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 More than half of people with high blood pressure do not have the
condition well controlled, which may in part be because patients
often believe hypertension means “too much tension,” or too much
stress, the authors write.
In fact, hypertension refers to high blood pressure, which happens
when the force of the blood pumping through arteries is too strong.
Chronic high blood pressure, which affects one in three U.S. adults,
can strain the heart, damage blood vessels, and increase the risk of
heart attack, stroke, kidney problems, and death, according to the
National Institutes of Health.
Patients who misunderstand the term hypertension may turn to stress
management to control their high blood pressure, which they view as
a psychological condition more than as a physiological one,
according to a perspectives article by Barbara G. Bokhour and Nancy
R. Kressin of Boston University School of Public Health in the
journal Circulation: Cardiovascular Quality and Outcomes.
These patients may focus more on stress management instead of taking
effective blood pressure medications, like diuretics,
calcium-channel blockers or ACE inhibitors.
“It’s always good to manage stress, that’s always good for your
health writ large, but for hypertension in particular stress
management will not be enough,” Bokhour told Reuters Health by
phone.
Lifestyle management and taking prescribed medications are much more
important for controlling blood pressure, she said.
Providers often use the term hypertension and don’t always
explicitly link it to blood pressure, she said.
“They are using the words interchangeably, but patients do not
always understand that they are interchangeable,” Bokhour said.
She and Kressin suggest that doctors should exclusively use the term
“high blood pressure” rather than hypertension when talking to
patients.
“I tend to agree with the authors' suggestion,” said Dominick Frosch
of the David Geffen School of Medicine at UCLA, who has also studied
common beliefs about high blood pressure and their effects on
medication use.
His own study found that patients who were told about “hypertension”
were more likely to think that relaxing more would be an effective
treatment, compared to patients who were told about the same
condition under the name “Korotkoff syndrome.” But regardless of
label, patients still believed that evidence-based medications would
be more effective than relaxing more, Frosch noted.
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“A substantial proportion of individuals who have high blood
pressure inadequately control it, contributing to avoidable
cardiovascular disease risk as well as kidney disease risk,” he told
Reuters Health by email.
“If we want our healthcare system to be patient-centered, why would
we use ambiguous, potentially misleading language, when we can just
as well avoid it,” he said. “Tradition and habit are not good
justifications, in my view.”
Patients may also be reluctant to take their medications regularly
because in many cases high blood pressure does not cause symptoms,
so they do not feel like they need medication, Bokhour said.
Doctors should first ask patients what they understand about high
blood pressure, then have a conversation clarifying any
misunderstandings, she said.
“Oftentimes providers give information in a very rapid format, using
biomedical language,” which is true for other conditions as well,
not just high blood pressure, she said.
“Hypertension is one of many, many examples where providers have an
understanding of a word and patients do not, and if we don’t start
to bridge that gap we’ll continue to over-treat and under-treat,”
she said.
SOURCE: http://bit.ly/XaY6j7 Circulation: Cardiovascular Quality and
Outcomes, online July 7, 2015.
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