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‘Hypertension’ doesn’t mean ‘too much tension’

Not everyone understands what “hypertension” means, and as a result, some patients may not take their blood pressure medications as directed or manage lifestyle factors effectively, a new paper suggests.
More than half of people with high blood pressure do not have the condition well controlled, which may in part be because patients often believe hypertension means “too much tension,” or too much stress, the authors write.
In fact, hypertension refers to high blood pressure, which happens when the force of the blood pumping through arteries is too strong. Chronic high blood pressure, which affects one in three US adults, can strain the heart, damage blood vessels, and increase the risk of heart attack, stroke, kidney problems, and death, according to the National Institutes of Health.
Patients who misunderstand the term hypertension may turn to stress management to control their high blood pressure, which they view as a psychological condition more than as a physiological one, according to a perspectives article by Barbara G. Bokhour and Nancy R. Kressin of Boston University School of Public Health in the journal Circulation: Cardiovascular Quality and Outcomes.
These patients may focus more on stress management instead of taking effective blood pressure medications, like diuretics, calcium-channel blockers or ACE inhibitors.
“It’s always good to manage stress, that’s always good for your health writ large, but for hypertension in particular stress management will not be enough,” Bokhour told Reuters Health by phone.
Lifestyle management and taking prescribed medications are much more important for controlling blood pressure, she said.
Providers often use the term hypertension and don’t always explicitly link it to blood pressure, she said.
“They are using the words interchangeably, but patients do not always understand that they are interchangeable,” Bokhour said.
She and Kressin suggest that doctors should exclusively use the term “high blood pressure” rather than hypertension when talking to patients.
“I tend to agree with the authors' suggestion,” said Dominick Frosch of the David Geffen School of Medicine at UCLA, who has also studied common beliefs about high blood pressure and their effects on medication use.
His own study found that patients who were told about “hypertension” were more likely to think that relaxing more would be an effective treatment, compared to patients who were told about the same condition under the name “Korotkoff syndrome.” But regardless of label, patients still believed that evidence-based medications would be more effective than relaxing more, Frosch noted.
“A substantial proportion of individuals who have high blood pressure inadequately control it, contributing to avoidable cardiovascular disease risk as well as kidney disease risk,” he told Reuters Health by email.
“If we want our healthcare system to be patient-centered, why would we use ambiguous, potentially misleading language, when we can just as well avoid it,” he said. “Tradition and habit are not good justifications, in my view.”
Patients may also be reluctant to take their medications regularly because in many cases high blood pressure does not cause symptoms, so they do not feel like they need medication, Bokhour said.
Doctors should first ask patients what they understand about high blood pressure, then have a conversation clarifying any misunderstandings, she said.
“Oftentimes providers give information in a very rapid format, using biomedical language,” which is true for other conditions as well, not just high blood pressure, she said.
“Hypertension is one of many, many examples where providers have an understanding of a word and patients do not, and if we don’t start to bridge that gap we’ll continue to over-treat and under-treat,” she said.

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