HYPERTENSION CLINICS AND THEIR RELEVANCE

Why is the treatment of hypertension important?

Early detection and treatment of hypertension are significant to prevent complications due to hypertension. High blood pressure may not have symptoms most of the time. The only symptom could be complications due to hypertension. However, controlling high blood pressure and preventing complications due to hypertension possesses multiple challenges.

What is a hypertension clinic?

This is a team of healthcare workers who are dedicated to this field of management of blood pressure, and it’s complications. This may belong to a multidisciplinary team who are highly capable of managing hypertension, particularly the secondary causes of hypertension. Such hypertension clinics are necessary in all parts of India that should work according to a specific, evidence-based and driven by a team of experienced and dedicated personnel.

What about diabetes clinics in India?

There are many clinics to handle diabetes in almost all districts in India. The same can not be said about hypertension clinics in India. The number of deaths directly related to hypertension is almost 5 times more than diabetes. This is as per the Global Burden of Diseases Study 2016. Thus, a strong unmet need exists in focus Approximately 20 crore people are disabled due to hypertension in India. It accounts for 57% of deaths due to strokes or brain haemorrhage and 27% of deaths due to heart failure. Though hypertension management and diagnosis are simple, inadequate management and diagnosis and treatment are quite common. The hypertension clinic is a specialized centre with an integrated and comprehensive approach to the management of high blood pressure. The approach in the treatment of hypertension. A simplified and appropriate protocol can curtail complications due to hypertension and improve quality of life.

What should every hypertension clinic provide to the patients?

There should be accurately validated BP monitors with 3 different cuff sizes. Self-blood pressure measurement should be popularized and encouraged. Infrastructure to manage
emergencies due to hypertension should be available around the clock. Patient education, rehabilitation program, advice on lifestyle management and facilities to assess target organ damage should be available.

What are the responsibilities of the Hypertension Speciality Centre?

Public health education and routine screening facilities at the library, bus stands, railway stations, airports, pharmacies, and gymnasiums should be available. Adopt a village and establish teleconsultations for the people in the village. They should maintain the Hypertension registry and do clinical research.

What are the human resources needed for Hypertension Speciality Clinic?

A general physician, nephrologist, cardiologist, endocrine specialist and neurologist are required. Technicians for ECG, fundus camera operators, and ambulatory BF measurement trained technicians are important. Besides these nutritionists, yoga teachers, a home BF’ monitoring team and an online counselling team are significant. Data entry and clinical research staff are a must.

What should be the goals of a Hypertension Speciality Centre?

Proper management of hypertension, improving compliance and adherence to treatment, and follow-up aimed at reducing the incidence of strokes, brain haemorrhage and heart failure are some significant factors. New cases should be detected by having a massive, consistent and periodic screening. Awareness of hypertension and complications, yoga therapy, diet, salt restriction, and mental health issues are significant. The use of modern technology in proper adherence to treatment is necessary.

How can the follow-up monitoring be simplified?

Hypertension management is a lifelong process. Good management will give positive results and prolong life. The follow-up management can be done through mobile phones, WhatsApp, Internet. Reviewing cases regularly is important.

How do you evaluate target organ damage?

Basis tests like CBC, kidney function tests, lipid profile and blood sugar tests are necessary Electrocardiographs, stress ECG, and echocardiograms are required. Examination of the retina and ankle-brachial index is necessary. These can be done in dedicated hypertension clinics. Diagnosis and proper management of hypertension are very rewarding as it prevents complications due to hypertension and prolongs your life in good health. Proper corn-medication, adherence to therapy and speciality clinics, and a dedicated work force to detect and diagnose hypertension are the need of the hour in every village or town in our country.

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Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.

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