R D Feldman


Department of Medicine, The University of Western Ontario, London, Ontario, Canada


Hypertension remains the leading atherosclerotic risk factor leading to premature death.  The management of hypertension remains problematic, despite its ease of diagnosis, the simplicity of blood pressure monitoring and the wide availability of a number of effective antihypertensive drugs with excellent safety profiles. Based on these considerations, self care of hypertension – both in terms of monitoring and treatment would seem to be a feasible option. Further, self care models are becoming the norm for many of the other major factors leading to atherosclerosis. This brief review examines the key considerations underlying the feasibility of a self care model for the diagnosis, monitoring and management of hypertension. Monitoring of blood pressure (as opposed to taking antihypertensive therapy in the absence of baseline blood pressure assessment) still appears to be a required step in the diagnosis and management of hypertension. Over the counter (OTC) availability of antihypertensive drugs would need to be based on the assessment of the safety of these agents and probably be limited to those with self-evident adverse effects (i.e., not requiring laboratory monitoring). Alternatively, the availability of low dose single pill combinations might be advantageous in this setting given the greater effectiveness and better safety profile of these formulations of antihypertensive drugs. Overall, self care models for the management of hypertension remain attractive but unproven in the management of hypertension.

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