By Blake Farmer,
Nashville Public Radio APRIL 18, 2018
There’s
an irony at the heart of the treatment of high blood pressure. The malady
itself often has no symptoms, yet the medicines to treat it — and to prevent a
stroke or heart attack later — can make people feel crummy.
“It’s
not that you don’t want to take it, because you know it’s going to help you.
But it’s the getting used to it,” said Sharon Fulson, a customer service
representative from Nashville, Tenn., who is trying to monitor and control her
hypertension.
The daily
pills Fulson started taking last year make her feel groggy and nervous. Other
people on the drugs report dizziness, nausea and diarrhea, and men, in
particular, can have trouble with arousal.
“All of
these side effects are worse than the high blood pressure,” Fulson said.
Research
shows roughly half of patients don’t take their
high blood pressure medicine as they should, even though heart disease is
the leading cause of death in America. For
many unfortunate people, their first symptom of high blood pressure is a
catastrophic cardiac event. That’s why hypertension is called the “silent killer.”
A drug
test is now available that can flag whether a patient is actually taking the
prescribed medication. The screening, which requires a urine sample, is meant
to spark a more truthful conversation between patient and doctor.
Fulson’s
blood pressure has been a moving target, she said. She regularly checks it at
home, but it sometimes registers as a little high. Even having it taken in a
doctor’s office can add enough stress to elevate the results.
This is
why taking patients’ pressure — the familiar cuff test — doesn’t confirm for
cardiologists whether patients are consistently taking their hypertension meds.
The new drug test, dubbed KardiAssure, uses computers to analyze urine
to search for 80 kinds of blood pressure and cholesterol medication, reporting
the results in just three minutes.
The
test can determine only whether a patient has taken pills in the past day or
two. But Aegis
Sciences Corp.’s CEO Frank Basile said that’s a starting point.
“What
we give doctors is a tool that enables them to have a very focused conversation
with their patients,” he said. Only after the problem is out in the open, he
said, can doctors get to the reasons behind it.
The
conversation starter has been effective for cardiologist Bryan Doherty in Dickson, Tenn., who has
been working with Aegis to test the test. In one case, when the results showed
a patient wasn’t regularly taking his medicine, though he’d claimed he was, he
quickly confessed.
“He
immediately turned around and told me that the cost was an issue,” Doherty
said. “I think there was a degree of embarrassment there, potentially, or a
feeling of letting me down in some way — something that had not come up in a
25-minute initial encounter when we had spoken before.”
Of
course, the test has a cost, too — about $100 — though Doherty noted that
insurance, including Medicare, has been covering it.
The
conversation is important, Doherty said, because he can try less expensive
prescriptions if cost is the issue, or experiment with different kinds of drugs
if side effects are the problem. It’s worth the potentially uncomfortable
encounter with the patient, he said, since the medication might make the
difference between life and death.
The
screening could also help a patient avoid other unnecessary tests or additional
prescriptions, said Dr. Thomas Johnston. He runs the hypertension
clinic at Centennial Medical Center in Nashville and is board president of the
local chapter of the American Heart Association.
Other
than calling the pharmacy to make sure people are refilling their prescription,
he said, he generally takes their word for it.
“I
think there are a lot of times where you’re questioning in your mind whether
someone has taken their medicine or not,” he said. “I think it would be good
for the patient, too, for the doctor to know that they’re not taking their
medicine so that we may not go down the wrong pathway.”
Johnston,
who is not affiliated with Aegis, said his only concern about using a drug test
would be running the risk of setting up an adversarial relationship with a
patient. But there’s a way around that, too, he said, by making them understand
how vital it is to take the drug properly.
Sarah
Avery of Nashville said she’s fully aware of the consequences.
“My
daddy died because he didn’t take his medicine,” she said.
Hypertension
runs in her family. Her mom and grandmother also battled high blood pressure.
Still, the medication is such a drag, she said, that she’s decided at times to
stop without consulting her doctor.
“I
lied. Really, I lied,” she admitted. “He said, ‘Are you taking your medicine?’
I said, ‘Mmhmmm. Yeah, my momma makes sure that I do.’ I was just lying,” she
said.
That
is, until she, too, had a stroke. Now, she has three blood pressure medications
and said she takes them without fail.
Blake Farmer,
Nashville Public Radio: bfarmer@wpln.org, @flakebarmer
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