Antihypertensive drugs have an important role in the treatment of malignant hypertension, secondary prevention of cardiovascular disease, and primary prevention for people at high risk: those with moderate to severe hypertension (≥160/100 mm Hg), diabetes, or chronic kidney disease. Debate continues, however, about the level at which treatment should begin and the appropriate targets for treatment. The greatest uncertainty surrounds mild hypertension (140-159/90-99 mm Hg), which accounts for over 60% of those with hypertension or 22% of the global adult population. Evidence suggests no net benefit from drug treatment of mild hypertension in people without the higher risks of diabetes or chronic kidney disease. Nevertheless, most people with mild hypertension are treated with drugs. In this article, we examine the overdiagnosis and overtreatment of mild hypertension.

Background: Currently, the timing and variety of health education topics that are covered during prenatal visits are decided upon by the individual physician caring for the patient. Consequently, some patients do not gain exposure to important subject matter that could potentially improve their satisfaction and pregnancy outcomes. Previously reported studies have found evidence that improved patient education may increase rates of breastfeeding (as well as duration), seat belt use during pregnancy, and decrease preterm low birth weight infants. In addition, one study has shown that when prenatal visits are targeted to specific objectives, the number of prenatal visits can be decreased without negatively affecting pregnancy outcomes. Objectives: The objectives of this study were to evaluate if prenatal patient satisfaction and knowledge about pregnancy improves if a structured prenatal education plan is implemented throughout a family medicine health center. Also, we sought to evaluate if a structured prenatal education plan for expectant mothers will improve specific clinical outcomes. Methods: Focus groups were held in which prenatal patients were asked about their level of satisfaction with current prenatal care practices at the Hahnemann Family Health Center. Advice for improvement was also elicited. The data gathered from the focus group, the input of physicians at the health center, and information gathered from a review of current prenatal education materials around the country was used to create a new prenatal health education plan. In addition, data collection tools (three surveys) were specifically created for this study (partially based on previously validated tools). Surveys were specific for the first trimester, third trimester, and postnatal period. Currently in year one, pregnant women have been, and will continue to be, surveyed regarding their prenatal knowledge and satisfaction given the current state of prenatal care at the health center. During this year approximately 50 patients in their first trimester will be enrolled and surveyed throughout the pre and postnatal period. At the beginning of year two, the new prenatal education plan will be implemented. A new cohort of about 50 patients at the health center, who receive the new prenatal health education, will be assessed on their level of prenatal knowledge and satisfaction using the same survey tools. Knowledge/satisfaction will be compared between the two groups. In addition, clinical measures (such as number of phone calls regarding prenatal issues between scheduled visits, number of trips to the emergency room, preterm labor, smoking cessation rates, and breast feeding) will be compared, via a chart review, between the two groups. Results: Focus groups, with women who currently receive prenatal care at the health center, revealed that women were inconsistently counseled about ways to combat stress during pregnancy, expectations for the mother and baby while in the hospital during labor and delivery, the reason the health center collects a urine sample during each prenatal visit, as well as dental care and preterm labor precautions. In addition, at least one woman reported never discussing with her physician topics such as nutrition during pregnancy, weight gain, breastfeeding, stages of pregnancy, and development of the baby. Initial survey results indicate that women in their first trimester of pregnancy most often feel they have “some knowledge” about pregnancy and prenatal-related issues but patients vary widely on their confidence in making decisions regarding basic pregnancy issues without having to talk to a doctor. About 50% believe they have added stress in their life due to pregnancy. Worries regarding pregnancy and child care topics vary widely. About 78% of the time, women answered knowledge-based questions concerning pregnancy-related topics correctly. Conclusion: Initial results indicate that there are currently gaps in prenatal education and knowledge throughout prenatal care at the health center. Based on our findings and those of previously published studies, it can be hypothesized that by closing these gaps, as with a structured health education plan, clinical outcomes will improve. We will be better able to assess this hypothesis after year two of this study. While patient satisfaction cannot be assessed at this time, our early survey results indicate that first trimester women seem to subjectively and objectively have some accurate prenatal knowledge.