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Hypertension and Ways to Keep It Under Control

Hypertension is a significant health problem. Hypertension, or high blood pressure, is often known as a “silent killer,” as it frequently has no signs or symptoms. If left uncontrolled, hypertension can increase a person’s risk for heart disease, stroke, heart failure, kidney disease, pregnancy complications, and cognitive decline or dementia later in life. However, hypertension is a preventable risk factor for heart disease and stroke. Hypertension is all too common, as nearly 1 in 2 adults have hypertension, yet only about 1 in 4 have it under control. Hypertension care and treatment are also costly, resulting in an estimated $131 billion to #198 billion in medical costs each year.

Currently, there is limited data and information about the impact of underlying medical conditions- including hypertension- on the risk for severe illness from covid-19. While the understanding of covid-19 is still improving and evolving, it is known that people with hypertension may be at an increased risk for severe illness from civd-19.

What works to improve hypertension control is continuing to take hypertension medications as directed; continuing to practice safe social distancing when being physically active; continuing healthy eating; and staying connected to a medical care team. Most importantly, if you are feeling any signs or symptoms of a heart attack or stroke, DO NOT DELAY medical attention.

Here are 10 most effective strategies for achieving control of hypertension:

  1. Increase awareness of health risks

    1. Some subsets of the us population have higher rates of hypertension and lower rates of controlled blood pressure. For example, more than half of black men and women have hypertension, with about 20% under control. African Americans have higher rates of hypertension than any other racial or ethnic groups. Black men and women also develop hypertension at younger ages and have more severe outcomes than whites.

    2. Hypertension rates for black adults is 54%, white adults 46%, Asian adults 39%, and Hispanic adults 36%.

  2. Recognize economic burden

    1. The economic aspects of hypertension are critical to modern medicine; however, the medical profession often feels too uncomfortable applying economic concepts to its daily practice. This may be because doctors lack formal education in economics, and because a doctors’ professional ethos is to effectively resolve patients’’ problems, irrespective of cost.

    2. Treatment of hypertension requires an investment over many years to prolong disease-free quality years of life.

    3. Investment in the treatment of hypertension must compete with demands for investment in other important diseases.

    4. The benefits of adding a second or third drug to a treatment regime, or of treating mild dyslipidemia or prediabetes in the hypertensive patient, are questions commonly encountered.

    5. While the cost of treating hypertension is important, a more important question may be the cost of no treatment.

  3. Eliminate disparities in access to care and health outcomes

    1. We need to identify factors in our area that negatively affect hypertension control in minority populations, including health disparities and inequalities in the distribution of social, economic, and environmental conditions necessary for better health

  4. Promote physical activity opportunities

    1. Regular physical activity makes your heart stronger. A stronger heart can pump more blood with less effort. If your heart can work less to pump, the force on your arteries decreases, lowering your blood pressure.

    2. Regular exercise also helps you maintain a healthy weight- another important way to control blood pressure.

    3. Any physical activity that increase your heart and breathing is considered aerobic activity, including household chores, such as mowing the lawn, raking leaves, gardening or scrubbing the floor, active sports such as basketball or tennis, climbing stairs, walking, jogging, bicycling, swimming, and dancing.

    4. The Department of Health and Human Services recommends getting at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. Aim for at least 30 minutes of aerobic activity most days of the week.

    5. The benefits last only as long as you continue to exercise.

  5. Promote opportunities to access healthy foods and good nutrition

    1. The DASH diet emphasizes the right portion sizes, variety of foods and nutrients. DASH stands for Dietary Approaches to Stop Hypertension. The diet encourages you to reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium, and magnesium.

    2. Standard dash diet 2,300 mg of sodium each day

    3. Lower sodium dash diet 1,500 mg of sodium each day

  6. Connect to lifestyle change resources

    1. Lifestyle changes may include: losing weight, exercising regularly, eating a healthy diet, reducing sodium in the diet, limiting alcohol, quitting smoking, cutting back on caffeine, reducing stress, monitoring blood pressure at home, seeing the doctor regularly, and having supportive friends and family.

    2. Speak with your doctor about local support groups such as weight watchers, YMCA, AA, therapists, etc.

  7. Use standardized treatment approaches

    1. A number of pharmaceutical agents as evidenced by large randomized clinical trials, are available for treatment of high blood pressures and include: older molecules such as thiazide diuretics and beta-blocking agents, and newer molecules such as calcium channel blockers (CCB), angiotensin converting enzyme inhibitors (ACE), and angiotensin receptor blockers (ARB).

    2. Comprehensive hypertension management focuses on reducing overall cardiovascular risk and should be the preferred approach for initial management of hypertension.

  8. Promote team-based care

    1. Having 2 or more health care providers working collaboratively with each patient helps to improve high blood pressure control. As a team, they can educate patients, identify risk factors for disease, prescribe and modify treatments, and maintain an ongoing dialog with patients about their health.

    2. This team may include doctors, nurses, pharmacists, community paramedics, primary care providers, community health workers, dieticians, and others.

    3. Team based care also increases medication adherence.

  9. Empower and equip patients

    1. Many physician offices are teaching how to use home blood pressure monitoring equipment

    2. Buying self-monitoring blood pressure equipment encouraged

    3. Local health screening fairs are recommended

    4. The widespread accessibility of smartphones and mobile health applications offer new potential for monitoring parameters

    5. The cardiogram application on the Apple watch has been evaluated for its utility at using deep learning algorithms to predict hypertension from inputs of hear rate and step count

    6. Patient participation in the management of their illness is now a factor that can improve patient outcomes

  10. Recognize and reward clinicians

    1. There is a need for physician practices and health care organizations to prioritize blood pressure control.

    2. To recognize organizations for their efforts, the AMA and American heart association (AHA) and others, have honored nearly 1,200 physician practices and health systems across the country.




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