Hypertension Patient Education
Patient Education
High Normal or Elevated BP
- Warn patients with high normal or elevated BP that they are at high risk for developing hypertension
- Inform them that lifestyle modification may reduce this risk
- Advise those with DM and kidney disease that they are candidates for drug therapy if lifestyle modification fails to decrease their BP to goal
- Periodic follow-up (eg every 3-6 months) is recommended to detect and treat hypertension as early as possible
All Patients
- Patients need to be highly motivated to establish and maintain a healthy lifestyle and to take prescribed antihypertensive medications
- If diagnosis of hypertension is not made, measure the patient’s clinic BP at least annually thereafter
- More frequent BP measurement for patients whose clinic BP is close to 130/80 mmHg
- Encourage measuring BP at home
- In Asians, strict 24-hour BP control starting with HBPM is important
- Patients should be made aware that lowering BP can decrease death from stroke, coronary events, heart failure, along with decreasing the progression of renal failure
- All causes of mortality can be reduced with effective antihypertensive management
- Work with the patient to establish the goal of therapy
- The patient’s cultural beliefs may influence their attitude and the physician needs to be sensitive when handling these issues
BP Measurement and Monitoring
- Before taking BP measurements, advise patients to:
- Avoid exercise, caffeine intake and smoking 30 minutes prior to measurement
- Remove any clothing that can hinder cuff placement
- Make sure the logbook is within reach
- Make sure all devices to be used are working properly (tubes, cuff, batteries, stethoscope)
- Avoid crossing legs, talking and any sudden movements during the measurement
- Advise patients about different BP measuring devices:
- Make sure devices to be used are professionally validated annually
- Devices that measure BP from the brachial artery are preferred than those that read from distal sites (fingers, wrists)
- Electronic/digital BP devices are preferred to be used
- Patients and caregivers should be well trained in using an aneroid BP device; advise patients to have their mercurial/aneroid apparatus checked every 1-2 years and every 6 months for electronic devices
- Inform patients about appropriate cuff sizes (refer to table below)
RECOMMENDED CUFF SIZES | ||
---|---|---|
Arm Circumference | Description | Cuff Size |
22-26 cm | Small Adult | 12x22 cm |
27-34 cm | Adult | 16x30 cm |
35-44 cm | Large Adult | 16x36 cm |
45-52 cm | Adult Thigh | 16x42 cm |
- Instruct patients on how to do self-measurement/monitoring of BP. Advise them to:
- Measure at the same time in the morning and evening
- Find a quiet room with a comfortable chair
- Rest for at least 5 minutes before taking BP measurement
- Sit down with back supported, feet on the floor, arm supported horizontally, and BP cuff at the level of the heart
- When using a sphygmomanometer, slowly inflate the cuff while palpating the brachial artery. When the pulse disappears (SBP), slowly deflate the cuff, taking note when the pulse reappears (DBP)
- Now with the use of a stethoscope, reinflate the cuff 20 mmHg above the previous SBP, then deflate the cuff by 1-2 mmHg/second. Inform the patient that when a tapping sound is heard, this is the SBP, and when it disappears, this is the DBP
- Follow instructions on how to use electronic devices properly. Stay still while the apparatus takes the BP reading
- Wait for 1-2 minutes, then take another BP measurement
- Write the results in the logbook immediately after each reading
Lifestyle Modification
- Considered the cornerstone of hypertension prevention and treatment
- BP-lowering effects can be equivalent to drug monotherapy; major drawback is diminishing patient compliance over time
- Effects include:
- Prevention or delay of hypertension among nonhypertensive individuals
- Prevention of or delay in the use of drug therapy among those in stage 1 or grade 1 hypertension
- Contribute to BP reduction among hypertensive patients already on drug therapy, allowing for the reduction of the doses and number of antihypertensive agents
- May also contribute to the control of other medical conditions and CV risk factors
- Annual follow-up is recommended to detect and treat hypertension as early as possible
Weight Reduction and Maintenance
- Helpful in treating hypertension, DM and lipid disorders, especially among overweight or obese patients
- Weight loss of ≥5% in overweight or obese patients is significant
- Maintenance of a healthy body weight (BMI of about 23 kg/m2) and waist circumference (<90 cm in men; <80 cm in women)
- SBP is reduced by 1 mmHg with a weight loss of 1 kg from baseline
- Should use a multidisciplinary approach that includes regular exercise and appropriate diet
- Increase intake of polyunsaturated fatty acids and decrease total and saturated fat
- Weight loss and exercise are recommended in patients also because of the relationship between obesity and obstructive sleep apnea
- Continuous positive airway pressure (CPAP) therapy may also be used to reduce obstructive sleep apnea
Salt Restriction
- Asians have a higher salt sensitivity, even with higher intake of salt and mild obesity
- There is evidence that a causal relationship between BP and salt intake exists
- Excessive salt intake may contribute to resistant hypertension
- Mechanisms include increasing peripheral vascular resistance and extracellular volume
- A daily intake of 5-6 g of salt is recommended for the general population; optimal goal is <1.5 g/day
- Studies have shown that a salt reduction to about 5 g/day results in a modest (1-2 mmHg) SBP-lowering effect among normotensive individuals while this effect is more pronounced (4-5 mmHg) among hypertensive individuals
- Effects of salt reduction is seen more among older people, among black population, and in patients with metabolic syndrome, DM or CKD
Other Dietary Changes
- Advise patients to follow the Dietary Approaches to Stop Hypertension (DASH) diet and to consume whole grains and proteins from plant sources, soluble fiber, low-fat daily products
- Replace traditional diet with fresh vegetables and fruits
- Consumption of fruits among overweight patients should be done with caution due to possible high carbohydrate content of some fruits which may promote weight gain
- Potassium supplementation (3.5-5 g/day) is recommended except in patients with CKD or patients using drugs that decrease excretion of potassium
Regular Exercise
- Regular aerobic and resistance exercises can contribute in both in the prevention and management of hypertension, and in lowering risk of CV morbidity and mortality
- Patients may be advised to engage in at least 30 minutes of moderate-intensity dynamic aerobic exercise (eg walking, cycling, jogging, swimming) for 5-7 days weekly
Moderate Alcohol Consumption
- Discourage excessive alcohol consumption since great amounts can raise BP
- Limit alcohol consumption:
- Among hypertensive men: To <20-30 g of ethanol/day (<140 g/week or <14 units/week)
- Among hypertensive women: To <10-20 g of ethanol/day (<80 g/week or <8 units/week)
Smoking Cessation
- Since smoking is a major CV risk factor, patients must be advised to stop this habit
- Also a most effective lifestyle measure for preventing CVDs, including myocardial infarction, stroke and peripheral vascular diseases