The Management of the Hypertensive Patient in General Practice

Hypertensive disease has been recognised for many centuries. References to the heart and the consequences of high blood pressure are to be found in many ancient writings. The incidence of the condition has probably increased. There is a relatively high incidence of the condition in relation to other important diseases, such as diabetes meliitus and pernicious anaemia. This is demonstrated by the incidence of these diseases in my own practice. The family doctor is well placed to study the condition. He sees the patient first and is able to observe the early signs and symptoms of the illness. It is usually he who is first aware of the complications of the illness and it is almost certainly he who supervises the medical and nursing care of the patient in the terminal phases of the illness. Management of the patient suffering from hypertension involves not only drug treatment but many other factors. These factors are discussed. in this thesis, a description is given of the ways in which a family doctor encounters hypertension, and the various factors which influence the disease. Diagnostic methods are discussed with particular reference to the resources available to the family doctor. The results of treatment as seen by the family doctor are are described. The extent of the problem with reference to one general practice is described, in this practice of 4,600 people, there were ninety six patients who merited the diagnosis of hypertension. The manifestations of the condition seen in this practice are described. Gases other than idiopatnic encountered in this practice are described, thereby illustrating the rarity of these cases. The recognition of the established disease process is discussed and the grades which are recognised are described. The treatment of the condition is discussed from the point of view of the family doctor. It is shown, by reference to my own practice, that the treatment is nearly always along simple lines. It is only rarely that the powerful ganglion-blocking drugs are required. It is also shown that the prognosis, particularly in women is good. Hypertension is no more a disease entity than a skin rash, a fever or anaemia. It is a measurable manifestation of an illness which has widespread effects on the body. The factors which influence the disease are numerous, and these factors may undergo qualitative and quantitative change at various stages, even in the same patient. The family doctor is uniquely placed to study this complex but interesting illness