High Blood Pressure Therapy

high blood pressure therapy

The Clinical Validation of High Blood Pressure Therapy, or CVPHBT, is one of two official Hill- Bones Scales. This is an updated version of the originally developed, 14-item Hill- Bone Score used to assess patient behavior for all three major sub-scales of hypertension treatment (the original three-item score was later revised in 2003). Although other scores may be used to determine hypertension, such as the supplemental index, the CVPHBT provides a more complete reflection of hypertension treatment effectiveness.

In its current formulation and validation, the CVPHBT includes four domains of important hypertension-related behaviors. These include: Appointment keeping (nationally and within each individual’s social network), diet (food frequency and type and amount), medication adherence (prescribed and over-the-counter drugs), and exercise (physical activity level and frequency). Although these are the four domains of important hypertension behaviors, there are additional domain specific factors that affect patients with type 2 diabetes and hypertension. For example, many diabetics are overweight or obese, and are known to experience significant changes in diet and exercise patterns over time. Other factors that are typically associated with hypertension include alcohol use, tobacco use, and depression.

Because the CVPHBT includes both domain specific items and composite items, it is important that patients follow the therapy precisely for the appropriate duration and length of time needed for optimal clinical benefit. It is usually recommended that patients receive high blood pressure therapy for not less than five years. If the CVPHBT domain of attention is neglected (such as in the case of patients who are experiencing significant changes in diet and/or exercise patterns), the reappearance of hypertension or other serious medical issues may be inevitable. In this case, the option of an intensive treatment group often makes more sense.

Blood pressure control is not the only benefit of intensive therapy. Long term effects of this intervention are also often discussed in follow-up sessions. Changes in body weight (normalizing BMI to the target body weight for age and gender), general health, blood pressure control, sleep quality, depression, irritability, impulsivity, and fatigue are typical long-term effects of high blood pressure. Similarly, other important long-term health outcomes that are associated with patients receiving standard care include improvement in liver function (such as hepatitis, cirrhosis, and cancer), lower risk of diabetes, decrease in renal function (decrease in kidney function), decrease in asthma episodes, and reduction in joint pain, stiffness, and swelling.

As with the evaluation and management of patients with high blood pressure, patients must adhere to the recommended medications during the course of treatment. Monitoring of symptoms, changes in medication, and adherence to therapy are performed through regularly scheduled visits. The first visit usually includes the presentation of the initial electrocardiogram or other diagnostic test (e.g., electrocardiogram of the right arm or a treadmill test of the leg and arm movements). Initial testing is followed by repeated electrocardiograms at intervals over four to six weeks. A minimum of three repeat tests is required for the diagnosis of normality.

For individuals with hypertension who are unresponsive to at least a partial program of medication and who do not demonstrate a significant improvement on the baseline HbA1c assessment, a modified dietary approach may be indicated. Patients may have a higher HbA1c score at the initial visit but should follow a program of improved diet and reduced sodium intake. A modified food pyramid guide and a prescription for a selective diet pill may be prescribed.

For some patients, intensive treatment can result in significant improvement, reduction of stress, and prevention of serious adverse cardiovascular events. If left alone, patients in the intensive treatment group will maintain similar HbA1c responses at approximately 40 percent with standard treatment. After one year, when the modified Dietary approach has been implemented, about a third of hypertensive patients in the intensive treatment group have achieved normal blood pressures, and about a quarter of those in the standard treatment group are still at an elevated HbA1c. Of those in the intensive treatment group who are still in the improved category at one year, about a quarter have reached the modified target of lower hypertension than at the end of the intensive treatment; the remaining patients in the improved category have maintained their blood pressure levels at approximately normal levels.

Hypertension is a serious condition that deserves careful management in all patients with regard to diet and exercise. If you have been diagnosed with hypertension, please consult with your doctor regarding ways to control your high blood pressure before it gets worse. The earlier it is detected and treated, the better chance you have of avoiding the more serious cardiovascular disease that can occur as a result of uncontrolled hypertension. You owe it to yourself to learn more about the potential risks of untreated hypertension.