It’s a killer public health problem, but with effective treatment when properly executed.
The “Silent Killer” is high blood pressure, also known as hypertension.
And yet according to the U.S. Centers for Disease Control and Prevention (CDC), only about half of the 75 million Americans living with blood pressure have the disease under control.
Research published in Annals of Internal Medicine shows why America, and indeed the world, needs a more comprehensive approach to blood pressure treatment.
Prescribing blind until a doctor finds something that works isn’t working. We need a comprehensive approach that includes patient coaching while clinicians work to find the right treatment, the authors concluded.
It usually takes a combination of treatments, not just one prescription, to get blood pressure under control.
The study by researchers at Tulane University explains barriers to hypertension treatment exist at the health care system, health care provider, and patient levels.
“Such barriers include limited health care resources, lack of performance standards, and limited reimbursement for health coaching at the system level; lack of adherence to clinical guidelines at the provider level; and lack of adherence to prescribed medications, lifestyle modifications at the patient level,” the authors explained.
Doctors from Ireland and the United Kingdom, where blood pressure treatment outcomes are even more abysmal than in the U.S., spoke up in an accompanying editorial.
“The answer seems to lie in the ‘swamp’ that is everyday clinical practice, where unreliable blood pressure measurement and polypharmacy with associated patient illness seem to challenge adherence at every turn and can create a complicit therapeutic nihilism between patients and health care providers,” they blasted.
Anxiety meds, gym pushed my blood pressure up
Anyone who has battled high blood pressure knows how difficult it can be to control.
With chronic-complex PTSD, I had been prescribed whopping amounts of benzodiazepines, a type of anxiety medication also known as Ativan, Xanax, or Klonopin.
After a while, as is the case with some people, the benzodiazepines began to have a reverse effect. I began to experience explosive fits and flashbacks.
I worked out at the gym, but I began to gain weight and experience even worse anxiety. This did not make sense to me. But my therapist explained this can happen because of cortisol production.
Cardiovascular exercise does not always calm people with PTSD and anxiety.
I went back to doing lots of walking and working in the yard (which is scientifically proven to help people with PTSD).
I sold my vehicle. Driving stresses me out and always has.
PTSD, anxiety make controlling BP challenging
Recovering alcoholics only should be prescribed benzodiazepines as a last resort. The medications affect the brain like alcohol.
My anxiety medication began to inch me into rages toward the end. I have no doubt this was affecting my blood pressure.
I was taking two beta blockers per day plus a water pill for my blood pressure. While the treatment worked better than previous treatments, for many years I took medications that did not work.
Some made me retain water, the opposite of what the medications are supposed to do.
Other times I had been prescribed blood pressure meds that made getting up in the morning so difficult (dizziness) that I just stopped taking my meds.
Other blood pressure medications made me wet the bed.
Where were my doctors when I was having all these blood pressure problems? Waiting for my one-month follow-up appointment, like most doctors do after prescribing blood pressure medication.
There’s an easier, more effective way to blood pressure management: Clinicians and patients talking more frequently, sharing what works and what doesn’t.
It’s a job that doesn’t have to be completed by a doctor. Medical professionals should be reimbursed for it, however, and usually aren’t.
Doctors need training; patients need education
In the Tulane study, researchers conducted a systematic review and meta-analysis. In other words, they studied previous studies about blood pressure treatment.
“Multilevel, multicomponent strategies, followed by patient-level strategies (such as coaching), are most effective for BP control in patients with hypertension and should be used to improve hypertension control,” the authors concluded.
Top number blood pressure readings tended to plunge significantly in patients receiving extra support as opposed to those receiving medication alone. The number plunged more than seven systolic points in some cases.
Lesser interventions in addition to medication produced similar results, although not as pronounced.
Diastolic numbers similarly improved.
The researchers determined that to better manage patients with high blood pressure, both the patient and the doctor needs to better understand each other.
For doctors, this may mean more training about managing patients with high blood pressure. Those who face hurdles to healthcare need engagement.
Doctors may even consider a third-party audit of their blood pressure prescribing and treatment practices for constructive feedback.
For patients, it means understanding lifestyle modifications do work, and medication adherence is paramount. It means listening to your body.
If while on blood pressure medication you begin to fill up like a water balloon attached to a garden hose, something is not working.
Patients expect to be educated about good health
“Health coaching strategies could be delivered in person or by telephone at several individual or group sessions during the intervention,” the researchers explained.
I receive excellent healthcare. I’ve had intense cognitive behavioral therapy for trauma, so I have tools for managing triggers which can raise my blood pressure.
I abstain from alcohol and cigarettes. I also have a general knowledge of healthy eating.
I try to treat my body like a shrine.
It’s something we all can learn to do.
Whether it’s your blood pressure or some other health concern, respect for your body helps you maintain good health.
That should feel good.