Taking the Tension out of Hypertension: Moving Towards Better Control of High Blood Pressure

High blood pressure (HBP) is one of the most significant chronic disease issues that we face today from a public health perspective. It is an incredibly common condition with more than 1 out of every 3 adults having a diagnosis. If you don’t have high blood pressure, chances are that you have friends or family members who do. Despite this near universality (or perhaps because of it), there is often a lack of understanding on what HBP is, what its consequences are, and how it can be properly managed. To combat this, the American Heart Association began a program called Check. Change. Control. (CCC) dedicated towards achieving healthy blood pressure for all. Over the past few months, I’ve had the opportunity to serve as a Health Mentor for a number of these blood pressure management classes, and the insights that I’ve gained through my interactions with participating community members has been incredibly valuable.

A central focus of the CCC classes is raising awareness of the connection between high blood pressure and lifestyle, as well as increasing confidence in participants’ ability to improve their blood pressure through long-term behavior change. A common theme that I noticed was that many people were simply resigned to their diagnosis of HBP and did not think there was anything that they could reasonably do to return to healthy blood pressure levels. Discussing their high blood pressure and ways to manage it was a stressful and difficult topic for many people as they were simply overwhelmed with all of the things that it seemed they had to do in order to maintain a healthy lifestyle. In addition, all of our participants lived in communities where they faced a number of structural and environmental barriers to healthy living. Factors like unsafe sidewalks to walk and bike along and a lack of grocery stores with affordable fresh produce made it all the more difficult for them to maintain good nutrition and physical activity.

Thus, one of the goals of our blood pressure management strategy was to encourage our participants to take an active role in their wellness and create realistic goals for their health, specifically their blood pressure. Our curriculum was very focused on explaining the topics in an approachable and straightforward manner and centering our education within the context of our participants’ daily experiences. For example, telling someone to avoid foods high in fat is not particularly useful when the majority of their shopping is done at a convenience store that has very few low-fat options. Rather, we would attempt to provide achievable recommendations that could gradually push our participants towards a healthier diet. We might suggest steadily transitioning from whole milk to 2%, then 1%, then skim, or seeking out a nearby farmer’s market to pick up fruits for snacking instead of getting chips and crackers at the convenience store. By taking these minor steps on the path to wellness, we were able to build upon previous successes that we had and motivate our participants to truly take charge of their health by going to the gym on a daily basis and cooking their own meals regularly.

Another important aspect of CCC was its comprehensive scope and attention to other influences on blood pressure. We explored and discussed things like chronic stress, smoking, sleep, and even non-modifiable factors like age, race, and family history. By taking this multifaceted approach, we were able to help our participants understand their high blood pressure and the steps that they could take to lower it from a more holistic perspective. We also engaged with our participants multiple times per month over the course of four months. This longitudinal contact was essential in developing a strong relationship with participants and tracking their progress over the course of time. Interacting with our participants week after week certainly improved their motivation and increased the likelihood that the changes that we helped them make will be long-lasting.

As I am entering medical school this fall and embarking on my journey to become a physician, this experience proved to be an informative and formative one, especially with regards to the manner in which I hope to eventually practice medicine. I now truly understand the importance of immersing oneself in a patient’s environment and advising them from within the context of their lived experiences. To the average person, the medical world so often seems intimidating and detached from reality, and I aim to ensure that my patients never have that experience with me. My time with Check. Change. Control, and my time with the National Health Corps as a whole, has been incredibly enlightening, and I hope to use the lessons that I have learned this year throughout the rest of my career.


This post was written by NPHC member Dhruv Kohli.

Dhruv serves at ACHD Chronic Disease Prevention as an Outreach Coordinator.