Hypertension management
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Hypertension Management: Insights from Recent Research
Mobile Health (mHealth) for Hypertension Self-Management
Mobile health (mHealth) technologies have shown promise in improving hypertension management through self-monitoring and behavioral interventions. A systematic review and meta-analysis of 24 studies involving 8,933 participants found that mHealth interventions significantly reduced both systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared to control groups. The reductions were -3.78 mm Hg for SBP and -1.57 mm Hg for DBP, respectively. Additionally, mHealth interventions improved medication adherence and self-management behaviors in most studies, although economic evaluations yielded mixed results. Another study in low/middle-income countries demonstrated that automated self-management calls combined with home BP monitoring significantly reduced SBP, especially in patients with high information needs.
Guideline-Driven Hypertension Management
Recent updates to hypertension management guidelines emphasize the importance of accurate blood pressure measurement, comprehensive patient evaluation, and individualized treatment plans. The 2017 American College of Cardiology/American Heart Association guidelines highlight the need for lifestyle modifications and pharmacological treatments tailored to individual risk profiles and comorbid conditions. These guidelines also stress the importance of managing hypertension in older adults, patients with diabetes, chronic kidney disease, and resistant hypertension, using a combination of patient, provider, and health system approaches.
Hypertension Management in Older Adults
Managing hypertension in older adults requires a nuanced approach due to the increased prevalence of arterial stiffening and the associated risks of cardiovascular morbidity, cognitive decline, and loss of autonomy. Clinical evidence supports the benefits of lowering blood pressure in older adults, even those over 80 years old, but highlights the need for individualized treatment strategies based on functional status and comorbidities. For frail older individuals, a tailored approach that considers the balance of benefits and risks is essential, and further research is needed to optimize treatment strategies for this population.
Pharmacologic Treatment Targets for Older Adults
The American College of Physicians and the American Academy of Family Physicians recommend different SBP targets for adults aged 60 years or older. Moderate-quality evidence suggests that achieving an SBP target of less than 150 mm Hg reduces all-cause mortality, stroke, and cardiac events, while lower targets (less than 140 mm Hg) did not show significant additional benefits in some studies. The choice of BP targets should consider individual patient characteristics, including comorbid conditions and overall health status.
Digital Interventions and Home Monitoring
Digital interventions that combine self-monitoring of blood pressure with guided self-management have been effective in primary care settings. The HOME BP trial in the UK found that a digital intervention led to a greater reduction in SBP compared to usual care, with a mean difference of -3.4 mm Hg after one year. This approach also showed low incremental costs, suggesting it could be a cost-effective strategy for hypertension management in primary care.
Nursing Case Management
Nursing case management has proven effective in controlling blood pressure among hypertensive patients in primary healthcare settings. A randomized controlled trial in Brazil demonstrated that nursing case management, which includes consultations, telephone contact, home visits, and health education, significantly reduced both SBP and DBP compared to usual care. This model also improved other health outcomes, such as waist circumference, body mass index, and treatment adherence.
Supported Self-Management
Supported self-management strategies, including home blood pressure monitoring (HBPM) and telehealth, have consistently shown to reduce SBP and DBP. These interventions help bridge the gap between medical and lay perspectives of hypertension, fostering confidence in patients' ability to manage their condition. Effective self-management support often involves a combination of information, feedback, and a supportive patient-professional relationship.
Stepwise Treatment Approach
A stepwise treatment approach for uncontrolled hypertension in primary care involves a systematic work-up to exclude white coat hypertension, re-evaluate lifestyle and drug adherence, optimize antihypertensive treatment, and refer patients if necessary. This method aims to improve blood pressure control more effectively than usual care.
Lifestyle Interventions
Lifestyle interventions, such as regular physical exercise, body weight management, and healthy dietary patterns, play a crucial role in preventing and treating hypertension. The DASH diet, in particular, has been shown to be effective in reducing blood pressure. Other lifestyle factors, such as adequate sleep and stress management, also contribute to better hypertension outcomes.
Conclusion
Effective hypertension management requires a multifaceted approach that includes mHealth technologies, guideline-driven treatments, individualized care for older adults, digital interventions, nursing case management, supported self-management, stepwise treatment strategies, and lifestyle modifications. These strategies, when integrated into clinical workflows and tailored to individual patient needs, can significantly improve blood pressure control and overall health outcomes.
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