Hypertension Management Resources - For you to use

Improving Hypertension Control: Tips for Clinicians

(From the JNC 7 Report on High Blood Pressure)

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.

Clinical Inertia

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.
• Emphasize:
  • 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.

Patient Factors

Individualize the Regimen

• Include patient in decision making.
• Simplify the regimen to once-daily dosing, if possible.
• Incorporate treatment into patient's daily lifestyle; e.g., take medications just before or after brushing teeth.
• Agree with the patient on realistic short-term objectives for specific components of the medication and lifestyle modification plan.
• Encourage discussion of diet and physical activity.
• Encourage discussion of adverse drug effects and concerns.
• Encourage self-monitoring with validated blood pressure devices.
• Minimize the cost of therapy; recognize financial issues and enlist local community and national programs to assist in affording medications.
• Indicate that adherence to the regimen will be a subject of discussion at each visit.
• Encourage gradual sustained weight loss.

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.

See JNC 7 Report

• 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)