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RULE OF HALF IN HYPERTENSION AND ONE-THIRD IN PERIPHERAL NEURITIS
OP KAPOOR
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
Indian doctors are becoming so neurotic about the diagnosis of hypertension for which the patient has no complaints. The pressure is recorded and hypertension is diagnosed. This is wrong. Hypertension is a trait and not a disease. The patient has to continue the drugs for a lifetime. Therefore, many International Authorities feel that the definition of hypertension should change and be defined as any BP level, where the benefit of administering the drugs for lifetime will outweigh the cost and hazards of these drugs when taken for a lifetime. Similarly, the practitioners have a neurotic tendency to see that with any number of drug combinations and with as large doses as possible, pressure is brought down, irrespective of the side effects, which the poor patients complain of and which are neither heard by the doctors nor diagnosed. In this context, I would like you to remember the following figures of UK:-
1. In half the number of patients, the diagnosis of hypertension is not made.
2. Half of the patients who are diagnosed as hypertensive, have no motivation, are non-compliant and refuse to take the regular medication.
3. It is significant to note that amongst the other half who take the drugs regularly and religiously as prescribed by their doctors, in only half of them, the pressure is adequately controlled and the other half, live with the high BP inspite of multiple drug therapy.
Thus, I feel that this example of rule of half in the English population should teach our Indian doctors to learn many things in private practice, that we are not supposed to practise `academic medicine', but to be practical with the patient.
I would also like to introduce the figure of 1/3 in a very common disease known as peripheral neuritis or peripheral neuropathy. Although, these patients need extensive investigations which may cost a few thousand rupees to the patient, it is important to note that in only 1/3 of the patients, the cause which has produced peripheral neuropathy can be found. It is important to note that even when the cause is detected, only 1/3 of the patients can be cured. It is worth remembering that in this group, a majority of the patients will come under the label of `Acute Neuropathies', which are therefore, nowadays treated as `emergencies'. In others no relief can be offered to the patient! In 1/3 of the patients no cause is detected and no relief can be offered!
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