A Patient‐Centric Web‐Based Approach to Improve Hypertension Management: A Lesson Learned From Postmenopausal Women

Abstract

Awareness, treatment, and control of hypertension are characterized by different prevalence according to sex and race. Although women demonstrate higher rates of awareness and treatment of hypertension as compared with men, they are less frequently controlled with the administered antihypertensive treatment. 1 Moreover, as shown in the same survey, non-Hispanic black women compared with their non-Hispanic white and Mexican American counterparts, were characterized by higher rates of hypertension awareness, treatment and control. 1 Despite these epidemiologic observations, hypertension remains still nowadays largely uncontrolled, despite improved treatment, a condition occurring also in women and defined as the hypertension paradox by Chobanian. 2 Such a paradox requires more efforts to address a number of yet unmet needs in this field. First, the commonly recommended but largely neglected lifestyle modifications should be more effectively promoted. Second, the doctor’s time spent with the patients has to be improved, both quantitatively and qualitatively. Finally, the issue of inadequate hypertension control should also be revisited through a patient-centric approach. This approach might be particularly important in postmenopausal women because of the accelerated age-related increase in the incidence of hypertension, in the progress of arterial stiffening, and in the rate of fatal cardiovascular events, especially after the age of 65 years. 1 In the present issue of The Journal of Clinical Hypertension, Doner Lotenberg and colleagues 3 describe the results obtained by mapping the journey of postmenopausal women going through the steps required to diagnose and manage a high blood pressure (BP) condition. Authors, through analysis of an online survey, examined the experiences in this regard of 300 postmenopausal women with at least 6-year lasting hypertension. These data were extracted from a structured questionnaire focusing on hypertension diagnosis and monitoring, on hypertension treatment, and on long-term disease management. The main findings of the present study 3 confirm the low adherence of these women to treatment, the inadequate rate of lifestyle intervention counseling by health care providers, and the limited use of home BP monitoring to measure routinely out-of-office BP levels, especially in the elderly. Additionally, the finding that the diagnosis of hypertension was made in the majority of women (77%) during a check-up or a sick visit also demonstrates that prehypertension is not regularly searched. This omission to follow the increasing BP changes with aging are partially driven by the inadequacy of educational programs focusing on regular BP measurements and by the widespread belief that prehypertensive BP levels should generally be overlooked. The authors also report that a high clinical suspicion of hypertension or the identification of patients with prehypertension should be corroborated by out-of-office BP measurements (eg, measurements in pharmacies, grocery stores, or health clubs) that are more easily accessible in the general population setting than measurements by physicians.