By Caitlin Waters
As the fourth patient of the day walks through the door, I glance at his chart and see the letters HTN penned once again under medical history.
HTN stands for hypertension, more commonly referred to as high blood pressure. The patient’s pressure reading is 178/103 mm Hg. With a target goal of 140/90 mm Hg, his hypertension is far from controlled. In the past year alone, this patient has experienced atrial fibrillation and stroke, both brought on by his hypertension.
Four patients – back-to-back – all with uncontrolled hypertension: A routine day at many medical practices.
High blood pressure occurs when narrowed arteries or high blood volume increases the force of blood on artery walls. Hypertension, defined by a pressure of 140/90 mm Hg or greater, leads to serious health problems such as heart attack, congestive heart failure, stroke, or kidney damage.
More than 67 million American adults have hypertension. That’s over 30 percent of the population. After all, who doesn’t have some family history of high blood pressure?
If the risk of heart disease and stroke are not troubling enough, the U.S. Centers for Disease Control and Prevention estimates that high blood pressure alone cost the U.S. $93.5 billion in the year 2010. Clearly, we need to better manage this disease.
Methods for lowering hypertension are actually pretty straightforward. First and foremost, lifestyle changes, especially in diet and exercise, can substantially reduce blood pressure. These modifications can also be supplemented by a combination of different medications when necessary.
If we have the tools to control hypertension, why does it remain so poorly managed?
Limited success in managing hypertension stems partly from the way we monitor our blood pressures. A single blood pressure reading (or the suggested three readings) that occurs when a patient enters a doctor’s office is not exactly a wealth of information.
Case in point: white-coat hypertension. This is the phenomenon in which patients have higher blood pressure readings during office visits, possibly due to anxiety about the visit. Conversely, masked hypertension occurs when patients have elevated pressures during daily activities but lower pressures during clinical visits.
So if the pressure “snapshot” taken in a doctor’s office doesn’t capture the entire picture, what will?
One practical solution: systematic, at-home blood pressuring monitoring, also known as ambulatory blood pressure monitoring (ABPM). This is different from the traditionally used continuous 24-hour single day monitoring.
Hypertensive patients may use ABPM to take their blood pressure twice daily, over the course of one to two weeks, with an easy-to-use, digital blood pressure cuff. This method has been useful in better understanding, and, thus, better managing, hypertension.
The Parker Family Health Center (PFHC) in Red Bank, where I volunteer, has launched an ABPM program based on recommendations by experts in hypertension. The results are being successfully utilized to address white-coat hypertension, masked hypertension, compliancy issues, and medication adjustments.
One of the best aspects of PFHC’s ambulatory program is that patients are encouraged to have a more active role in managing their health. In addition to knowing their current medications, patients are required to understand their blood pressure goals and necessary lifestyle modifications before using the digital blood pressure cuffs.
In our ABPM program, patients sit down to take pressure readings twice daily, once in the morning and once in the evening. At each sitting, three measurements are taken, 1 minute apart, for a total of six measurements daily. Patients record all readings then the practitioner analyzes and averages the measurements.
Together, the patient and practitioner then develop the best treatment plan to achieve blood pressure goals and reduce cardiovascular risk.
Ambulatory blood pressure monitoring is a useful method to gain a more holistic understanding of and treatment plan for a patient’s hypertension.
Those with hypertension should talk to their physician to see if ABPM would be a useful tool for managing their hypertension.
Digital blood pressure cuffs can be purchased or borrowed through a lending program.
Remember, ABPM is a tool to use with your practitioner. It should not be used without the guidance of a medical expert.
The growth of ABPM programs, like the one utilized at the Parker Family Health Center, has the potential to improve successful management of hypertensive patients.
Four patients – back-to-back – all with uncontrolled hypertension … a thing of the past.
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