Role of Counseling for Hypertensive Patients

Hypertension is one of the silent conditions and it can lead to devastating complications including coronary artery disease, stroke, and renal failure.1 Hypertension is defined currently as systolic blood pressure measured values of 130 mm Hg or more and/or diastolic blood pressure of more than 80 mm Hg in two or more accurately measured blood pressure readings on each of two or more assessments.2 Hypertensive patients need education and counseling about their medications and the importance of adherence. Hypertension can be managed appropriately through counseling on lifestyle with a combination of drugs for some patients.3 It has been demonstrated that the use of self-assisted educational intervention reduces systolic blood pressure and diastolic blood pressure in patients with hypertension.4 Low adherence to antihypertensive medication is a major factor in uncontrolled blood pressure. Nonadherence of patients with treatment regimens is an important factor affecting blood pressure control.5,6 Therefore, non-adherence is a healthcare issue and is associated with poor blood pressure control and increased cost of hypertension treatment.7,8 Home pharmacy care programs were found to be effective in improving medication adherence and blood pressure outcomes among hypertensive patients, according to a study that started counseling patients with hypertension during home visits for the purpose of monitoring and evaluating their medication adherence and blood pressure control. 9 A study on the quality of counseling for hypertension management in Tanzania showed that diet and lifestyle counseling of patients who were diagnosed with hypertension was low; 14% of patients were advised about reducing salt in cooking, 29% reduced table salt consumption, 21% reduced consumption of sodium-rich foods, caloric intake, and increasing physical activity, and 43% were informed on follow up assessments. Only 1 patient who was a smoker was counseled about quitting smoking and reducing alcohol consumption.10 A cross-sectional study in Dessie City, Ethiopia assessed the poor compliance status of hypertensive patients computing from poor medication adherence, sedentary lifestyle, smoking, drinking alcohol, ‘Khat’ chewing, and high salt intake. The above study mentioned that most hypertensive patients on antihypertensive treatment had poor compliance toward clinician counseling. Self-employed, psychological domains and social support were the factors that affect poor compliance towards clinician counseling.11

In conclusion, counseling plays a critical role in the management of hypertensive patients. Effective counseling provides a deeper understanding of the disease, its implications, and the long-term commitment required for successful treatment outcomes. Healthcare professionals can inform patients about important topics like drug adherence, lifestyle changes, and the value of routine monitoring by providing them with individualized assistance. This proactive strategy lowers the risk of consequences including stroke, heart attack, and renal disease while also improving patient compliance and empowering individuals to take control of their health. Healthcare professionals can assist patients in overcoming the difficulties of managing their hypertension by incorporating counseling into the treatment plan. This will ultimately enhance the patient's quality of life and improve long-term results.

References

1. Esther, Y.T., Wan, E.Y., Mak, I.L., Chao, D.V., Ko, W.W., Leung, M., Li, Y.C., Liang, J., Luk, W., Wong, M.M. and Ha, T.K., 2023. Assessment of hypertension complications and health service use 5 years after implementation of a multicomponent intervention. JAMA network open, 6(5), pp.e2315064-e2315064.

2. Adnelda, W.p,               Kardela, W., Ifora, I.A. A review: effect of counseling adherence and blood pressure control in hypertensive patients. Sci     Int (Lahore), 2020, 32(6):66772.

3. Van Onzenoort, H.A., Verberk, W.J., Kessels, A.G., Kroon, A.A., Neef, C., van der Kuy, P.H.M. and De Leeuw, P.W., 2010. Assessing medication adherence simultaneously by electronic monitoring and pill count in patients with mild-to-moderate hypertension. American journal of hypertension, 23(2), pp.149-154.

4. Liu K, Xie Z, Or CK. Effectiveness of mobile App-assisted self-care interventions for improving patient outcomes in type 2 diabetes and/or hypertension: systematic review and meta-analysis of randomized controlled trials. JMIR Mhealth Uhealth 2020;8:e23600. 10.2196/23600

5. Chobanian AV and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2013:289,2560-72.

6. de Oliveira-Filho AD, Costa FA, Neves ASF, de Lyra Junior DP, Morisky DE. Pseudoresistant hypertension due to poor medication adherence. Int J Cardiol. 2014:2,e2.

7. Smith BA. Problem of nonadherence in chronically ill adolescents: strategies for assessment and intervention. Current Opinion Pediatrics. 2017:3, 613-8.  

8. Kane S, Shaya F. Medication non-adherence is associated with increased medical health care costs. Digestive Diseases Sci. 2008:3,1020-4.

9. Kristina, S.A., Dewi, P.P. and Widiastuti, W., 2019. Effectiveness of counseling for hypertensive patients on adherence and blood pressure outcome in primary care provider in Indonesia. International Research Journal of Pharmacy, 10(7), pp.40-44.

10. Edward, A., Hoffmann, L., Manase, F., Matsushita, K., Pariyo, G.W., Brady, T.M. and Appel, L.J., 2020. An exploratory study on the quality of patient screening and counseling for hypertension management in Tanzania. PloS one, 15(1), p.e0227439.

11. Fentaw, Z. and Adamu, K., 2022. Hypertensive patients compliance for clinician counseling in dessie city, Ethiopia. Heliyon, 8(11).