A scene like this plays out many times every day: A patient with newly diagnosed hypertension, confirmed with out‐of‐office readings, is seen in the clinic. What happens next depends on the patient, the doctor, and other less understood dynamics of that interaction. In most settings, the patient walks out with a plan to change their lifestyle, a prescription for a pill, or sometimes both. On one hand, most individuals demonstrate significant pill disutility, defined as the longevity gain desired by an individual to offset the inconvenience of taking a preventative tablet for life. This can vary considerably, ranging from >1 month for about two‐thirds of patients, to 12% demonstrating extreme pill disutility (bordering on pill hatred), actually desiring ≥10 year increased life expectancy before taking any new medication. On the other hand, undoubtedly, giving a prescription for a medication is a much faster and easier option for the physician. Data from a large health maintenance organization, which has achieved an enviable 85% hypertension control, demonstrate that the path to lower blood pressure does go through optimal pharmacotherapy. Additionally, a successful non‐pharmacological strategy should take into account the patient motivation for lifestyle changes and the pieces needed for actual execution, not just
Journal of Clinical Hypertension – Wiley
Published: Jan 1, 2018
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