Published studies show that about 9% of men and 7% of women who fall in the young adult age range—defined as ages 18 to 39—have hypertension. “Although young adults have lower rates of hypertension when compared with those aged 40 and older, only about 38% of these individuals have their hypertension under control,” explains Heather M. Johnson, MD, MS.
Recent guidelines have identified lifestyle modifications as a critical first-line step to controlling hypertension. Several strategies are recommended, including losing weight for overweight and obese individuals; adopting the Dietary Approaches to Stop Hypertension (DASH) plan; reducing dietary sodium; increasing physical activity; consuming alcohol in moderation; and quitting smoking.
“Lifestyle modifications have been shown to be effective in improving hypertension control, reducing cardiovascular risk, and enhancing the efficacy of antihypertensive medications,” says Dr. Johnson. Despite these benefits, research suggests that adults with hypertension receive little physician education about lifestyle modifications. Few studies have assessed lifestyle education among patients who develop incident hypertension.
Examining Current Patterns
An understanding of lifestyle education patterns and the influence of such counseling are needed to develop targeted hypertension interventions. In a study published in the Journal of General Internal Medicine, Dr. Johnson and colleagues sought to determine the presence of any documented lifestyle education in an electronic health record system for young adults with incident hypertension. The study also aimed to identify patient, provider, and visit predictors of receiving documented education.
“Our study results showed that only 55% of the 500 participants received documented lifestyle education from a clinician within 1 year of presenting with incident hypertension,” Dr. Johnson says. Just 23% of participants received an initial hypertension diagnosis and/or an initial antihypertensive prescription within 1 year. Overall, 22% did not have any documentation, a finding that emphasizes a lack of hypertension awareness.
Other Important Trends
When patients received lifestyle education counseling, exercise was the most frequently discussed topic, with about two-thirds reporting such dialogue (Figure). Low-fat diets and other dietary topics were also discussed more than half the time and 71% of current smokers had documented smoking cessation education. However, education about lowering sodium intake and initiating a DASH diet was documented in just 25% of counseled young adults.
Young adult males had a significantly lower likelihood of receiving documented education. Several patient, provider, and visit characteristics predict documented education (Table). Patients with a previous diagnosis of hyperlipidemia or a family history of hypertension or coronary artery disease had higher odds of documented education. Patient age and baseline study year were not significant predictors of documented lifestyle education. Among visit types, chronic disease visits were identified as a predictor of receiving documented lifestyle education, but acute and other preventive visits were not.
Capitalize on Opportunities
Throughout the United States, heart disease and obesity rates continue to increase among young adults despite increased awareness of these conditions and the emergence of therapies to treat them. “Young adults with hypertension will likely have more than one cardiovascular risk factor, meaning they will need recurrent lifestyle education in order to manage multiple comorbidities,” says Dr. Johnson. “That’s why it’s critical to take advantage of the teachable moment when managing young adults with incident hypertension. Our research, however, suggests that many clinicians are missing this opportunity to advise young adults with high blood pressure about lifestyle changes.”
Patients need to understand that hypertension is a chronic but manageable disease when lifestyle interventions are used as directed, according to Dr. Johnson. “They need to be informed about all of the self-care strategies to use in order to get hypertension under control,” she says. “This requires efforts to ensure that support systems are available and that patients are consistently monitored and followed for progress with using lifestyle treatments.”
Published research suggests that team-based interventions may help address the competing clinical demands that can emerge when managing young adults with hypertension and may improve the administration of lifestyle education. “We need to develop interventions that empower clinical staff to provide lifestyle education to patients and overcome the time constraints that often impact busy physicians,” Dr. Johnson says.
“It is also important to address other potential barriers to providing young adults with counseling to manage hypertension,” says Dr. Johnson. “We can’t lose sight of the importance of informing patients about what they can do to control their hypertension. Doing so may reduce the burden of heart disease and enable patients to live longer, healthier lives.”
Johnson HM, Olson AG, LaMantia JN, et al. Documented lifestyle education among young adults with incident hypertension. J Gen Intern Med. 2014 Nov 6 [Epub ahead of print]. Available at: http://link.springer.com/article/10.1007%2Fs11606-014-3059-7.Bell RA, Kravitz RL. Physician counseling for hypertension: what do doctors really do? Patient Educ Couns. 2008;72:115-121.Egede LE, Zheng D. Modifiable cardiovascular risk factors in adults with diabetes: prevalence and missed opportunities for physician counseling. Arch Intern Med. 2002;162:427-433.Valderrama AL, Tong X, Ayala C, Keenan NL. Prevalence of self-reported hypertension, advice received from health care professionals, and actions taken to reduce blood pressure among US adults—HealthStyles, 2008. J Clin Hypertens (Greenwich). 2010;12:784-792.