricting, thus lowering blood pressure.  He said that as a result of a similar lecture by Dr. Neutel in December 2011, his modified pharmacologic intervention served him well with no side effects at all.

Neutel affirmed that non-pharmacologic treatment for pre-hypertensive (PHPN) patients such as low-salt intake, natural remedies, and exercise do not work in the long run because of patient issues and psychological effects.  He said that most patients who do not consistently show symptoms of high BP do not feel the need to take prescribed medications, oftentimes begging their doctors to give them time to try natural remedies and/or supplements.

Likewise, he said that labelling patients as “Pre-hypertensive” leads to psychological effects, particularly in making them believe that they are not yet suffering from the disease, thus making them less compliant with medications.

Newly-elected Philippine Heart Association president Dr. Saturnino Javier stresses the importance of simultaneous pharmacologic intervention and lifestyle change in pre-hypertensive patients.

Using the findings of his research and those of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, Neutel warned that neuro-hormonal and metabolic changes happen in people with normal BP but with family history of the disease.  He added that family history is “an incredibly strong predictor” of the disease and that, in fact, hypertension is being beaten too late.  Much of the damage in hypertensive patients, he said, might occur before the onset of the disease which means that the endothelial cells that line the interior surface of blood vessels and lymphatic vessels are becoming dysfunctional, leading to vassal constriction and cardiovascular diseases.
He thus stressed the need to label pre-hypertension as “stage 1” of hypertension to increase compliance of patients to medications.

In some of his internet blogs, however, Neutel does not dismiss the importance of non-pharmacologic intervention. “It is important to maintain a low fat, low calorie diet high in potassium, magnesium, and calcium, and low in salt. You should also try to fit in thirty minutes of aerobic exercise four times a week. Some examples of aerobic exercise are: walking, dancing, jogging, bicycling, skating, swimming, yard work, house work. Even if you cannot find thirty minutes a day, any amount of physical activity is beneficial. In addition to a healthy diet and regular exercise, natural agents, with scientific basis that have been shown to lower blood pressure may be an alternative first step prior to starting anti-hypertensive drugs.”

PHA incoming president, Dr. Saturnino Javier, agrees, saying there is no conflict between pharmacologic intervention and lifestyle change and that the two should go together.  The PHA, however, is a strong advocate against dietary supplements, believing in the importance of pharmacologic intervention based on intensive scientific and clinical researches.

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