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This is an article for a healthcare management firm's corporate publication
Addressing Hypertension in Your Patients
Cardiovascular disease is the leading cause of avoidable inpatient hospital admissions and readmissions among Healthfirst members. As such, monitoring cardiovascular disease and its associated conditions is vital. Identifying and managing patients with hypertension and those at risk of developing hypertension by using the guidelines in the Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8) is a cornerstone in the prevention and management of high blood pressure.
Unfortunately, many patients who are prehypertensive are not taking the necessary precautions, such as lifestyle modifications, to prevent the development of hypertension, and often those who have been diagnosed do not adhere to their medications. This is why it’s critical to counsel patients on hypertension control and lifestyle modification.
Some things you can do:
• Evaluate your patients without hypertension to identify and address blood pressure (BP) readings greater than
119/79
• Assess your patients’ major cardiovascular disease risk factors, such as obesity (BMI ≥ 30 kg/m2), physical inactivity, cigarette smoking, diabetes, and dyslipidemia
• Encourage healthy lifestyle changes and knowledge about the management and consequences of high blood pressure
• Adhere to the JNC 8 guidance for appropriate levels of blood pressure control for your patients living with hypertension
• Educate your patients about the importance of refilling their antihypertensive medication prescriptions on time
• Monitor closely for signs and symptoms of hypertension complications due to atherosclerosis, including: left
ventricular hypertrophy, coronary artery disease, renal failure, stroke, peripheral artery disease, retinopathy,
and congestive heart failure
Use the guidelines above to encourage your at-risk patients to:
• Freely ask you questions about hypertension and medications
• Get at least 30 minutes of physical activity at least four days a week
• Eat plenty of fruits, vegetables, low-fat dairy products, whole grains, fish, lean poultry and nuts
• Reduce salt intake to no more than 2.4 grams a day
• Achieve and maintain a healthy weight (BMI < 25)
• Limit alcohol consumption (men-two drinks a day; women and lighter-weight individuals-one drink a day)
• Stop smoking
• Refill prescriptions on time
SUMMARY OF HEDIS REQUIREMENTS FOR HYPERTENSION:
When it comes to controlling blood pressure (CBP), members are identified by the percentage who are 18–85 years of age and have had a diagnosis of hypertension (HTN). Most recent BP is adequately controlled during the measurement year. For a member’s BP to be controlled, both the systolic and diastolic BP must be < 140/90 (adequate control).
Improving Outcomes for Hypertension
The Healthfirst website has helpful tools that can assist you in explaining hypertension in your patients’ preferred language. Go to: www.healthfirst.org/heart-health.html or www.healthfirst.org/smoking-cessation-tools-and-resources.html. It is important for medication doses to be titrated in order to safely achieve the anticipated response. JNC 8 recommends hitting blood pressure goals within one month otherwise therapy modification is required.
The following excerpts from the publication Talking With Your Older Patient: A Clinician’s Handbook can help you inform patients about medical conditions and their treatment:
• As a physician, your advice generally receives greatest credence, so you should introduce treatment plans.
• Try to take a universal, nonthreatening approach. Start by saying, “Many people your age experience . . . “ or “Some people taking this medication have trouble with . . .” You can also try, “I have to ask you a lot of questions, some that might seem silly. Please don’t be offended . . .”
• Let your patient know you welcome questions. Indicate whom on your staff he or she can call to have questions answered later.
• Encourage the patient to take notes. It’s helpful to offer a pad and pencil. Active involvement in recording information may promote your patient’s retention and adherence. Check that the patient understands what you say. One good approach is to ask that they repeat the main message in their own words. Repeat key points about the health problem and treatment at every office visit.
• Provide encouragement. Call attention to strengths and to ideas for improvement.
• Some patients avoid issues that they think are inappropriate to discuss. One way to overcome this is to keep informative brochures and materials readily available in the waiting room. In addition to talking to the patient, you can use fact sheets, drawings, models, videotapes, or audiotapes. In many cases, referrals to websites and support groups can be helpful.
For more details on hypertension recommendations go to http://healthfirst.org/providers/clinical-partnerships/spectrum-health/