NICE is insisting that its plan to get GPs to get patients with high blood pressure to exercise more are workable (and will apparently be imposed next year), despite the fact that the General Practitioners Committee of the BMA has denounced the plan as unworkable.
NICE’s intention is that GPs will demonstrate to hypertensive patients that exercise to drive up their heart rate will be beneficial, which is quite absurd. I know from experience that exercise drives up my blood pressure to highly dangerous levels. Ditto heart rate. Such a generalisation, by NICE, is simply stupid.
That there are some patients who will benefit I have no doubt, but they need to be selected with great care, and given detailed instructions – not simply sent out for a brisk walk! And what of terrain? Where I used to live I was about two-thirds of the way up a steep ridge. So whichever way I walked I faced a steep hill either going out or coming back – sometimes both. Not good for someone with high blood pressure, I’d have thought, especially if they’re generally unfit and overweight.
It is absolutely essential, with unaccustomed exercise, to start gently and build up, and for a deeply unfit patient, that can easily take as long as a year before exercise levels reach the point at which they can be medically beneficial (though any exercise is better than none).
And, of course, it depends a great deal on the cause of the hypertension – some people simply shouldn’t exercise.
And for those that can. I’d like to see their blood pressure reduced by medication to a safe level, as exercise can drive it even higher if it starts high. For example, last time I went to the cardiology OPD at Arrowe Park, I trundled my manual chair half-way round the damn hospital to get there, and immediately had my BP checked – which, naturally enough, was extremely high.
I tried to explain this to the clown of a cardiologist, but he was convinced I’d been sitting in the waiting room for ages, before it was checked and wouldn’t listen (I’m supposed to be seeing this guy at 10.15 next Thursday – not a prayer).
Anyway, NICE would like to see experts employed by GPs, to instruct patients in “how hard they had to work in terms of getting their heart rates up.” Bugger that – I need to keep my heart rate down!
NICE also wants to “include assessing exercise levels annually** in patients with high blood pressure, and delivering a brief intervention in those who are considered ‘less than active’.” A stupid statement. There are many degrees of “active” before you get anywhere near inactive. There is no such state as “less than active”. That’s like saying someone is less than alive!
**About as useless as all the other annual snapshots – money for the practise, minimal or no benefit to the patient. If my GP wants my daily Fev1 and Peak Flow numbers, I can provide them – they’ll be a bloody sight more useful than the badly-conducted annual spirometry check. And I was recently summoned for a “healthy heart” check-up. This included my booking and attending the surgery for blood tests, and also going the following week for the results and – possibly – a ECG. All pointless as we know what’s wrong with my heart, and it’s not CHD.
If any of this crap comes my way, my GP will be firmly told to bugger off. Problem is, though, far too many patients, particularly of my generation, unquestioningly do as their doctor says, and some of them, unavoidably, will be at risk.
And what of those people who aren’t at risk, but for whom exercise is excessively painful? Are they going to get more effective analgesia to enable them to cope? No, of course they’re not!
This whole scheme is so simplistic it borders on the simple-minded – exercise is good, as a general rule in healthy people, is a truism. But only in healthy people. People who have an underlying illness – possibly undiagnosed/untreated – as well as high blood pressure, might be put at serious risk.
Anyway, if things continue the way they are, I shouldn’t be bothered, as my BP is fine at 127/63 which, in fact, is better than it’s ever been thanks entirely to my intervention in my medication. And that’s another reason for staying away from APH – I don’t want anyone changing my meds.
You simply cannot impose this exercise regime on patients with high BP without assessing the patient as a whole – simply saying “Hey, you’re a fat bugger with high blood pressure, get off your arse and exercise!” will put some people at risk, at best, and at worst could be potentially fatal. Why they have high blood pressure is more important than the fact that they do – there is no one-size-fits-all solution as these dangerous buggers at NICE seem to think.