The 2017 U.S. hypertension guidelines rightly recommend lifestyle modifications for a large proportion of patients with high blood pressure, noted the authors of a new editorial, but those guidelines fall short in addressing exactly how to facilitate those changes.
“We know that merely providing education and recommendations to ‘eat better’ or ‘exercise more’ is insufficient to change behavior,” wrote E. Amy Janke, PhD; Caroline Richardson, MD; and Kristin L. Schneider, PhD, in the Annals of Internal Medicine. “Likewise, patients of a physician who tells them to monitor blood pressure at home but offers no motivational or educational guidance to support successful adherence are unlikely to achieve the desired goal.
“Therefore, ensuring that clinicians knowledgeable in behavior change theory and evidence-based lifestyle interventions are part of the primary care team is even more important.”
Janke and coauthors pointed to a single-center study which showed 45 percent of young adults with newly diagnosed hypertension didn’t receive any lifestyle counseling within one year.
They said another barrier to widespread implementation of lifestyle counseling is the varying rates to which insurance carriers reimburse such interventions. To address this, the editorialists suggested long-term studies evaluating the cost-effectiveness of these approaches, which may demonstrate the value of helping patients make meaningful changes to diet, physical activity, smoking and alcohol intake to reduce their cardiovascular risk.
Finally, Janke et al. recommended behavioral scientists and other nonphysician providers experienced in implementing lifestyle changes take a larger role in future guideline development, or at least communicate with the clinicians who are responsible for taking these messages to their patients.
“Professional and scientific societies should collaborate to support the dissemination and implementation of lifestyle counseling approaches and to provide networking opportunities, continuing education resources, increased awareness, and the shared evidence base that can help achieve the goal of the 2017 ACC/AHA guidelines,” the authors wrote.
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