A cornerstone of hypertension control is living a heart-healthy lifestyle, which can be cultivated through community support. In a call to action to control hypertension from U.S. Surgeon General Jerome Adams, MD, three goals and strategies are provided for physicians, health systems and other organizations to follow. One of those goals is to ensure that the places where people live, learn, work and play support hypertension control.
“Lifestyle changes that support hypertension control and broader cardiovascular health include increasing physical activity, adopting a healthy diet, not smoking, maintaining a healthy weight, and consuming alcohol in moderation if at all,” says the surgeon general’s report. “These actions are more easily implemented when they are part of everyday life.”
The AMA has developed online tools and resources created using the latest evidence-based information to support physicians to help manage their patients’ high BP. These resources are available to all physicians and health systems as part of Target: BP™, a national initiative co-led by the AMA and American Heart Association.
However, while clinical guidelines for BP management highlight the importance of nonpharmacological interventions and lifestyle change to improve cardiovascular health, it can be difficult for patients to accomplish.
This is where community-level strategies that change the environment where people live, work, learn and play can impact health outcomes. Here are three strategies to promote.
While physical activity helps people with hypertension lower their blood pressure, only about half of U.S. adults meet the current recommendations for physical activity. Adults should do at least 150 minutes a week of moderate-intensity activity, or 75 minutes a week of vigorous-intensity activity, according to the 2018 Physical Activity Guidelines. To make matters worse, about one-quarter of adults are inactive. This sedentary behavior is associated with increased risks of other chronic diseases and death.
To improve physical activity, physicians can recommend organized activities such as recreational sports that are available in the community. These can provide both social and cardiovascular benefits. Nonorganized activities, such as running or cycling, can also be helpful. However, an easy way to begin and maintain an active lifestyle is by walking.
Learn more from the AMA about how patients can start—and stick with—key lifestyle changes, including physical activity.
There is also a need to promote population-level strategies that create healthy nutrition environments. This is key to hypertension control and eliminating disparities in the consumption of a healthy diet. Food consumption and healthy eating patterns should include a variety of vegetables, whole fruits, grains, fat-free or low-fat dairy, a mixture of protein sources and healthy oils.
It is also recommended that people limit saturated fats, trans fats, added sugars and excess sodium. To lower sodium intake, physicians can recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan. The DASH diet has strong evidence supporting its ability to lower BP.
Physicians and health systems can meet this goal by creating healthy procurement policies and nutrition standards for packaged and prepared foods. They can also encourage meal preparation practices that can help reduce the amount of sodium and increase healthy foods offerings. Increasing awareness of healthy eating patterns and ensuring access to nutritious options for all residents should be a top priority.
Physician practices and health systems can increase access to community resources, collaborate with community health workers and lay health partners, and use population-health management tools. By identifying community resources and improving physicians’ awareness of them can help promote lifestyle changes for patients with hypertension.
Sharing this responsibility between health systems and community organizations can lead to more effective use of existing resources and better care delivery. Through increased awareness of these community resources, it has been linked with referrals among physicians. It can even promote the use of evidence-based interventions in local communities.
However, referring someone without considering barriers to access to programs and activities in communities can limit the benefit. Instead, physicians should talk with families to uncover any potential barriers to access to participating in those programs. Diverse clinical and community partnerships should also be considered to improve links to programs and support across communities.
Learn more from this JAMA Viewpoint article, “A National Commitment to Improve the Care of Patients With Hypertension in the U.S.,” written by Dr. Adams and Janet S. Wright, MD, also of the surgeon general’s office.