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High blood pressure is a silent killer and is therefore one of the most significant of the medically related problems that afflicts modern man. Approximately 25 million people living in the United States have the disease. In reality, it is not a "disease" in the classic meaning of that term; instead its sequelae, or subsequent effects, are diseases that are all too familiar and deadly: stroke, kidney disease and myocardial infarction (heart attack), to name just a few. In fact, there are more deaths in the United States each year attributable to the sequelae of high blood pressure than to cancer.
High blood pressure is a direct consequence of the heart having to force blood through excessively constricted blood vessels. Therefore, the heart is overtaxed and can fail; furthermore, blood vessels are exposed to high pressure and therefore have the potential for sttoke, or the bursting of a blood vessel in the brain. In addition, the presence of high blood pressure accelerates the process of atherosclerosis or hardening of the arteries.
Despite these clear dangers and their growing prevalence, it was not until 1967 and 1970 when it was conclusively demonstrated that the treatment of both severe and even mildly elevated blood pressure had any effect on the reduction of the various morbidities mentioned above.1.2 Now that the benefits of treatment have been documented, other problems have become apparent and demand answers from the various scientific disciplines involved in research in this field. One of these problems is the fact that the disease generally has no symptoms until end organ damage has resulted some ten or more years after the onset of even a mild form of the disease. The only way that a person knows that he/she has high blood pressure is to have the blood pressure read by use of a sphygmomanometer (a blood pressure cuff). The procedure takes approximately 30 seconds, is simple to do and painless; but in only 66 percent of physician visits was this procedure performed. 3 Once high blood pressure is documented through a series of three or four blood pressure readings, the treatment of the vast majority of cases of high blood pressure is rather simple. The patient is put on an appropriate medication which he/she will probably have to take for the rest of his/her life. While that may sound simple enough, one of the most significance problems in blood pressure control is helping the patient toward self motivation to maintain him/herself on therapy. The maintenance of such therapy is problematic because the patient is asymptomatic and occasional undesirable side effects may accompany therapy thus militating against pill taking. Some of the research to be reported on here involves this issue of patient facilitation in maintaining clinical regimens.