Patient perspective—treatment initiation Michael Kavanagh “When I was first prescribed antihypertensive medication, I thought it might be for the short to medium term. Perhaps it should have been made clear that it would be an ongoing process. I quickly developed a side effect of the medication and had to return to the physician to change it. Some months later, a BP check showed that the new medication was not sufficiently effective. As a consequence, the dose was doubled, and when this proved ineffective, the medication was changed. Over the last 2 months, I have had three 24-h BP monitors applied, so we are still tweaking 3 years on. It needs to be made clear, when medication is initiated, that it is different to, for example, antibiotics in that you do not see an immediate clinical benefit, and you do not necessarily feel any better. While I had no problems with adherence, there was a difficulty in arriving at the correct medication and dosage, and I am still not sure that the correct medication/dosage has been arrived at. The whole process is much more interactive than I thought it would be and I am not sure that this is generally understood. For a lot of people, hypertension may not be the reason that brings them to the physician, rather, the hypertension is identified as part of a general medical examination. When hypertension is identified, patients should be advised by their physician that treatment will • Be an ongoing process, • Be long term, • Not necessarily effect a sense of improvement in general health • Will probably need to be adjusted initially and over time.