THE RULE OF HALVES

BY Dr. Sanjiva Wijesinha 

Dr. Julian Tudor Hart was a British GP who worked in the tiny mining village of Glyncorrwg in southern Wales. His pioneering work in Glyncorrwg – where he practised for many years as the local family physician – revolutionised the management of high blood pressure (BP) or hypertension among the Welsh people.

One of his oft quoted aphorisms was the ‘rule of halves’ – when it comes to a chronic illness such as high blood pressure, approximately half of those who are suffering from it aren’t aware that they have it.

Only half of those detected are receiving treatment for it; and of those who are under treatment, only half are being properly treated so that their illness is controlled.

Hart’s seminal work began when he relocated to work in Glyncorrwg as a young family doctor. He realised that many of the patients who came to the little clinic to consult his colleague and him would only do so when they suffered an ailment that caused symptoms of concern.

He was well aware that the real killer diseases like high blood pressure and diabetes don’t display any symptoms until the late stages. So patients who feel quite well because they don’t notice any symptoms could be having dangerously high blood pressure that could even result in premature death.

Upon studying the problem further, he realised that the mortality rate from heart disease in his part of the world was alarmingly high. While
it’s well-known that controlled blood pressure can reduce the risk of heart attacks and strokes, how can a patient’s blood pressure be controlled if he or she is unaware that they have high blood pressure?

So the doctor decided to check the BP of all patients registered with his practice. He began by improving the clinic’s data management system and introduced computers to record his consultations. His clinic became one of the first health centres in Britain to have electronic records.

Hart then started measuring the blood pressure of every adult patient who visited the clinic – yes, even if the consultation was unrelated to blood pressure!

If anyone was found to have elevated blood pressure, Hart asked them to return so he could check it again – to confirm that the person did in fact have hypertension.

He explained the situation to them and put them on a treatment programme. In addition to this opportunistic method, he also began calling patients in the community to drop in for a free blood pressure check and visited the homes of those who couldn’t do so.

Hart succeeded in measuring and recording the blood pressure of 98 percent of his patients.

Over the years, his simple technique of measuring the blood pressure of all patients and treating those with elevated BP – so that their pressure reverted to normal levels – resulted in a drastic reduction in deaths due to heart attacks and strokes in the community.

There’s a simple lesson in this for us all. The next time you consult a doctor – whether it’s for a cough, backache or even a pain in your little toe – ask him or her to check your blood pressure.

Detecting hypertension before it causes symptoms and taking the appropriate treatment for
it could save your life.