Recent epidemiological studies prove beyond any doubt that the already low compliance with doctors' orders by patients with chronic diseases is particularly low among hypertensives. One of the reasons as we all know is the fact that hypertensives often feel well and energetic and do not experience their hypertension either as an impairment or as a threat. Like the obese patient the hypertensive's "cognitive dissonance" is supported by the absence of discomfort, and thus lacking overt symptoms, he is more likely to ignore medical advice. Another reason for the poor response of hypertensives to medical advice is the lack of information (substantially below the awareness of diabetics) about the nature, hazard, and necessity for treatment.

Only recently have efforts to raise public awareness been intensified. Yet at the same time studies have shown that more information can also have negative effects. For example, the recent augmentation of information about drugs and their possible side effects has made many people reluctant to take pills. The listing of the potential side effects on the labels has aroused widespread fears. The patient is told about the danger of a given treatment but nothing about the need for and success of the therapy.

Thus he is unable to weigh its potential risks against the great hazards of untreated hypertensive disease.

This makes it incumbent upon us not to let up on our efforts to counteract ignorance and misunderstanding with information and motivation. It has been my experience that people with chronic diseases, and hypertensives in particular, listen to their doctor only if the nature of their disease has been explained to them and they understand the need for cooperation and regular checkups. That is a time-consuming process, and even then misinformation can continue to flourish. A recent study showed that 70% of all patients have forgotten vitally important instructions five minutes after leaving the doctor's office.

That is why I have tried to emphasize the importance of the doctor-patient relationship. In addition, I am sure that even doctors who have spent a lifetime fighting this epidemiologically most widespread disease of our time cannot confine themselves simply to the purely medical and scientific area. I was therefore glad to be able to contribute this volume to the Medical Adviser Series. I knew before I began that it would not be easy to render medical information in terms understood by the layman. I have tried to give the patient objective information about high blood pressure without creating insecurity through medical half-education, and to motivate him psychologically to cooperate in his treatment without exaggerating the dangers.

If in your opinion I have not always succeeded in what I have set out to do, you can help me by suggesting revisions for future editions. Write to me which sections you feel could stand clarification and improvement. Send an annotated copy to the publisher who will gladly replace it with a new desk copy.


Cardio & Blood