A very popular topic. Even doctors dream that the patient himself correctly measures blood pressure, and then he himself changes something in the treatment. On autopilot. Very comfortably.
It is noteworthy that this topic is also mentioned in modern clinical guidelines for the treatment of high blood pressure. But in passing. Without details.
This is called self-titration of the dose of antihypertensive drugs.
Self-titration. Strange word.
In general, the situation is well known. Patients with diabetes mellitus consider their own dose of insulin.
Patients on warfarin also regulate their INR by dose or diet.
Everyone knows about nicotine. People throw this nicotine gum like candy.
And now it's time for blood pressure medications
It all started about 15 years ago. There are a couple of super popular scientific studies where people with high blood pressure measured this pressure for themselves with a very accurate apparatus and changed the dose at home. Like, after a year or so, it has a very good effect on blood pressure. Everything is under the strict supervision of the attending physician. By phone or whatever.
Only for some reason there are no intelligible algorithms for titrating the dose of pressure drugs at home. Well, that is, when the drugs were simpler and short-acting, then they wrote directly into the table how to take short-acting captopril, depending on the pressure. Even if someone foolishly ate captopril, then after 6 hours it will cease to work, and everything will be all right.
But time is running out. And now short-acting drugs for pressure are considered bad form. Captopril is, of course, used for emergency pressure relief, but this is not self-titration. If the pressure jumped, and the patient threw in captopril, then this is bad, and in an amicable way, one should run to the doctor today, or at least call him.
It seems to me that modern medicines for pressure, which last for three days, will not allow you to titrate something for today, yesterday or tomorrow. Something else may come out by next week.
And all these stories that the doctor told someone at a pressure of 130/90 to drink this, and at a pressure of 140/80 to drink that - this is all a gamble.
Even if we ignore the fact that drugs work longer than a day, our people simply do not know how to measure their blood pressure. This is much worse than you think.
Someone constantly swears at me that I am measuring my blood pressure incorrectly. Well, that is, there is a white coat syndrome, when at the doctor's appointment the pressure scales, and unnecessary medications are prescribed. In my case, the opposite is true - I make me sit for 5 minutes with a cuff on my shoulder, and then I measure it a few more times. And I also pick up the cuff. Then it turns out that the pressure is normal. With great difficulty, such people manage, having turned themselves into hysterics, to catch up with blood pressure, but still it is no longer as terrible as in their stories.
In short, I don't believe in this self-titling.
Basically
Yes, in principle, if you are offered (sorry) to self-titrate, then you should focus not on 150/100 before bedtime, but rather not on the extreme values and the average.
Extreme values are if your upper blood pressure falls below 110 millimeters of mercury or rises above 180. This bad today and something needs to be done with this right today. This can damage the cerebral circulation or something bad happens to the heart.
Average values are exactly what we focus on when choosing antihypertensive drugs. That is, you need to measure your blood pressure several times a day, and then for a few more days you need to measure your pressure and as a result count something in between. This is discussed separately with the attending physician. Based on the average values obtained, something will change in the treatment. Like now to drink not half a pill, but a whole pill.
These are the pies. And now, dear friends, please tell us what self-titration scheme did the attending physician suggest to you? Share with the public. Don't press. And do not be fooled that this was not the case. I know for sure that almost all therapists are guilty of this.
