Addressing hypertension in patients can include both stress management and pharmacological therapy. Stress is an important factor to consider when determining the etiology of hypertension. The cumulative effects of short-term and stress-related spikes in blood pressure may increase an individual’s overall risk for developing hypertension. If signs of stress are identified, consider discussing how it may result in hormone production that elevates blood pressure causing arterial damage that may lead to heart disease.1
Encourage patients to take control of their condition by educating them about the signs and symptoms of stress. The body sends out warning signs2 that patients should respond to, in order to avoid developing more severe health issues. Patients may notice physical indicators, such as dizziness, headache, indigestion, or insomnia. Other symptoms may include increased level of worry, forgetfulness, or lack of concentration. Emotional responses such as unusual anxiety or irritability may also be indicators. Patients may even experience changes in their behavior, such as impulsiveness, compulsive eating, a critical demeanor, or avoidance of social situations.
As healthcare providers, we can assist patients in finding effective methods2 of stress management, such as lifestyle modifications that can reduce stress and help improve overall health. Discussions on reducing stress and avoiding or treating hypertension should include reminders to maintain a balanced diet, a regular exercise routine, and a sufficient amount of rest. It is not only important for patients to monitor how they nourish and strengthen their bodies, but also for them to take control of external factors that cause stress and to be informed about ways to manage their responses to it. Patients can assess where sources of stress in their life are, and come up with strategies to lessen their own negative reactions by learning ways to cope. Adopting a positive mindset as well as practicing relaxation techniques can be beneficial for patients who face stressors. Methods we can counsel patients on trying to practice include deep breathing, progressive muscle relaxation, and mental imagery relaxation.
When hypertension is not controlled with lifestyle modifications alone, pharmacological therapy may be necessary. According to the National Heart, Lung, and Blood Institute,3 the target blood pressure is <140/90 mmHg or <130/80 mmHg in patients with diabetes or chronic kidney disease. The institute also notes that a majority of hypertensive patients will require two medications to reach their goal. Anti-hypertensive drugs do not cure hypertension; the goal is to control blood pressure and bring it down to a normal level.4 Current anti-hypertensive treatments include diuretics, which aid kidneys in removing salt and water from the body, resulting in less blood volume circulating in blood vessels. Examples of drugs in this pharmacological category include Aldactone (spironolactone) and Microzide (hydrochlorothiazide), and also combination diuretics such as Dyazide (hydrochlorothiazide and triamterene). Beta-blockers, which reduce heart rate and pressure within the blood vessels, are also an option. Examples of drugs in this category include Levatol (penbutolol sulfate) and Tenormin (atenolol). Angiotensin-converting enzyme, or ACE, inhibitors are a third category of drugs used to treat hypertension. These drugs prevent the body from making the blood-vessel constricting hormone called angiotensin II, so that vessels remain relaxed, allowing blood to flow more easily. Examples of these drugs are Mavik (trandolapril) and Zestril (lisinopril). Angiotensin receptor blockers, or ARBs, are also available and have similar actions as ACE inhibitors. Examples of these drugs are Diovan (valsartan) and Cozaar (losartan).
Both stress management and pharmacological therapy require education and encouragement to achieve results. PDR Network can be a useful resource for information on available products such as those used to treat hypertension, as well as other drug types, offering alerts and specific product labeling. Keep current with information on products by using PDR.net and by keeping your contact information up to date at PDR.net. If you use an electronic health record (EHR), please ask for it to include the PDR drug data feeds, including PDR BRIEF, which delivers updated drug information, full labeling, and safety warnings integrated into your electronic prescribing system automatically and at NO cost to you. Drug information in EHRs is often months out of date, which is why PDR BRIEF is available at no cost to providers and EHR vendors. PDR Network can also assist with certain requirements under Stage 2 of Meaningful Use. There are a total of 20 objectives that require reporting under Meaningful Use Stage 2 (MU2). One of the core MU2 objectives, "use certified EHR technology to identify patient-specific education resources," requires that physicians provide more than 10% of their unique patients with education resources specific to their needs.5 PDR+ for Patients drug education guides are just one resource that may currently be available in your EHR that you can provide to your patients to help you meet this objective. When PDR+ for Patients drug education guides are integrated into your EHR, you can use them to help you fulfill this requirement and help your patients start and stay on therapy. Click here to see a sample. Don’t have PDR+ in your EHR? Email us at EHR@pdr.net and tell us the name of your EHR. We’ll let them know you want PDR in your EHR.
Salvatore Volpe, MD, FAAP, FACP, CHCQM
Chief Medical Officer
||Mayo Clinic. Stress and high blood pressure: What's the connection? [article online]. Available at www.mayoclinic.com/health/stress-and-high-blood-pressure/HI00092. Accessed November 15, 2013.
||WebMD. Stress and High Blood Pressure. [article online]. Available at www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-easing-stress. Accessed November 15, 2013.
||National Heart, Lung, and Blood Institute. Reference Card from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) [materials online]. Available at www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf. Accessed November 14, 2013.
||WebMD. High Blood Pressure Drugs. [article online]. Available at www.webmd.com/hypertension-high-blood-pressure/guide/high-blood-pressure-medicine-how-can-it-help-you. Accessed November 15, 2013.
||Centers for Medicare and Medicaid. EHR Incentive Programs [materials online]. Available at www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/
Stage2_Guide_EPs_9_23_13. Accessed November 27, 2013.