From the Guidelines
Managing hypertension in homeless individuals requires a practical approach that prioritizes lifestyle interventions and medication adherence, with a focus on reducing morbidity, mortality, and improving quality of life. When managing hypertension in the homeless and unhoused, it is essential to consider the unique challenges they face, including unstable living conditions, limited resources, and competing priorities.
- The most recent and highest quality study, 1, recommends lifestyle intervention consisting of weight loss when indicated, a Dietary Approaches to Stop Hypertension (DASH)–style eating pattern, moderation of alcohol intake, smoking cessation, and increased physical activity for people with blood pressure >120/80 mmHg.
- Medication management should include long-acting, once-daily options that don't require refrigeration or multiple daily doses, such as amlodipine (5-10 mg daily), chlorthalidone (12.5-25 mg daily), or lisinopril (10-40 mg daily), as suggested by the example answer.
- Providing at least a 90-day supply of medication when feasible and connecting patients with pharmacy assistance programs or federally qualified health centers for affordable medication access can help improve medication adherence.
- Blood pressure monitoring can be facilitated through community health workers, street medicine teams, or by encouraging patients to use free blood pressure machines at pharmacies.
- Diet modifications should be realistic, such as suggesting reduced sodium intake through avoiding canned foods when possible and choosing lower-sodium options at soup kitchens or food pantries.
- Emphasizing the importance of medication adherence, even when symptoms aren't present, is crucial, as hypertension is largely asymptomatic until complications occur.
- Establishing a consistent follow-up system, potentially through community outreach workers or at regular locations like shelters or meal sites, can help ensure ongoing care and support. This approach acknowledges the reality that traditional hypertension management must be adapted to accommodate the unstable living conditions, limited resources, and competing priorities that homeless patients face daily, and is supported by studies such as 1 and 1.
From the Research
Managing Hypertension in the Homeless and Unhoused
- Hypertension is a significant health issue among the homeless population, with studies indicating a high prevalence of uncontrolled hypertension 2, 3, 4.
- The material conditions of homelessness, such as lack of access to healthcare, medication, and social support, complicate the management of hypertension 2.
- Research has shown that homeless individuals with hypertension often have limited access to healthcare services, and those who do receive care may experience poor health outcomes due to inadequate management of their condition 3, 5.
Barriers to Hypertension Management
- Lack of insurance is a significant barrier to blood pressure control among homeless individuals with hypertension 3.
- Social factors, such as smoking and alcohol abuse, can also impact blood pressure control in this population 2, 3.
- The high rate of uncontrolled hypertension among homeless adults is alarming, and comprehensive approaches are needed to improve social support, access to medical insurance, and medication adherence 3.
Effective Interventions
- Interprofessional education community-based health fairs have been shown to be effective in educating homeless individuals about hypertension and providing health screenings 4.
- Clinical pharmacy services have also been found to improve health outcomes and medication adherence concerning hypertension and diabetes in the homeless population 5.
- The use of antihypertensive therapies, such as angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and calcium antagonists, may be effective in managing hypertension in this population, but more research is needed to determine the best treatment approaches 6.