How To Avoid Blood Pressure Medications You Don't Need, And How To Ensure Your Blood Pressure Treatment is Optimized
February 10, 2016
Is high blood pressure a concern for you or a loved one? Would you like to stay as healthy as possible, yet avoid taking medications if you can? And if you must take medications, would you like to ensure that your treatment is as effective as possible to avoid stroke, heart failure, or kidney disease?
I'm Dr. Michel Accad, a board-certified cardiologist with 20 years of experience in the treatment of cardiovascular disease, and I would like to share with you my thoughts and approach to hypertension (high blood pressure), a condition which, in my opinion, is frequently either over-treated or under-treated.
Don't let "the number" tell the whole story
The main reason the treatment of high blood pressure is not optimized is because doctors and patients tend to focus too much on the blood pressure number itself, and don't pay enough attention to the effect a given blood pressure might have on the organs.
You see, not everyone reacts in the same way to a given amount of blood pressure. For one person, a blood pressure of 150/90 may be perfectly well tolerated, but for another person, even a blood pressure of 135/80 may be too high. The number we commonly use to "define" high blood pressure, say 140/90, is a number chosen out of convenience. It does not represent a true physiologic distinction. The risk imparted by blood pressure increases gradually, without any precise dividing line.
Let's look at how the pressure is affecting your organs
How do we get around this uncertainty? In my opinion, the best approach is to periodically examine the health of the organs which are the target of high blood pressure: the heart, the blood vessels, and the kidneys. Modern medical technology has produced excellent tools that can show abnormalities related to high blood pressure in its early stages, before the changes become irreversible and before complications occur. These tools can measure the size of the heart chambers, the thickness of the heart muscle wall, the stiffness of the arteries, the function and health of the kidneys, etc. In this way, management of the blood pressure is not based solely on the height of the blood pressure, but also on how the pressure is affecting your cardiovascular system. I wrote about this approach in a peer-reviewed medical journal, and a number of academic cardiologists are starting to recognize the value of this approach.
A well-designed program takes the "guessing-game" out of the picture
To optimize the surveillance and management of high blood pressure, I have designed a unique program suitable for anyone with blood pressure concerns, whether you were told that your blood pressure is "borderline high" and might need drug treatment, or whether it is clearly more serious but you want to make sure that the treatment is optimized.
The program consists of 1) a yearly examination with state-of-the-art non-invasive tests and 2) an ongoing program of remote monitoring by phone and email, where I make myself available to you throughout the year to address any concern you might have related to your blood pressure. That way, we are not in the dark, guided simply by a potentially misleading blood pressure value, but we can make decisions to either defer medication therapy or intensify it on the basis of reliable information.
- Yearly non-invasive tests include
- 12-lead ECG
- Quantitative echocardiography
- Pulse-wave analysis
- Review of blood and urine tests
- The on-going program of phone/email monitoring includes
- Periodic review of home blood pressure measurements
- Attention to lifestyle (weight loss, nutrition, etc.) to make sure goals are met
- Initiation and monitoring of medications, if and when needed.
- Coordination of care with your primary physician
The program is affordable, and I invite you to call my office at 415-567-1014 and schedule a complimentary phone call with me so I can describe it in more details, answer your questions, and make sure the program meets your needs. Alternatively, you can email me at CardioCheck@AthleticHeartSF.com.
Michel Accad, MD, FACC.
Medical Director, Athletic Heart of San Francisco