Hypertension Management Resources - For you to use
Improving Hypertension Control: Tips for Clinicians
Issues Dealing With Adherence to Regimens
Provide Empathetic Reinforcement
- Adopt an attitude of concern coupled with hope and interest in the patient's future.
- Provide positive feedback for blood pressure and behavioral improvement.
- If blood pressure is not at goal, ask about behaviors to achieve blood pressure control.
- Hold exit interviews to clarify regimen. A patient may tell you that they understand but tell the exit interviewer that they do not.
- Schedule more frequent appointments and health care personnel contact with patients who are not achieving goal blood pressure.
Clinician Awareness and Monitoring
- Anticipate adherence problems for young men.
- Consider nonadherence as a cause of:
- Failure to reach goal blood pressure
- Resistant hypertension
- Sudden loss of control.
- Encourage patients to bring in all medications from all physicians and other sources, whether prescription, complementary, or over-the-counter, to each visit for review and to rule out iatrogenic causes of elevated blood pressure.
- Ask what the patient takes for pain.
- Recognize depression and other psychiatric illnesses, including panic attacks, and manage appropriately.
- Be willing to change unsuccessful regimens and search for those more likely to succeed.
Organize Care Delivery Systems
- Schedule next appointment before patient leaves office.
- Use appointment reminders, preferably computer-based, and contact patients to confirm appointments.
- Follow up with patients who missed appointments.
- Use an office-based system approach for monitoring and followup (e.g., educate staff to provide patient encouragement, computer or chart reminders, disease management aids).
Patient Education About Treatment
- Assess the patient's understanding and acceptance of the diagnosis of hypertension.
- Discuss patient's concerns, and clarify misunderstandings.
- Tell the patient the blood pressure reading, and provide a written copy.
- Come to agreement with the patient on goal blood pressure.
- Ask the patient to rate from 1 to 10 his or her chance of staying on treatment.
- Inform the patient about recommended treatment, and provide specific written information about the role of lifestyle including diet, physical activity, dietary supplements, and alcohol intake; use standard brochures when available.
- Elicit concerns and questions, and provide opportunities for the patient to state specific behaviors to carry out treatment recommendations.
- Need to continue treatment
- Control does not mean cure
- One cannot tell if blood pressure is elevated by "feeling or symptoms"; blood pressure must be measured.
Role of Other Health Care Professionals
Collaborate With Other Health Professionals
- Use complementary skills and knowledge of nurses, physician assistants, pharmacists, registered dietitians, optometrists, dentists, and podiatrists.
- Refer selected patients for more intensive counseling.
Promote Social Support Systems
- With full permission of the patient, involve caring family members or other social support (e.g., faith-based or community organizations) in the treatment process.
- Suggest common interest group activities (e.g., a walking group) to enhance mutual support and motivation.
- For full chapter
- For more information on "Improving Adherence to Medical Regimens: Background and Nature of the Problem
Hypertension management. JNC 7 Report on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2 pages)
At-a-glance version, new treatment algorithms, compelling indications for drug classes (PDF - 2 pages)
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