Practical Problems in Hypertension Management

WE may approach the topic of Session 3 by asking two different questions. What should (and can) the practicing physician do? What can the patient contribute and how can the physician obtain the patient's cooperation? Aspects of these questions have already been discussed in the course of this symposium. Obviously, the large majority of hypertensive patients, independent of the degree or severity of the disease, are treated by practicing physicians. This means that, with the improved control of hypertension, the availability of active drugs, and the better understanding of the importance of general measures, patients seen in hospitals increasingly presented a special selection rather than those with ordinary uncomplicated hypertension. This has to be kept in mind in studying new drugs in hospitals without outpatient departments. General measures should always be considered at the beginning of treatment, especially in mild hypertension, and their long-term application is possible only in practice. In contrast to drugs, general measures have no demonstrable harmful effects. They may be cumbersome or difficult to maintain, but they do not cause adverse reactions; however, most of them have not been proved effective. The exception is reduction of overweight, which has been shown to reduce high blood pressure in some studies, though the decrease in weight by diet, changing eating habits, and increasing physical activity may be achieved for limited periods only. The value of moderate salt restriction and increased potassium intake is widely discussed, and the results of various studies have given equivocal results. The same is the case with an increase in physical exercises. Psychotherapy, yoga, biofeedback, and transcendental meditation are at best effective in only a small percentage of patients. Cessation of cigarette smoking has less effect on hypertension than on coronary heart disease, but reduction of excessive alcohol intake will reduce high blood pressure. Nevertheless, the success