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Published by Contra Costa Times
Posted on Wed, Nov. 16, 2005
By Stephen Daniels, MD

"HI, DOTHTOR," said Martha, as I entered the exam room. She looked the same as I had known her for years: neatly dressed, smiling.

But something was different. Her smile seemed a little crooked, and her words were slightly slurred. And she wasn't holding out her hand to be shaken.

The week before she had become confused and had trouble speaking and standing, so her family called 911. At the hospital, the 57-year-old woman was found to have a blood pressure of 196/108, and a brain scan confirmed she had had a stroke.

In most cases, a stroke is caused by a tiny blood clot that blocks the flow of blood to a part of the brain, which then dies. The medical term for the dead tissue is "infarct."

The bodily functions controlled by that part of the brain stop working, often affecting speech, facial or limb muscles, and/or the ability to think. If the clot cuts off blood to a critical or large part of the brain, the person may die.

In Martha's case, some of her lost function had returned, but she still couldn't speak normally, smile straight or walk without support.

For years, we had worked on lowering Martha's high blood pressure (also known as hypertension), which can lead to a stroke and other problems, if not treated.

She told me she was taking the five daily blood pressure medicines I had prescribed. Sometimes she even brought her pill bottles to her doctor's visit.

Her pressure was confusingly erratic, though. Sometimes normal, but more often it was high when taken in the office. She claimed it was normal at home or at the drug store.

Because of the mostly high readings, we tried adding more medicine. But she often complained of side effects, or found reasons to reject them.

When hospitalized for her stroke, though, Martha's blood pressure was easily controlled by only two of the five medicines she had been previously prescribed. She finally admitted that she hadn't been taking most of the prescribed blood pressure medicines.

Sometimes she took some of them, sometimes others, but never all of them.

It wasn't entirely clear why. One reason she gave was "too many pills." Another was, "I didn't really need them... I felt fine except for my back pain..."

Another was, "I forgot..." Yet another was, "I was afraid of all those pills..."

All this, despite having spoken with me and the nurse educator repeatedly about the dangers of untreated high blood pressure, and the benefits of the medicines.

Her overriding concern had always been her back pain, and pain medication. She missed appointments to check her blood pressure, but always came on time for refills of her pain pills.

She stated the pain medication controlled her pain, so she didn't want to miss a refill. She felt the benefits of the pain pills, but not of the blood pressure pills.

Finally, Martha understands the consequences of uncontrolled high blood pressure, and the benefits of taking those medicines, even if they don't make her feel better at the moment.

Don't make Martha's mistake. Don't wait to have a stroke before you are convinced that taking your blood pressure medicine is a good idea.

Dr. Daniels practices family medicine at the Pittsburg Health Center.

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