Carol Mohr attends Capital University where she is getting her BSN. 

In the climactic scene of the movie “The Silence of the Lambs,” FBI agent Clarice Starling is groping in the pitch-black basement while the mad killer watches her with night vision goggles, his gun trained on her every move. This scene cannot fail to get your attention. Hypertension, while just as deadly, does not have 1 out of every 3 Americans acting with laser sharp focus on everything they need to do to beat this deadly disease; yet that is how many people are afflicted with hypertension, according to the American Heart Association (2013).

Hypertension is called the silent killer. This disease does a lot of systemic damage, but does not have localized pain that would lead a person to act. Hypertension causes damage to arteries and veins. It predisposes the patient to diabetes, retinopathy, and nephropathy. Whereas nurses have this knowledge, those with undiagnosed hypertension generally have no idea of the irreversible changes occurring in their bodies. Health coaching is a possible approach to address patient compliance with treatment once hypertension has been identified.

There are many reasons for patient non-adherence to anti-HT medication regimens. (1) The first reason could be that patients may no longer feel any symptoms, so they discontinue their medication, thinking they are “cured.” (2) Another reason could be that they think the medication is not accomplishing anything. (3) A third reason could be that patients do not think HT is such a big deal, since it appears to be so widespread. (4) A fourth reason could be that the action of the multiple different medications is not understood by the patient. Health coaching can help with patient compliance, no matter what the specific reason for non-adherence.

Leung et al. (2012) explored the use of health coaches to increase prescribed medication adherence by patients diagnosed with hypertension. This intervention has been shown to be effective for diabetic patients. This study used volunteer students training to be nurses, doctors, and pharmacists as health coaches. There was a positive reaction to the coaches from those who were patients in the trial. They reported that they felt the counselor “understood how I feel about having hypertension” (85.6% of respondents said either “very much” or “somewhat” agree). More significantly, all participants agreed either very much or somewhat with the statements “Talking to my counselor made me feel more confident that I can improve my hypertension” and “The counselor made me feel like I am able to make changes to my hypertension.” It seems that the coaching, even by relatively novice providers, is likely to help bring patients into compliance in their hypertension treatment.

Think back to the scene with Agent Clarice Starling. With night-vision goggles, all of the danger is apparent; having regular calls by health coaches is like giving the patients a way to see their silent killer, and know the ways to stop the destruction that HT is doing to their bodies. The health coaches in Leung et al. asked for patients to share their BP records. This reinforced that taking BP measurements is important, and that treatment of HT should have an effect on BP. For patients who thought they were “cured” and no longer had to take their meds [reason (1)], these telephone calls help reinforce that treatment will be lifelong. Patients who are seeing a change in their BP with adherence to meds have someone to confirm the cause and effect relationship [reason (2)]. Patients who think that HT is widespread and therefore innocuous get the counseling from outside this limited experience, and they get knowledge reinforcement of the serious and life-shortening consequences of HT [reason (3)]. Finally, the numerous and confusing multiple medications that HT patients are prescribed can be overwhelming. Continued calls from a health coach can provide support and understanding of the purpose of these medications [reason (4)].

In my opinion, the nurse has a clear role in patient education on the effects of hypertension. While as a student I still have an imperfect understanding of hypertension medications, I am slowly gaining in my knowledge. I am certainly able to meet patients where they are and discuss their individual meds and the reason for each one. Of the Americans with HT, 47.5% do not have it under control; HT was listed as the primary or contributing cause of death for 348,102 Americans in 2009 (American Heart Association). Every time the patient has a teachable moment with a nurse could be the opportunity to move them into the category of “under control” HT. Which can stop the silent killer.

As a new graduate nurse, the information I learned from Leung et al. will help me own my sense of agency. While I see patients with HT every time I am in the clinical setting, it may be the first time for that patient to have a medical professional sit down with them and listen to their concerns or reasons for not being compliant with their medications. I will be able to be an educator for them, because I know that knowledge of HT is the one best hope to save their lives. I am the best avenue for them to see their silent killer, and to know that their medications are their best tool to stay alive and well.


American Heart Association. (2013). Statistical fact sheet; 2013 update [website].

Leung, L. B., Busch, A. M., Nottage, S. L., Arellano, N., Glieverman, E., Busch, N. J., & Smith, S. R. (2012). Approach to antihypertensive adherence: A feasibility study on the use of student health coaches for uninsured hypertensive adults. Behavioral Medicine, 38, 19-27.