Controlling High Blood Pressure in the Community
Many people in the world suffer from high blood pressure. Worldwide, approximately 1 in 4 adults have high blood pressure. In America, 1 in 3 adults with high blood pressure are unaware they suffer from the condition. Only about one half of hypertensive people get treatment to lower their blood pressure and of those folks only 35% are at their target goal blood pressure. The purpose of this medical blog is to brainstorm techniques to increase knowledge in the community so that we raise awareness so that the people with high blood pressure not only get treatment but also get controlled. Normotensive (normal blood pressure) patients are protected over the long term from heart disease, kidney disease, and stroke.
So how do we improve hypertension in the community? The first approach you might consider is seeing your primary care provider. The doctor’s office is a great place to check a person’s blood pressure. But there is a problem here — the person must be willing to go to the doctor. Adult men, and to a lesser extent women, have little interest in visiting a physician. This lack of interest is multiplied when a patient has conditions that are asymptomatic (no symptoms) until a stroke, heart attack, or worsening kidney function occurs. In addition to identifying patients with hypertension, health care providers are available at the clinic to prescribe medication to help get a patient to goal. This model of care is the traditional paradigm for the treatment of hypertension.
What if we were to think outside of box and consider alternative locations to promote blood pressure awareness? A recent study did just that. The experiment, published in the Archives of Internal Medicine, looked at whether barbers catoring to an African American population could improve blood pressure control in the community. The results of the intervention — taking blood pressure in the barber shop and recommending seeing the doctor for those who needed to do so — showed an improvement compared with a control population.
What a clever approach to blood pressure management. America’s Medical Blogger does the math for you: there are 18,000 barbershops that focus on cutting African American hair. With this simple intervention we could reduce the following adverse outcomes in the African American (black) population:
- 800 heart attacks
- 900 deaths
- 500 strokes
I envision many possible interventions local community businesses in Omaha could do to help their customers maintain healthy blood pressure and provide a service their competitors do not. Consider the following approach: patients at a synchronized pharmacy during their monthly appointment with the pharmacist get their blood pressure checked. If the patient is trending high, a call is made to the patient’s physician for follow up. This maneuver would decrease the interval of time a person is hypertensive and at risk for a heart attack or stroke.
In fact, anywhere a person routinely visits should be considered a possible site to provide this beneficial customer service. For example, parents bring their children to the family doctor for a check up. Even though the purpose of the visit is the child, there is no reason why the parents shouldn’t be evaluated for high blood pressure and goal rate attainment. If a parent has elevated blood pressure, a follow up appointment for the parent can be scheduled at that time.
Other places we could increase awareness of high blood pressure in the community:
- the dentist
- at work
- the mall
- the library
- the gas station
In conclusion, I think it important to have means available for people to see if they are hypertensive and at risk for heart attack, kidney failure, and stroke. Frequent blood pressure screening can help identify those at risk for disease without having to see the doctor every time to determine if there is a problem. It is true that some health risk factors will be missed (such as high cholesterol and sugar diabetes); however, the above approach is a way to identify a group of people at risk who may not have gone to the doctor in the first place or are not adherent with their medication. Since risk factors tend to cluster together, high cholesterol and sugar diabetes will be picked up once the person had seen the doctor.