The Management of Hypertension: A Clinical Dilemma with Health Policy Implications

Abstract

Analysis of benefit, cost, and efficacy have become increasingly prominent in discussions of health care. As the presentations in this working conference demonstrate, it is always important to preface any discussion with a clear statement of the perspective from which the issue is viewed. Even such purists as economists, health planners, and clinicians may find that their scientific clarity is sometimes distorted by an unappreciated bias. Thus, I would like to state at the outset that my analysis of antihypertensive therapy is from the perspective of the clinician at the point of encounter with the individual patient. While health economists may talk of utility and cost of life years gained with a precision born of detachment, the personal encounter physician enjoys not such luxury. The commitment to his or her patient is absolute. While not unmindful of cost and cost efficacy calculations, the physician at the point of contact is most likely to be influenced by his perception of optimal clinical practice. Furthermore, in that setting, it is my belief that this is exactly what the patient would expect.