Main-blog-page-header


​​LATEST POST




Comorbid High Blood Pressure in the Injured Individual: Part three

by
Clinical Connection team
| Oct 23, 2019

Injuries can often lead to comorbidity and complications that can lengthen the duration of treatment, delay return to work and increase costs. Hypertension, or high blood pressure, was the most prevalent comorbid condition in workers’ compensation according to a study published in 2012, and its frequency and costs have increased.1

  • Diagnoses of comorbid hypertension tripled from 2000 to 2009.1
  • Costs doubled compared to similar workers’ comp claims without comorbid hypertension.1

Hypertension is defined as a blood pressure reading of 130/80 millimeters of mercury (mm Hg) or higher based on an average of at least two elevated blood pressure readings on two separate occasions.2 This problem impacts nearly one in every three adults in the United States ― approximately 75 million people.3 And if left untreated, hypertension can lead to severe complications such as stroke, heart attacks, heart failure and kidney disease.

Injuries can contribute to hypertension
Injured individuals may be more likely to develop hypertension as a comorbidity, especially older adults. Lack of activity or mobility, stress, and poor diet management due to income reduction are likely contributing factors.

Hypertension can complicate the treatment of an injured person

  • Chronic hypertension can harden arteries, thereby reducing the flow of oxygen and nutrients to a wounded area and delaying healing.4
  • Uncontrolled high blood pressure among injured individuals requiring surgery and general anesthesia can potentially halt, interfere and delay needed treatment.4
  • Certain prescription medications used to treat an injured person can contribute to elevated blood pressure, such as: corticosteroids, non-steroidal anti-inflammatory drugs and antidepressants.4

Careful oversight of prescribed hypertension medications is critical to avoid adverse side effects
Some medications used for treating hypertension have potential to interact with medications commonly seen in workers’ compensation or auto claims.

Co-administered medication issue
Amlodipine, a medication routinely prescribed for high blood pressure, is classified as a calcium channel blocker and can increase the effects of an opioid, such as methadone, when used concurrently. When both medications are used together, there is an increased risk for respiratory depression and sedation because amlodipine can increase methadone exposure in the body.5,6

A solution to the co-administration of these medications is to reduce the dose of methadone or use an alternative antihypertensive medication.6

NSAID concerns
Similarly, NSAIDs (non-steroidal anti-inflammatory drugs) can interact with a class of antihypertensive medications known as Angiotensin-converting enzyme inhibitors (ACE inhibitors). NSAIDs can weaken the antihypertensive effects of ACE inhibitors and can cause severe renal damage in older adults when used concurrently.5,6

Certain NSAIDs, such as indomethacin, naproxen and piroxicam have a greater impact on elevating blood pressure in the presence of ACE inhibitors, whereas NSAIDs like sulindac and nabumetone have a lesser impact.5,6

Generally, NSAIDs should be avoided in older adults. But if simultaneous use is needed, blood pressure and renal function should be monitored throughout treatment. Clinicians can consider alternative pain treatment modalities if significant risk from the drug-drug interaction is present.

Early recognition of hypertension and a full clinical picture of the claimant can improve outcomes
Although many risk factors that contribute to developing hypertension are beyond control, prevention, early identification and holistic management can vastly benefit claimants and outcomes.

  • Lifestyle modifications, including diet and exercise, can reduce a systolic blood pressure by approximately 4 to 11 mm Hg.
  • Reducing salt intake, a diet rich in fruits, vegetables and whole grains, and decreasing alcohol consumption are beneficial ways to improve blood pressure control.
  • Encouraging blood pressure self-monitoring can improve self-awareness and aid in treating and managing hypertension.
  • Initiating blood pressure-lowering medications with favorable side effect profiles can be instrumental where medication intervention is warranted.7,8,9

Conclusion
Treatment of comorbid high blood pressure in an injured person requires a holistic view of the case and a multidisciplinary approach to treat and manage the comorbidity.

Hypertension often is not recognized because there are generally no signs or symptoms. Early identification, and consistent screening and monitoring of high blood pressure allow for the best possible outcome.

Check out parts one and two of our series on comorbid conditions in workers’ comp and auto no-fault, on our Clinical Connection page here.

Sources:

  1. https://www.ncci.com/Articles/Pages/II_research-brief-comorbidities-in-workers-compensation-2012.pdf
  2. https://www.ahajournals.org/doi/10.1161/HYP.0000000000000066
  3. https://www.cdc.gov/bloodpressure/index.htm
  4. https://labor.mo.gov/sites/labor/files/2017_DWC_Conf_Cormorbidities_Injured_Melander.pdf
  5. https://www.eshonline.org/esh-content/uploads/2014/12/17_Newsletter-Interactions-Between-Antihypertensive-Agents-and-Other-Drugs.pdf
  6. http://www.clinicalpharmacology-ip.com/Forms/Monograph/monograph.aspx?cpnum=350&sec=moninte&t=0
  7. https://professional.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_497445.pdf
  8. https://professional.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_497445.pdf
  9. https://www.heart.org/-/media/files/health-topics/high-blood-pressure/tylenol-hbp/aha19_tylenolbroch_web2.pdf?la=en&hash=C9F6152CC02E8C5A47F88C997C0664466DD540E7

Stay informed by receiving latest updates

Do you have a question about a blog post?