Kidney Health Wellness

Controlling High Blood Pressure in the Community

January 6, 2011

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.

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    Nancy Robertson

    We had quite a few Alegent employees with higher blood pressures during our employee health screenings. 1 in 4 for higher blood pressures does not surprise me at all.

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    Michael Aaronson

    I wholeheartedly agree and think Dr. Van De Graaff's opinion would be welcomed here.

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    Maggie Sweigart

    Right on with the positive comments for checking blood pressures. That is why I love my job with the Heart and Sole Walking Program. We do blood pressure checks for everyone - not just members. Over this Fall/Winter season I have seen our numbers increasing for the walkers at Westroads Mall and at the Lakeside Wellness Center. Plus the human touch is much better than a blood pressure machine!

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    Brenda Glover

    I have had high blood pressure since I was 25 and I think having alternative loations to check blood pressure is a great idea.

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    My mother (a retired RN) has a desk set up next to the cashier at the lenten Friday fish fry's in her town of Lincoln. She catches some that are very high and tells them to see their doctor. What a great service! Thanks for your blog, I appreciate it.

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    Eric Van De Graaff

    Dr. Aaronson, I think this is a great idea and I'm impressed with your statistics. You've come up with creative ways to screen the community for hypertension. I do question the accuracy of a blood pressure measurement at the dentist office (I know they frequently do this, and I've always wondered about it). I imagine my own BP is up whenever I sit in that antiseptic-smelling office waiting to get my teeth drilled. Other places we may wish to avoid checking blood pressure would be the DMV, out shopping with one's spouse, or attending a kid's birthday party at Chuck-E-Cheese. Dr. VDG

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    Bridget Branch

    I think this is a great idea and have always wished I could do this with my pharmacist when I go in for my prescriptions due to the convenience. It would be great if Alegent gave people access to and information about buying a home monitor as well, as unlike diabetes, blood pressure monitors are not covered by insurance even though most doctors want people to check it at home as well. During the Health Fair discounts on things like home monitors would be great for people needing them or having a high reading, and someone there could show you how to actually use them and read it. Distribute a recipe book for recipes for people with high blood pressure that uses salt alternatives with healthy spices, etc. More needs to be done regarding blood pressure education and help for those who have it like they do currently for people with diabetes.

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    Ronnette Sailors

    Dr. Aaronson, I'd like to add another site to your list. Faith Community Nurses (or Parish Nurses) have been doing blood pressures for a good number of years in congregations, and the stories are amazing. Our Alegent Health Faith Community Nursing Network presently works with 45 churches in the area and 66 active nurses. We give each church a blood pressure kit, and re-calibrate equipment yearly. Nurses have not only found hypertension and referred congregation members to physicians (sometimes saving a life), but develop preventive activities such as nutrition education, offer healthy food options along with those classic "doughnut Sundays", set up walking programs (our current one is "Jerusalem Journey" where members add miles together to reach Jerusalem by Easter). It takes us all--the barbers, the dentists, the malls, the pharmacies--but we hope we're adding to the positive shift in how people are looking at their health.

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    Bob G

    I have always thought that the community pharmacy is / would be a great place to provide blood pressure checks. Some of the larger chains have the blood pressure machines that are located in the pharmacy area. This is a step in the right direction, but I think it becomes more powerful when a pharmacist can get involved to help provide information about the dangers and long term effects of hypertension and to provide referrals when necessary. I think many times people use the automatic machines and get a reading but don't have the proper resources to make a determination on when a visit to their physician is warranted.

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