Improving Patient Outcomes: Lifestyle Changes and Blood Pressure Management

As physicians, we do everything that we can to make sure that our patients can live healthy and productive lives. We know the risks of uncontrolled hypertension, and that lifestyle interventions such as managing weight, healthy diet, exercise, avoiding alcohol use, avoiding smoking, managing stress, and healthy sleep can be effective in both controlling hypertension and improving overall health. How, though, can we effectively convey this information to our patients? It is important to ensure that our patients know how health outcomes can be improved when we recommend lifestyle interventions.

• Managing weight: obesity can impart as much as a twofold increase in risk of developing hypertension. Managing weight can lead to reduced blood pressure, decreased dosage or discontinuation of antihypertensive medications, and improvement in insulin sensitivity
• Diet and nutrition: Excessive consumption of sodium can result in hypertension and is the most important dietary risk factor for cardiovascular disease and death. Reducing sodium intake has been shown to reduce blood pressure and reduce risk for cardiovascular disease by more than 25%. Several diets such as the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet have been shown to lower blood pressure.
• Exercise: sedentary lifestyle is a risk factor for hypertension and cardiovascular disease. Exercising is associated with reduction of risk for hypertension, and evidence suggests that exercise may reduce blood pressure as much as antihypertensive medications. Even moderate intensity exercise activity such as walking can help to lower blood pressure.
• Alcohol use: regular alcohol consumption as well as binge drinking are associated with hypertension. Decreasing alcohol consumption has been demonstrated to be associated with significant decreases in blood pressure.
• Smoking: smoking or use of electronic cigarettes are known to acutely increase blood pressure and also be a risk factor for cardiovascular disease. Smoking cessation is an important lifestyle intervention that can decrease this risk.
• Stress: Stress from psychosocial factors is associated with an increased risk of both hypertension and cardiovascular disease independently. Additionally, stress is associated with other unhealthy habits such as poor diet, alcohol use, smoking, and lack of exercise. Stress reduction techniques such as mindfulness-based stress reduction have been shown to decrease blood pressure in patients with hypertension.
• Sleep: poor sleep, including poor sleep duration, poor sleep quality, and poor sleep efficiency are associated with increased risk of hypertension. Additionally sleep disorders, such as obstructive sleep apnea, are associated with high blood pressure and other cardiac risk factors. Ensuring proper sleep hygiene and treating sleep disorders can improve both hypertension and cardiac risk.

Supplementing a discussion about lifestyle interventions with connection to resources can help patients make and sustain some of these changes. Offering referrals to resources such as weight and wellness or a community health worker could help patients navigate making lifestyle changes. For physicians who do not have access to these resources in their practice, connecting patients with community resources can also be valuable. Organizations such as the American Heart Association, the YMCA, or even state/local health departments may have resources and programs that patients can access for assistance and support. Some of these programs are:

• YMCA's Blood Pressure Self-Monitoring Program
• National Healthy Heart Ambassador Blood Pressure Self-Monitoring (HHA-BPSM) Program
• Expanded Food and Nutrition Education Program (EFNEP), including Cooking Matters
• Diabetes Self-Management Education & Support (DSMES)
• Enhance Fitness
• Health Coaching
• Medical Nutrition Therapy (MNT)
• Medication Therapy Management (MTM)
• National Diabetes Prevention Program (NDPP), in person
• National Diabetes Prevention Program (NDPP), online and distance learining
• Tai Ji Quan: Moving for Better Balance
• Tobacco Treatment Specialist (TTS)
• Walk With Ease
• Chronic Disease Self-Management Program (CDSMP)

While lifestyle interventions can be powerful tools in controlling hypertension, these types of intervention are most effective when they are sustained over long periods of time. Helping our patients understand the impact these interventions can have on their health, and then connecting them to resources and programs that can help them navigate these lifestyle changes, can maximize their chances of success.

Resources:

• Find High Blood Pressure Tools and Resources (American Heart Association)
• Hypertension Control Change Package, Second Edition (Million Hearts)
• Managing High Blood Pressure (US Centers for Disease Control and Prevention)
• Patients can take these steps to lower their high blood pressure (American Medical Association)
• Blood Pressure Self-Monitoring (The YMCA)

This material is provided as part of a public health grant between NHMS and the New Hampshire Department of Health and Human Services’ Division of Public Health.