Care of a Patient with Hypertension by a Health Worker

Introduction

Objectives of care

1. Maintain blood pressure within the prescribed target.
2. Prevent complications and target-organ damage.
3. Promote healthy lifestyle habits.
4. Ensure regular use of prescribed medicines.
5. Identify danger signs and arrange timely referral.
6. Support the patient and family for long-term care.

1. Assessment of the patient

A. Measure blood pressure correctly

• Allow the patient to rest quietly for at least 5 minutes.
• Explain the procedure and keep the patient relaxed.
• Ensure the patient has not recently smoked, consumed caffeine, exercised, or eaten a heavy meal.
• Seat the patient with back supported, feet flat on the floor, and arm supported at heart level.
• Use the correct-size cuff.
• Record systolic and diastolic BP, arm used, position, date, and time.
• Repeat the reading if it is high, according to local protocol.
• Encourage home BP monitoring if a validated device is available.

B. Assess symptoms and risk factors

• Headache, dizziness, blurred vision
• Chest pain, breathlessness, palpitations
• Weakness of one side of the body, slurred speech, confusion
• Reduced urine output or swelling of feet
• Fatigue and sleep problems

• Family history of hypertension
• High-salt diet, obesity, lack of exercise
• Smoking, alcohol intake, stress
• Diabetes, kidney disease, high cholesterol, heart disease
• Use of medicines that may raise BP, such as some painkillers, decongestants, oral contraceptives, stimulants, and herbal preparations.

C. Basic physical observation

• Check weight, body mass index if possible, and waist circumference.
• Observe for pedal edema, breathlessness, and signs of poor circulation.
• Check pulse and, where available, urine sugar/protein and blood glucose.
• Review prescribed medicines, dose, timing, missed doses, and side effects.

2. Health education and lifestyle modification

A. Dietary advice

• Reduce salt intake. Avoid adding table salt and limit salty foods such as pickles, papad, chips, salted snacks, processed meats, instant foods, and packaged soups.
• Encourage a balanced diet rich in vegetables, fruits, pulses, whole grains, and low-fat foods.
• Reduce saturated fats, fried foods, excess sugar, and refined foods.
• Encourage adequate water intake unless fluid restriction has been prescribed for heart or kidney disease.
• Advise gradual weight reduction if the patient is overweight or obese.

B. Physical activity

• Encourage regular activity such as brisk walking, cycling, gardening, or swimming.
• Aim for about 30 minutes of moderate activity on most days, if medically suitable.
• Begin slowly in older persons or those with heart symptoms.
• Avoid sudden strenuous exercise without medical advice.

C. Avoid harmful habits

• Advise complete cessation of smoking and tobacco use.
• Avoid or limit alcohol as advised by the clinician.
• Limit excess tea, coffee, energy drinks, and caffeine.
• Avoid self-medication, especially over-the-counter painkillers and decongestants.

D. Stress and sleep management

• Teach relaxation methods: deep breathing, yoga, meditation, prayer, or regular leisure activity.
• Encourage adequate sleep and a regular sleep routine.
• Identify social or financial stressors and involve family or community support where possible.

3. Medication care

Responsibilities

• Explain the name, dose, time, and purpose of each prescribed drug.
• Instruct the patient to take medicine daily at the same time.
• Do not advise stopping medicine when BP becomes normal. Normal BP may be due to the treatment.
• Do not change the dose or give another person's medicine.
• Ask about missed doses and identify barriers such as cost, forgetfulness, side effects, or misunderstanding.
• Suggest practical methods: pill box, calendar, alarm reminder, family supervision, and linking medicine to a daily routine.
• Observe for adverse effects and report them to the medical officer.

4. Monitoring and follow-up

• Maintain a BP record or hypertension card for each patient.
• Record BP, pulse, body weight, symptoms, medicines taken, side effects, and advice given.
• Ensure the patient attends scheduled follow-up visits.
• Check whether BP is controlled and whether medicines are being taken regularly.
• Reinforce diet, exercise, tobacco cessation, and stress-control advice at every visit.
• Encourage laboratory tests and specialist reviews ordered by the clinician, such as blood sugar, lipid profile, kidney-function tests, urine examination, ECG, and eye examination.
• Involve family members because family support improves adherence to lifestyle and medication plans.

5. Prevention of complications

• Brain: stroke, paralysis, confusion
• Heart: angina, heart attack, heart failure
• Kidneys: chronic kidney disease
• Eyes: visual impairment
• Blood vessels: peripheral vascular disease

6. Danger signs requiring urgent referral

• Severe headache, confusion, fainting, seizures, or altered consciousness
• Sudden weakness/numbness of face, arm, or leg
• Difficulty speaking or sudden loss of balance
• Chest pain, severe breathlessness, or palpitations with weakness
• Blurred vision or sudden loss of vision
• Severe vomiting
• Very low urine output or severe swelling
• Pregnancy with high BP, headache, visual symptoms, upper abdominal pain, or swelling
• Persistently very high BP on repeat measurement, especially with symptoms

7. Role of the health worker

1. Screen adults regularly for raised BP.
2. Measure and document BP accurately.
3. Identify high-risk persons and refer for confirmation and treatment.
4. Provide individualized education on diet, activity, tobacco cessation, and stress reduction.
5. Promote medication adherence and identify side effects.
6. Conduct home visits or phone follow-up for patients who miss appointments.
7. Involve family members in care.
8. Keep proper records and refer patients with uncontrolled BP or complications.
9. Support community awareness programmes on hypertension prevention.
10. Maintain confidentiality, respect, and a non-judgmental attitude.

Conclusion