Wednesday, 11 April 2012

High blood pressure: Plenty of hype about hypertension

It’s fantastic this week to see diabetes as a front page headline on the BBC Health website, the subject of a new report on the national diabetes audit for England. It shows that only about 50% of people with diabetes have blood pressure below the recommended levels. Hypertension, the term for blood pressure higher than the recommended levels, is an important issue in diabetes as it is common but often silent, and can cause all sorts of problems, including strokes and kidney problems, both cited in this report. It can only be a good thing that public awareness is kept high about this condition.

However, it’s a rather less good thing to read some of the terminology used in the report. This kind of suggests that people with diabetes themselves are deliberately putting themselves in the way of these raised levels. It says that people with diabetes are ‘failing’ to control their blood pressure, and are ‘told’ to keep it under 130/80. The implication is that they are not doing as they are told or making the grade, as if it were some sort of exam they have to pass to gain approval. Added to this, for good measure, a fear factor is thrown in, namely that people with diabetes suffer ‘record levels of stroke and kidney failure and are dying years younger than the rest of the population’. 

Whilst we are sure these implications and scaremongering are not conscious reprimands to people with diabetes, these kinds of messages are not necessarily helpful in enabling people to take action to rectify what’s going wrong. For a start, blaming people or telling them off is rarely effective in changing behaviour and making people fearful of consequences is more likely to lead to inaction than proaction. Equally, it is not the fault of individuals that they are more susceptible than others to a particular condition.

The Department of Health is also cited in the report telling people what to do. In this case, health professionals are exhorted to ensure all people with diabetes (which they term ‘diabetic patients’) have their blood pressure checked and to give them advice and treatment. Again, this gives the suggestion that this is not already happening, and is more likely to cause indignance amongst health professionals than make a useful contribution to their work.

How about other, perhaps broader ways of looking at the issues? Are there other factors which might contribute to so many people having high blood pressure? Firstly, a few ideas about this in relation to the suggestion that it might be people’s own failure to control their blood pressure that has led to this problem:

·      Someone living with type 2 diabetes once told us in a meeting ‘diabetes doesn’t come to the party on its own, it brings its friends’ – in this case high blood pressure, high blood lipids and being overweight, all of which are frequently present alongside type 2 diabetes in particular.
·      Type 2 diabetes is a condition whose progress is not always easy to understand. Even with the best efforts of all concerned, it becomes harder to manage over time and co-conditions such as hypertension can be equally hard to control.
·      When treatment is prescribed for high blood pressure, it often involves taking multiple different sorts of tablets, some of which are not always palatable or tolerable. To get the right mix for an individual, a series of different combinations may need to be tried. The more tablets there are prescribed, the more risk of confusion and forgetting of doses.
·      People respond to medication differently at different ages, ethnicities and with other illnesses or complications of diabetes.
·      It’s much more difficult than anyone makes it sound to apply the commonly cited ‘simple lifestyle advice’ such as losing weight, taking more exercise and eating more healthily to manage high blood pressure, and even more so when you also have diabetes.

Secondly, some thoughts in relation to healthcare professionals giving advice and treatment:
  • There can be flaws in the way advice is given – for example, a blood pressure check may be taken, but people are often not informed of the actual level, just given a broad message that it is ‘ too high’ or ‘it’s better than last time’. This is not necessarily meaningful and is unlikely to lead to concrete action.
  • While there are nationally agreed treatment recommendations for what medication can be prescribed and in what order, sharing these plans with the people actually affected is not common. This means that they have not necessarily been informed whether a new tablet is an additional treatment or a replacement, which can result in under treatment of the condition (and also unused supplies cluttering people's cupboards). 
  • Even when the best advice is given, and care taken that it is clearly understood, there is also the question of how it can be practically implemented – for example, a tablet regimen that involves taking different pills at different times of the day can be really tricky to fit in to any lifestyle.

As ever with reports such as this, the headline news is often the most dramatic. Short reports need to have soundbites to capture the media’s attention and it’s great that this is obviously the case with the announcement of this report. But behind the headlines, let’s not forget that living with diabetes and hypertension is a marathon not a sprint, and people need some practical ways that they can make a difference to their blood pressure levels that give them a sense of control and reward rather than being thought of as at the mercy of health professional and medication instruction.

We’d like to offer a few other suggestions that could make a difference to high blood pressure, but are less often talked about in the excitement of the medical side of things. So if you have high blood pressure and want to try something different, these practical ideas could help:

·      Relaxation – from taking 2 or 3 deep breaths and exhaling gradually a few times a day, to formal relaxation tapes or classes: it all helps to calm you and your blood pressure down
·      Take your own blood pressure with a machine bought from the high street chemist, keep records and look for trends. This puts you firmly in control and will give you levels to compare ‘before and after’ when you make any changes in tablets or your lifestyle
·      Ask questions of your GP or practice nurse, and find out what your actual level is and what you are aiming for it to be. The more you know about your blood pressure, the better.
·      Find out more about blood pressure in general, on Internet sites or through books and leaflets. Being informed like this helps you think about your blood pressure in the context of your overall health
·      Talk to other people who have high blood pressure or who have treatment for it. Can you learn anything from their experiences?
·      Check with your GP or pharmacist about possible interactions among the tablets you are taking when new ones are added and ask them to ensure you are taking the least number possible per day. The less tablets you have, the less likely it is you will forget to take them!
·      Keep a mood diary and see if you can link your high blood pressure to the way you are feeling emotionally. It may be that you need treatment for anxiety or depression as well as, or even rather than high blood pressure


10 April 2012 15.00

Whatever your role, what’s your experience of high blood pressure, diabetes and discussions about it with health professionals in consultations? What works or doesn't work for you or someone you live with or know? This blog is open for discussion!