Engaging Patients in Managing High Blood Pressure

High blood pressure, aka ‘hypertension,’ is a killer, and a largely silent one. As we age it develops slowly, until one day that intolerable threshold of pressure is reached and we’re at much increased risk for strokes and other cardiovascular events.

We do have effective medications to treat hypertension, but many people find them a pain in the — to take, complaining more about not feeling well when their blood pressure is normalized than when it’s sky high.  What to do?  A study in this week’s Lancet may help: Telemonitoring and self-management in the control of hypertension: a randomized controlled trial.

As I opine in the podcast, I love this study. Just over 500 people with established hypertension (over 140/90; as a reminder that’s the systolic pressure or an approximation of the pressure generated when the heart beats and pumps blood through the body, over the pressure remaining when the heart is at rest, or the diastolic pressure).  About half of these folks agreed to monitor their blood pressure at home and report this data to their primary care physician, and were given instruction on how to adjust their dosage of medication in response to changes in their blood pressure.  The other half  were managed as usual, with office visits and adjustments managed by the physician.

At both six and twelve months, those who managed their own blood pressure had much better reductions in systolic blood pressure than those managed per usual practice.  At a year, those managing their own hypertension reduced the top number by almost 18 mmHg (that’s millimeters of mercury, the scale for assessing blood pressure).  Since many physicians turn handsprings with much more modest reductions than that it’s worth celebrating and considering engaging patients in their own care.

As anyone who’s listened to our podcast knows, both Rick and I are huge advocates of empowering people as their own best advocates for health care.  That’s what we do weekly (and as we explain in our YouTube), as we hope to demystify the jargon of medicine into digestible bites people can use in medical decision making.  And that’s what this study does: it educates the biggest stakeholder in hypertension management and then says, you’re on.  Rick points out that not only is there empowerment, there’s responsibility, and witness the success of this strategy!

Who can’t be engaged in this way? Some people don’t have the technology needed to support this method (computers and computer literacy), others prefer to leave it all in the hands of their physician.  But as healthcare reform proceeds, and the rate of discovery in medicine continues apace, it is increasingly necessary to engage and empower the patient.  And as patients, that’s how we can assure receiving the best (and most vested) care.

Other topics this week include telomere length and cancer risk in JAMA, a relationship between dementia and the development of Alzheimer’s disease in Neurology, and use of drugs for erectile dysfunction and sexually transmitted infections in Annals of Internal Medicine.  Until next week, y’all live well.

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