Blood Pressure Lowering Treatment Follow Up
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Providing your physician has a well-organized follow up system, you are likely to be better off with your general practitioner than with any hospital clinic. There is likely to be more continuity and it is much easier to integrate care of any other problems you may have with control of your blood pressure. Some general practitioners have no organized follow up system, but rely instead on people asking them to do things when they com to surgery for an appointment. With well-informed people this can work, but you must make sure that your blood pressure is checked every three months or so and that you have a more general check (including a urine test for kidney function) about once very 5 years. If your general practitioner is really not interested, you will probably be better off with an endless succession of young doctors in training in a clinic hospital. They won't know you, but they will check the most important things that need checking.
It is just as good to be followed up by a practice nurse as by a doctor. Generally, practices which have developed enough of a team approach to delegate follow-up to nurses are likely to be more thoughtful and up to date than practices which have not, but there are many exceptions, particularly in practices too small to allow division of labor. More and more practice nurses are getting special training to run blood pressure follow up clinics and often clinics for other related problems such as diabetes or coronary heart disease prevention. Those with recent training may even be more up to date that the doctors who employ them. Nurses usually have more time and are often more in touch with the practical problems of living on an average income.
However well you seem to be doing, you should see your doctor for a review at least once every 5 years and many doctors do this annually. Unless the practice has some computer-based reminder system, it can be easy to let this slide, because general practitioners practices are so busy. Your nurse should be operating within guidelines, which indicate when a doctor's opinion is needed. This should include a target pressure, usually less than 160/90 mmHg or thereabouts. If your measurements are consistently higher than this, either the nurse will change your medication (with guidelines) or you should see your doctor.
If you are concerned about other problems, which may or may not be related to either your high blood pressure or to its treatment, there's no harm in asking your nurse about this first. If she's not sure of the answer, she will probably either ask a doctor, or arrange for you to see one. Problems may arise where nurses are under pressure to protect a doctor from an excessive workload, often real enough. If you suspect this is the case and you really to want to see your doctor, you must insist on your right to do so. In the last resort, you can change to another doctor.
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