To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: ASH: Low Rate of Nutrition and Exercise Counseling in Patients With Hypertension URL: http://www.pslgroup.com/dg/23323A.htm Doctor's Guide May 21, 2003
By Jill Stein NEW YORK, NY-- May 21, 2003 -- Despite accepted guidelines on lifestyle modification for the treatment of hypertension, patients with high blood pressure are counseled about nutrition and physical activity in less than one-third of office visits, researchers reported at the 18th Annual Scientific Meeting of the American Society of Hypertension. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) recommends lifestyle intervention, with or without pharmacological therapy, for all patients with borderline or high blood pressure. Philip B. Mellen, MD, a resident in internal medicine, Wake Forest University School of Medicine, Winston-Salem, NC, and colleagues evaluated the prevalence of counseling on nutrition and exercise in 6696 hypertensive patients, using data from 2 nationwide surveys. The surveys, which included the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, compile information from randomly selected physicians who complete a 1page questionnaire on patient visits in office-based practices or hospital outpatient departments. The project is conducted annually by the Centers for Disease Control. In the present trial, investigators examined all encounters with patients 18 years of age or older who had a diagnosis of hypertension in the years 1999 and 2000. Results show that dietary counseling was provided at 29.5% of office visits, and exercise counseling at 19.2%. One or both interventions were offered at 32.4% of visits. "Patients with cardiovascular comorbidities often fared no better than other patients with respect to nutrition and exercise counseling," Dr. Mellen said. For example, in patients with hypertension and coexisting coronary artery disease, diet was discussed in 29.6% of visits, and exercise in 26.3% of visits. In patients with hypertension and concurrent diabetes, a discussion of diet was included in 38.4% of visits, and exercise in 20.6%. Patients who were severely hypertensive, and patients who had more than one cardiac risk factor, were significantly more likely to receive diet or exercise counseling. Counseling about lifestyle modification was also significantly more frequent in patients who were Asian, privately insured, and living in the western US. Family physicians were better at providing counseling about diet and exercise than were general internists and cardiologists. "While it has long been known that hypertension is a major risk factor for cardiovascular morbidity and mortality, and that lifestyle changes can complement pharmacologic therapy in lowering this risk, our results from nearly 7000 patient visits indicate that doctors are largely ignoring the data," said Dr. Mellen. The JNC VII guidelines for lifestyle modification recommend that hypertensive patients limit alcohol intake to no more than 1 ounce of ethanol per day (or 0.5 ounce of ethanol per day for women and lighter- weight people). Patients are also advised to reduce sodium intake to no more than 100 mmol per day (1.4 g sodium or 6 g sodium chloride), to maintain an adequate intake of dietary potassium (approximately 90 mmol per day) and dietary calcium and magnesium for general health. The guidelines say all hypertensive patients should stop smoking, and reduce dietary saturated fat and cholesterol for overall cardiovascular health. Overweight patients are advised to lose weight. Dr. Mellen emphasized that while patients are usually blamed for not complying with recommended lifestyle interventions and drug treatment, his study suggests that doctors also bear significant responsibility. And, while a lack of time and training may in part explain why doctors neglect to counsel patients about lifestyle modification, the more important issue is resolving the problem. "What's clearly needed are health care professionals other than physicians who can lead the way in counseling patients who have an increased risk of cardiovascular events," he added. --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. 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