Psychosomatic Component

Abstract

Long-term therapy with immediate-release nifedipine is rightly considered to be obsolete. However, the prescription observed by the authors, as a single administration, shows that the reason for the prescription was not long-term treatment. The authors' recommendation of supervising and monitoring patients in intensive care rather than issuing a prescription is often pointless, as primary care experiences have shown. Of course there are extreme hypertensive crises that require supervision and monitoring in intensive care, but this is not the most common course. Hypertensive crises are known to have a psychosomatic component. The patients are agitated; they have cardiac palpitations; on measuring their own blood pressure they find an increased value; and they become anxious. Their blood pressure rises further, and their anxiety turns into panic. Because of this feedback effect patients often develop so-called cardiophobia. The result: anxious self-monitoring with rising blood pressure, increased overall medication, and more frequent spikes in blood pressure. Frequent admission to hospital would increase the psychosomatic pathological process. Hypertensive crises can of course occasionally be resolved by the family physician, but the significance of the required medical consultation also increases the pathogenic feedback effect. On the other hand: if the effectiveness of a transmucosal-resorption nifedipine capsule for hypertensive crisis has been demonstrated by the doctor, then having a small quantity of this “rescue medication” in the cupboard has a calming effect on the patient. Experience has shown that utilization is low. Just the awareness that self-help is available reduces the anxiety, breaks the vicious cycle, and reduces drug costs, medical consultations, and admissions to hospital.