In September 2011, the United Nations held a high-level meeting on the prevention and control of chronic non-communicable diseases with the participation of heads of state or government, proposing tasks and requirements to strengthen the prevention and control of non-communicable diseases (usually cardiovascular diseases, cancer, diabetes, and other common chronic diseases). Chronic diseases have become an important public health issue in China.
It is an important measure to improve the treatment rate and control rate of hypertension
Currently, cardiovascular diseases account for 41% of all deaths in China, with 3.5 million deaths per year, of which 70% of strokes and 50% of myocardial infarctions are related to hypertension. Lowering blood pressure levels in hypertensive patients can reduce the risk of stroke by 40% to 50% and myocardial infarction by 15% to 30%. Therefore, controlling hypertension is the entry point for cardiovascular disease prevention and treatment.
It is estimated that there are 266 million hypertensive patients in China in 2012, but the treatment rate and control rate are less than 40% and 10%, respectively, for various reasons. Surveys have shown that the one-year compliance with treatment for first-time hypertension is only 30%, which seriously affects the improvement of the treatment rate and blood pressure control rate of hypertension. Therefore, it is necessary to educate hypertensive patients and raise their awareness of the dangers of hypertension and the importance of long-term treatment, and hypertension patient education guidelines are important measures and boosters that will improve the treatment and control rates of hypertension.
Positively promote scientific health knowledge, resist pseudoscience, and clarify misconceptions about hypertension
Common misconceptions about hypertension abound, mainly: hypertension has no uncomfortable symptoms, so no antihypertensive medication can be used; medication is used according to the feeling, dizziness to take medication, no dizziness to stop medication; using food therapy or physical therapy equipment, not taking antihypertensive medication; think that medicine is three parts poison, unwilling to use long-term antihypertensive medication, etc. In response to the above misconceptions about hypertension, it is necessary to promote scientific knowledge of hypertension prevention and treatment.
Hypertension education needs to be standardized, and authoritative scientific guidance materials are needed
At present, the fragmentation and irregularity of health education in China can no longer meet the new requirements of hypertension prevention and treatment. There is an urgent need to develop national authoritative, scientific and practical hypertension education materials and a guiding document for medical personnel to carry out hypertension education – namely, the “China Hypertension Patient Education Guide”.
Guideline Development Process
Under the guidance of the Bureau of Disease Prevention and Control of the National Health and Family Planning Commission, the China Health Education Center, and the Chinese Society of Preventive Medicine, the Hypertension Alliance (China), the National Center for Cardiovascular Diseases, the Cardiovascular Disease Branch of the Chinese Medical Association, and the Hypertension Specialty Committee of the Chinese Medical Association jointly organized the development of the Guidelines. Several organizations, including the Chinese Medical Association General Practice Branch, the Chinese Medical Association Geriatrics Branch, the Chinese Society of Nutrition Clinical Nutrition Branch, and the Chinese Center for Disease Control and Prevention Chronic Disease Center, are collaborators.
A kick-off meeting was held in Xi’an on July 1, 2012, attended by leaders and experts from the Bureau of Disease Prevention and Control of the National Health and Family Planning Commission, the organizers and relevant societies. The framework for the preparation of the Guidelines was determined, and more than 20 experts from relevant fields (clinical, nutrition, exercise, health education, community, and management) wrote the first draft. Since then, several opinion solicitation meetings and high-level expert seminars attended by experts, primary care physicians, CDC and health education personnel were held in Shanghai, Hangzhou, Nanjing, Tianjin, Chengdu and Beijing, and valuable revisions to the Guidelines were proposed. The final draft of the Guidelines was held on April 19, 2013, and the consultation meeting with primary care physicians and media was held on June 19, 2013. The development and publication of the Guidelines is the result of the collective wisdom of the Guidelines Committee.
Responsibilities and content of patient education for medical staff
Educating patients with hypertension is the responsibility of medical professionals
Because hypertension is a chronic disease, once hypertension occurs, it requires lifelong management. Patients need to self-monitor and manage their blood pressure most of the time, except for a brief interaction with the doctor during the visit. It is the duty of medical personnel to strengthen health education for hypertensive patients, to guide them to gradually master the knowledge and skills of hypertension prevention and treatment, and to urge them to develop good medical compliance behavior, so as to consciously change poor lifestyles, control risk factors, improve treatment compliance, increase the rate of blood pressure reduction and reduce the occurrence of complications.
All types of medical personnel, including doctors, nurses, pharmacists, dieticians, public health personnel and health educators, have the responsibility to educate patients about hypertension according to their professional knowledge and according to local conditions. Most patients with hypertension are seen in primary medical institutions, and primary medical or health management institutions, including community health service centers (stations), health centers, village health clinics, health centers, and health education clinics, are the main battlefield of health education, and primary medical personnel are the main force of hypertension education.
Content of hypertension health education
The core of health education is behavioral intervention: for different target groups, provide corresponding health education content and behavioral guidance.
Hierarchical goal education: the overall goal of the health education program can be divided into different levels of small goals, setting each level goal as acceptable to patients and achievable through efforts, while the former level goal is necessary to achieve the latter level goal.
Methods of hypertension health education
Hospital health education
Outpatient education: When waiting for consultation, health education is carried out in the form of verbal explanation, bulletin boards, blackboards, pamphlets, radio, hospital video health education link system, video, electronic display, computer touch screen, multimedia projection, etc. Provide patients with health education prescriptions for self-care of hypertension during follow-up consultations. Tell patients what they should do to prepare before seeing a doctor. One-minute education: With the busy schedule and time constraints of physicians in large medical institutions, one-minute focused education can be provided to address the main issues of patients. Patients trust their doctors and can achieve good results.
Inpatient education: During hospitalization, more systematic and progressive education on hypertension prevention and treatment, skills and self-management can be provided. Patients should be discharged from the hospital with discharge education and follow-up visits.
Selection of educational content: The educational content should be decided according to the patient’s condition and learning ability. The educational content should be simple, important, useful, and can be repeated several times to deepen the patient’s impression or make them proficient in certain skills.
Key educational contents: drug application guidance (the usage and dosage of drugs used by patients, adverse drug reactions and precautions for drug use, etc.), lifestyle guidance (dietary guidance, helping patients to establish good habits, living a regular life, appropriate time and content to participate in physical activities), psychological guidance (introduction of knowledge about the disease, enhance confidence in overcoming the disease, release excessive worries, and return to the family and meeting as soon as possible in a comfortable mood). (introduce knowledge about the disease, enhance confidence in overcoming the disease, relieve excessive worries, and return to family and society as early as possible), functional exercise guidance (develop functional exercise plans and patiently demonstrate exercise methods)
Composition of education team: In order to ensure the development of standardized health education for hypertensive patients, it is appropriate to establish hypertension or cardiovascular professional health education and consultation positions, which can be filled by nurses with rich clinical and nursing experience.
Health education in the community and workplace
Carry out community surveys to discover the health problems of the community population and the main target population; determine health education strategies according to the characteristics of the community population; use various social resources to carry out health education activities in living, working and study places according to the characteristics of the population in different places.
Social Publicity and Education
Take advantage of holidays or special publicity days (National Hypertension Day, Chrysanthemum Day, etc.) to actively participate in or organize social publicity, education and consultation activities. Organize medical personnel of relevant disciplines to promote correct knowledge of hypertension prevention and treatment, answer patients’ confusion and treatment problems in hypertension prevention and treatment; distribute relevant publicity materials and self-testing tools for hypertension prevention and treatment (salt spoon, oil jug; scale, pedometer, etc.); set up a prevention and treatment skills guidance experience area (blood pressure measurement, healthy diet, appropriate exercise, etc.) to help patients master hypertension prevention and treatment skills.
Techniques of hypertension health education
Techniques of talking with patients: stand in the patient’s position, listen patiently to the patient’s narrative, pay attention to the patient’s reaction and emotion, and adopt an accepting attitude, that is, to help and guide, not to criticize or admonish. When talking with the patient, the tone should be pertinent, active and enthusiastic, the attitude should be amiable, and the expression should be commonplace so that it is easy to accept. To let the patient feel the sincerity of the educator. Master the timing of the talk and grasp the focus. Avoid immature suggestions or promises that may add to the patient’s psychological burden or lead to medical disputes.
The telephone follow-up is an open and extended form of health education, which is simple and easy to implement. It is low cost, convenient and effective. Techniques to improve the effectiveness of telephone follow-up: preparation; interrogation; guidance; language: try to use easy-to-understand language; protection: pay attention to self-protection, do not make a big package; reminder: make an appointment for the next telephone follow-up.
Basic knowledge of hypertension
How is blood pressure formed?
The alternating systole and diastole of the heart drives the continuous flow of blood within a closed circulatory system consisting of the heart and blood vessels. The pressure on the walls of the blood vessels as the blood flows through them is called blood pressure.
What is hypertension?
A systolic blood pressure ≥ 140 mmHg and/or a diastolic blood pressure ≥ 90 mmHg measured on three different days without antihypertensive medication is considered hypertension.
The cause of more than 90% of hypertension is still unknown and is called “primary hypertension”. If the high blood pressure is caused by certain diseases (such as kidney disease, primary aldosteronism, pheochromocytoma, etc.), it is called secondary hypertension. Secondary hypertension is poorly treated with medication and should be treated for the cause, which can be effectively reduced or even restored to normal.
The susceptibility to hypertension
The risk factors for hypertension are as follows: excessive salt consumption, overweight or obesity, long-term excessive alcohol consumption, lack of exercise, long-term mental stress, etc. There is a hereditary family history of hypertension, and men ≥ 55 years of age and women after menopause are prone to hypertension. Those who have one of the above risk factors are recommended to have their blood pressure measured every 6 months and change their poor lifestyle to prevent hypertension.
Prevalence of hypertension in China
The prevalence of hypertension among adults in China was only 5% in 1959, but rose to 19% in 2002, and it is estimated that the prevalence among people aged 15 years or older was 24% in 2012, with about 266 million hypertensive patients nationwide and an estimated 10 million new cases per year. It is evident that the prevalence of hypertension is increasing along with the aging and urbanization of the population and changes in lifestyle and diet structure. At the same time, it should be noted that hypertension is getting younger and younger, and the prevalence of hypertension in children and young adults is on the rise.
There are 290 million people suffering from cardiovascular and cerebrovascular diseases in China. Every year, about 3.5 million people die from cardiovascular diseases, accounting for the first cause of death (41%), and on average, one person dies from this disease every 10 seconds. More than half of cardiovascular deaths are related to hypertension.
How can hypertension be detected and diagnosed early?
Most people with hypertension usually do not feel any discomfort, and many patients do not even know that their blood pressure is high, but only find out that it is elevated during physical examinations or occasional blood pressure measurements. Blood pressure measurement is a simple and easy way to detect hypertension. Normal adults should have their blood pressure measured at least once every two years. The first blood pressure measurement system for people over 35 years of age is continuously implemented.
Risk factors for the development of hypertension
Primary hypertension is a “lifestyle disease”, and poor lifestyle and behavior are the main risk factors for the development of hypertension. 70% to 80% of hypertension is related to poor lifestyle and behavior. The main risk factors for the occurrence of hypertension in China include: high sodium and low potassium diet, overweight/obesity, long-term excessive alcohol consumption, long-term mental stress, and insufficient physical activity. Changes in poor lifestyle can be beneficial for both prevention and treatment of hypertension.
Hypertension is a common complication of stroke, heart disease, kidney disease, peripheral vascular disease, and fundus disease. 70% of strokes and 50% of myocardial infarctions are related to hypertension.
The complications of hypertension are “three highs”: high incidence, high death rate, and high disability rate, which seriously affect the quality of life and life expectancy; China is a high incidence of stroke; the number of hypertensive patients with stroke is five times higher than that of myocardial infarction; the main goal of treating hypertension in China is to prevent stroke, and lowering blood pressure level is the key to prevent stroke. The key to stroke prevention is to lower blood pressure levels. The higher the blood pressure, the longer the duration of the disease, and the more risk factors accompanying it, the more severe the damage to target organs and the greater the risk of developing cardiovascular disease.