Treatment of patients with mild hypertension

Beyond Blood Pressure Screening: A Rationale for Promoting the Primary Prevention of Hypertension

High blood pressure is a major public health problem in the United States. However, the underlying reasons for the chronic elevation of blood pressure (BP) are unknown in most cases of hypertension (HT), and medical care has focused on lowering already elevated BP, primarily by pharmacologic means. Although an important factor in the development of HT appears to be a genetic predisposition, other potentially modifiable lifestyle risk factors associated with elevated BP have been identified. This article describes the scientific rationale for encouraging health promotion specialists to focus on the primary prevention of abnormally elevated blood pressure. Nonbehavioral risk factors such as increasing age, history of HT, Black ancestry, and consistent BP readings in the higher range of normality, and behavioral factors including dietary excesses and deficiencies, excessive body fat, a sedentary life style, and frequent episodes of unmanageable emotional stress are addressed. Recommendations are made based on scientific evidence supporting the relationships between these risk factors and the development of HT.

Strategies for patient education

Patient behavior is a part of the problem of high blood pressure and is also a major part of the solution. As with physical diagnosis and medical care, patient education should be based upon a careful assessment, a correct diagnosis, and an individualized plan of care. Health care providers must be able to identify the specific needs of patients for information, skills, support, and reinforcement. They must meet those needs with a combination of educational strategies, adapting approaches as necessary over time. Providers can determine the quantity and quality of information, interaction, and office procedures that reinforce appropriate behavior. Efforts to increase the number of patients who remain in care, with controlled blood pressures, should include effective educational strategies which increase providers' skills, enhance patient-provider relationships and promote active patient participation.