Elevating Blood Pressure Care: Emphasizing Behavior Change for Hypertension Control

Background: More than 70 million Americans have hypertension, with an additional 1 in 3 at risk. Only about half of hypertension cases are well controlled. Uncontrolled hypertension can lead to stroke, myocardial infarction, heart failure, and death. Healthy behaviors (i.e., appropriate diet, exercise, weight management) are critical components of hypertension prevention or management. Despite wide acknowledgment of the importance of these healthy behaviors, lifestyle self-management interventions are often underemphasized as hypertension treatments.

Purpose: The purpose of this comprehensive review of literature was to examine factors that may emphasize medication usage over healthy behaviors for the prevention or self-management of hypertension. Specific objectives were to examine 1) patient, 2) provider, and 3) system factors that emphasize medication usage.

Methods: Literature from PubMed, EBSCO (CINAHL, PsycInfo, PsycArticles, Psychology/Behavioral Sciences, Academic Search Elite, Consumer Health Complete, Health Source) was reviewed to explore various factors that may prioritize medication over healthy lifestyles to prevent or manage hypertension.

Results: Patient and provider attitudes, reimbursement practices, quality measures and guidelines prioritize medications over lifestyle behavioral management of hypertension. Patient factors may include comparative ease and convenience of using medication, low motivation or social support, interest, preference, and cost. Provider factors may also include convenience of prescribing medication, guidelines, quality measurements and related reimbursement policies that emphasize medication. National guidelines, quality measurements and subsequent reimbursement practices emphasize achieving standardized blood pressure values, with either medications or unspecified means.

Conclusions:  When aligned, patient, provider and system factors may minimize the importance of changing behaviors while favoring medication usage. While medications may be a necessary treatment for hypertension, the importance of healthy lifestyles as a first line of treatment should not be minimized. Individual, provider, and healthcare system factors currently emphasize the use of medication as a “quick fix” for hypertension. In light of growing numbers of hypertensive and at-risk individuals, as well as poorly controlled cases, emphasizing behavioral changes for hypertension prevention and management may be more beneficial for the health of society. Health care policies, quality measurements, and reimbursement practices should be redesigned to reflect the importance of healthy lifestyles for better hypertension prevention and management.