Research explains why hypertension (high BP) treatment is failing so many

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It’s a killer public health problem, but with effective treatment when properly executed: High blood pressure, also known as hypertension.

And yet according to the U.S. Centers for Disease Control and Prevention (CDC), only about half of the 75 million Americans living with this “silent killer” have the disease under control. Check out this CDC fact sheet on hypertension for yourself.

Research published online Christmas night in Annals of Internal Medicine shows why America, and indeed the world, needs a more comprehensive approach to blood pressure treatment.

Prescribing pills wily nily until a doctor finds something that works just isn’t working. We need a more comprehensive approach that includes patient coaching while clinicians work to find the right treatment combination, the authors concluded.

And it does take a combination of treatments – not just handful of pills – to get blood pressure under control.

The study published tonight by researchers at Tulane University explains “Barriers to hypertension control have been identified at the health care system, health care provider, and patient levels. Such barriers include limited health care resources, lack of performance standards, and limited reimbursement for health coaching at the system level; lack of adherence to clinical guidelines at the provider level; and lack of adherence to prescribed medications, lifestyle modifications at the patient level.”

You can read the study for yourself by clicking here.

In an accompanying editorial, doctors from Ireland and the UK, where blood pressure treatment outcomes are even more abysmal than in the U.S., use a decisively American term to describe what’s going on:

“The answer seems to lie in the ‘swamp’ that is everyday clinical practice, where unreliable blood pressure measurement and polypharmacy with associated patient illness seem to challenge adherence at every turn and can create a complicit therapeutic nihilism between patients and health care providers.”

You can read the editorial for yourself by clicking here.

Anxiety meds, gym actually resulted in my blood pressure going up

Anyone who has battled high blood pressure, like myself, knows how hard it can be to control. My blood pressure now is controlled with medical cannabis – it has dropped to normal levels since I obtained my Illinois Medical Cannabis Card with chronic PTSD as a qualifying condition.

Read more: Blood pressure down, anxiety receding. Me: Pharma free

But that doesn’t mean that’s an effective treatment for everyone, particularly since it is not legal for most.

And sadly, it is extremely expensive, and insurance does not pay one penny.

My blood pressure stays under control because I also eat right and get plenty of exercise. And I don’t smoke or drink. I wrote the blog about the blood pressure seemingly being controlled with cannabis only after consistently getting normal blood pressure readings even after going off the beta blockers.

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Essentially, I ran out of them after losing my insurance for a short time. I had weaned off them, however, knowing my medication supply was dwindling. I did not stop them cold turkey.

And I never would have stopped them without the medical cannabis card and a general feeling of wellness. I have not felt more physically healthy since high school. Mentally, I do feel I am on my way to achieving warrior status with my PTSD, but of course you never know where the next setback lies.

Normal blood pressure readings did not happen at first. My blood pressure became elevated for a while before essentially working itself out.

Never go off your blood pressure medication cold turkey and always listen to, and communicate with, your doctor.

With chronic PTSD, I had been prescribed whopping amounts of benzodiazepines, a type of anxiety medication also known as Ativan, Xanax, Klonopin, etc.

After a while, as it the case with some people, the benzodiazepines began to have a reverse effect. I began to experience explosive fits of rage again when remembering certain things I have survived.

And, I was finding that the gym was causing me to gain weight and experience intense anxiety. This did not at first make sense. But my therapist explained this can happen as a result of cortisol production.

Cardiovascular exercise (which is what I mostly did at the gym) does not always result in the desired calming effect in people with PTSD and anxiety. For me, the gym was a trigger. And after one member who works in the emergency room of a local hospital said something alarming and frightening to me, I never wanted to go again.

But I did keep going. For a while.

Finally, I quit the gym. And I told them, in writing, exactly why I quit.

Check out this interesting New York Times piece on why exercise isn’t always good for your health

Instead, I went back to doing what I did before I owned a vehicle – lots of walking, and a lot of time spent working in the yard (scientifically proven to help people with PTSD…check out this blog post I wrote).

And I sold my vehicle, awesome little car that it was. Driving stresses me out and always has.

PTSD, anxiety made controlling BP challenging

Recovering alcoholics only should be prescribed benzos as a last resort, as they affect the brain the same as alcohol. I already was a year sober when they put me on them, but after two and a half years, I experienced an alcohol relapse.

My anxiety medication began to inch me into rages toward the end. I have no doubt this was affecting my blood pressure, as it was happening most every day.

As for the relapse, I was on vacation in Fort Lauderdale in January, watching a live mermaid show, after many, many years of extreme duress. The boozing began to occur every time I went on a trip (and there were four of them January through May). Then, it happened at home a few times.

It was then that my healthcare providers decide to support me in my quest for a medical cannabis card. While I knew it would work for the PTSD and the anxiety, I did not expect my blood pressure to also resolve itself.

Until July, I was taking two beta blockers per day plus a water pill to treat my blood pressure. While that treatment was working, and working better than any previous regimen I had been on, for many years I had been prescribed wily nily medications that did not work. In fact, some made me balloon up and retain water, doing exactly the opposite of what the medications are supposed to do.

Other times I had been prescribed blood pressure meds that made getting up in the morning so difficult (intense dizziness) that I just stopped taking my meds altogether.

Other blood pressure meds literally resulted in my peeing the bed every night. However, this was back in my hardcore drinking days of long, long ago.

Where were my doctors when I was having all these blood pressure problems? Waiting for my one-month follow-up appointment, like most doctors do after prescribing blood pressure medication.

And yet there’s an easier, more effective way to blood pressure management: Clinicians and patients talking to each other more frequently and sharing what works and what doesn’t.

It’s a job that doesn’t have to be completed by a doctor. Medical professionals should be reimbursed for it, however, and usually aren’t.

Doctors need training; patients need education

In the Tulane study, researchers conducted what’s known as a systematic review and meta-analysis. In other words, they studied previous studies about blood pressure treatment.

“Multilevel, multicomponent strategies, followed by patient-level strategies, are most effective for BP control in patients with hypertension and should be used to improve hypertension control,” the authors concluded.

Top number blood pressure readings tended to plunge significantly in patients receiving multilevel care management as opposed to those receiving medication alone, dropping more than seven systolic points in some cases. Lesser interventions in addition to medication produced similar results, although not as pronounced.

Diastolic numbers similarly improved.

The researchers determined that to better manage patients with high blood pressure, both the patient and the doctor needs to better understand where the other is coming from.

For doctors, this might mean more training about how to manage patients with high blood pressure and the hurdles to healthcare many of them already face. It can even mean a third-party audit of their blood pressure prescribing and treatment practices and constructive feedback.

Read more: Medicine cabinet shakeup: Bye-bye benzodiazepines, hello Mother Nature

For patients, it means making them understand that lifestyle modifications really do work, and that medication adherence is paramount. It also means listening to your body to find out what works and what doesn’t.

For example, if while on blood pressure medication you begin to fill up like a water balloon attached to a garden hose, something is not working. The reverse should happen.

When it happened to me, I posted something about it on Facebook (I wasn’t working in healthcare yet and did not realize it was the BP meds) and a former newspaper colleague alerted me that my blood pressure meds weren’t working.

Patients and payors expect to be educated by clinicians about good health

Not everyone has such smart Facebook friends. They need simple coaching about what to look for when beginning blood pressure treatment so they can record it, as well as regularly record their BP, and communicate their findings with their doctor.

“Health coaching strategies could be delivered in person or by telephone at several individual or group sessions during the intervention. The strategies were patient-centered, with a component of behavioral self-monitoring,” the researchers explained.

“A health coach (case manager, nurse, medical assistant, or community health worker) and patients worked together using self-discovery or active learning processes to improve medication adherence and lifestyle modification.”

I have been blessed to have received excellent healthcare the past couple of years for the challenges I face. Having had intense cognitive behavioral therapy for trauma for two years, sometimes three times per week, I have tools for managing triggers, which also can raise blood pressure.

And with no booze, no drugs, no cigarettes, and a general knowledge of healthy eating (and a growing love for healthy foods…they really do taste awesome!) I have evolved into one of those people who really does treat his body and mind like a shrine.

It’s something we all can learn to do. Whether it’s regarding your blood pressure or any health problem, a commitment to lifelong learning about your body, and a respect for it, means you’re doing all you can for good health.

And that should feel good.

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You can find me on Twitter @DavidHeitz

 

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