Prevalence of nutrition and exercise counseling in patients with hypertension

Abstract

JNC-VI recommends lifestyle modification, with or without pharmacologic therapy, for the treatment of all hypertensive patients. This study sought to evaluate physician exercise and dietary counseling trends for hypertensive patients using nationwide survey data. Data were obtained from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey for the years 1999 and 2000. These yearly surveys obtain data on a random selection of patient visits to physician offices and outpatient departments of representative hospitals across the United States. All visits with a diagnosis of hypertension were included and examined for rates of nutrition and exercise counseling. For the combined 1999-2000 surveys, 6720 identified patient encounters had a diagnosis of hypertension. Dietary and exercise counseling were given at 29.5% and 19.2% of visits, respectively; one or both interventions were offered at only 32.4% of visits. Men were more likely than women to receive exercise counseling (20.6% vs. 18.3%, p=.02). Asians were more likely to undergo counseling, while African-Americans received less exercise counseling (see ). Patients in western states were more likely to receive exercise counseling while patients in the Midwest received less dietary or exercise counseling (see B). Dietary intervention and regular aerobic exercise lower blood pressure. We found that fewer than one third of visits associated with a hypertension diagnosis included counseling for nutrition or physical activity. While there were significant differences in counseling rates with respect to gender, race, and geographic location, counseling for therapeutic lifestyle change was sub-optimal throughout the sample. Physicians need heightened awareness of the importance of non-pharmacologic therapy in this large, high-risk population(see Table). Racial (A) and Geographic (B) Differences in Lifestyle Counseling for Hypertensive Patients P ≤ .001 Racial (A) and Geographic (B) Differences in Lifestyle Counseling for Hypertensive Patients P ≤ .001