Preliminary Care Coordination Plan for Hypertension


Hypertension belongs among the most common undesired conditions associated with heart diseases. It can affect people of any age; however, it is especially dangerous for older adults regardless of their health status (Benetoset et al., 2019). Generally, poorly treated hypertension is a frequent cause of life-threatening comorbidities and exacerbations, including arterial damage and poor blood flow (Benetos et al., 2019). In the case of people older than 65, chronic hypertension presents a risk factor for the occurrence of cognitive declines, partial or total losses of autonomy, and cardiovascular diseases (Benetos et al., 2019). Consequently, the issue has to be addressed from as many angles as possible, including its physical, psychosocial, and cultural considerations. In addition, to ensure an effective continuum of care, available community resources should be identified and allocated.

Physical Considerations

Physical exercises are a valuable asset in reducing hypertension prevalence and increasing control over it. According to recent studies, antihypertensive therapy in the form of habitual physical activity does provide significant benefits to societal public health (Pescatello et al., 2019). In particular, there is strong evidence of physical exercise reduces blood pressure among people with normal levels, prehypertension, and hypertension (Pescatello et al., 2019). Moreover, the blood pressure reduction was the smallest for the former and the strongest for the latter (5 times difference). Such a ratio allows for equalizing the blood pressure of people with hypertension to the normal one, which results in a significant decrease in the probability of possible coronary heart diseases and strokes. Types of physical activities can include aerobic, resistance exercise training, and isometric exercise training (Pescatello et al., 2019). However, their overall positive effect on blood pressure reduction proved to be the same.

Psychosocial Considerations

Psychosocial factors also contribute to the development of various undesired heart conditions, including hypertension. According to Albus et al. (2019), factors such as acute or chronic stress, depression or anxiety, and low socioeconomic status represent biological and behavioral risk factors and are highly prevalent among cardiac patients. It indicates their exposure to a higher risk of cardiovascular diseases and unfavorable illness development. Specifically, psychosocial factors such as loneliness, sleep disorders, and especially stress at work are the most impactful in the context of hypertension (Albus et al., 2019). Although they do not directly cause the illness, they foster an environment for health deprivations and exacerbations. For instance, working overtime and insomnia multiply the risk of hypertension occurrence by three times (Albus et al., 2019). There are specific ways and techniques for addressing patients’ psychosocial factors, such as yoga, autogenic training, and muscle relaxation. The study by Albus et al. (2019) provides evidence of the positive effect of relaxation techniques on blood pressure reduction. In addition, these techniques can provide sufficient improvement in patients’ quality of life.

Cultural Consideration

Cultural factors have an important role in illness prediction and prevalence in society. They provide a unique set of internal (genetics) and external (social and natural environments) population variables, reducing the extent of available treatments’ generalization. For instance, the study conducted by Bou Serhal et al. (2018) compared medication adherence in Lebanese people by a standard Morisky Medication Adherence Scale (MMAS – 8) and a newly developed Lebanese scale (LMAS – 14). According to Bou Serhal et al. (2018), MMAS does not consider psychological and cultural factors. For example, LMAS extended the MMAS questionnaire, inquiring about the frequency of the reminders. Due to social interactions assuming a privileged position in Lebanese society, the authors concluded that reminders might affect adherence rates (Bou Serhal et al., 2018). As a result, the latter proved to be a better hypertension control predictor for the Lebanese population.

Available Community Resources

The accessibility of available community resources might be crucial for people suffering from various illnesses, including hypertension. This topic resides between the clinical and patient sides of the treatment, which requires a proper community-clinical linkage. One such example is the community health workers (CHW) activity. According to Stupplebeen et al. (2019, p. 15), their job involves “serving as cultural mediators between patients and systems and providing culturally-appropriate health education, information, or direct services.” CHWs are instrumental in fostering and developing internal and external resources, such as exercise or education programs for hypertension patients. However, specific barriers limit service accessibility and hinder patient engagement. For instance, rural and urban settings have different needs, and, thus, available resources might vary (Stupplebeen et al., 2019). In addition, the lack of network interconnection can be an obstacle in CHW-CHW and CHW-community communications. Therefore, proper resource management with an emphasis on communication belongs among the key features of preliminary care coordination.


Overall, the issue of hypertension is a complex matter that requires a diversified approach. Thus, effective hypertension management and treatment should include its physical, psychosocial, and cultural aspects. Physical considerations imply controlling hypertension through specific physical therapies and exercises. In turn, psychosocial considerations require addressing the patients’ mental well-being and prevention of undesirable contributing factors. At the same time, acknowledging and utilizing cultural peculiarities will allow for a more robust disease prediction and timely responses. However, the clinical effort would not be as efficient without adequate community-clinical connections. These connections secure the availability and accessibility of various helpful resources for the patients to better cope with the treatment and increase their quality of life.


Albus, C., Waller, C., Fritzsche, K., Gunold, H., Haass, M., Hamann, B., Kindermann, I., Kollner, V., Leithauser, B., Marx, N., Meesmann, M., Michal, M., Ronel, J., Scherer, M., Schrader, V., Schwaab, B., Weber, C. S. & Herrmann-Lingen, C. (2019). Significance of psychosocial factors in cardiology: Update 2018. Clinical Research in Cardiology, 108(11), 1175-1196.

Benetos, A., Petrovic, M., & Strandberg, T. (2019). Hypertension management in older and frail older patients. Circulation Research, 124(7), 1045-1060.

Bou Serhal, R., Salameh, P., Wakim, N., Issa, C., Kassem, B., Abou Jaoude, L., & Saleh, N. (2018). A new Lebanese medication adherence scale: Validation in Lebanese hypertensive adults. International journal of hypertension, 2018.

Pescatello, L. S., Buchner, D. M., Jakicic, J. M., Powell, K. E., Kraus, W. E., Bloodgood, B., Campbell, W.W., Dietz, S., Dipietro, L., George, S. M., Macko, R. F., McTiernan, A., Pate, R. R. & Piercy, K. L. (2019). Physical activity to prevent and treat hypertension: A systematic review. Med Sci Sports Exerc, 51(6), 1314-1323.

Stupplebeen, D. A., Sentell, T. L., Pirkle, C. M., Juan, B., Barnett-Sherrill, A. T., Humphry, J. W., Yoshimura, S. R., Kiernan, J., Hartz, C. P. & Keliikoa, L. B. (2019). Community health workers in action: Community-clinical linkages for diabetes prevention and hypertension management at 3 community health centers. Hawai’i Journal of Medicine & Public Health, 78(6), 15-22.

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