Blog | Monday, November 18, 2013

QD: News Every Day--Team-based approaches needed to fight high blood pressure


Collaborative approaches can be effective in handling uncontrolled high blood pressure rates that are prevalent despite proven treatments, according to a science advisory from the American Heart Association, the American College of Cardiology and the Centers for Disease Control and Prevention.

“Despite access to health care, effective therapies that have been available for 50 years, and various education and quality improvement efforts that have been targeted at patients and health care providers, achieving success in hypertension control is still a challenge,” said Alan S. Go, MD, ACP Member, Director of the Comprehensive Clinical Research Unit at Kaiser Permanente Northern California and lead author of the advisory.

The advisory recommends that health care, industry and communities prioritize people with high blood pressure who are receiving treatment but haven’t achieved their target blood pressure. The writing group members noted that of those with uncontrolled hypertension, nearly 90% see a health care provider regularly, and 85% have health insurance.

The report, “An Effective Approach to High Blood Pressure Control,” is online at the ACC website and AHA website, and will appear in print editions of the Journal of the American College of Cardiology and Hypertension.

According to the advisory, educating patients and providers hasn’t been enough and interventions targeting only physicians have not led to sufficiently consistent and meaningful improvements.

“The tools to control blood pressure have long been available, but hypertension control requires patient and physician involvement within a supportive system,” said John G. Harold, MD, MACP, president of the American College of Cardiology. “We are advocating a team approach that reduces barriers for patients and leverages the power of electronic health records to improve cardiovascular health.”

The advisory also provides examples of successful programs that could be emulated. One is a Kaiser Permanente program that increased the proportion of its patients with hypertension with well-controlled blood pressure from 44% in 2001 to more than 87% in 2011. The program focused on 5 main elements: creating a system-wide hypertension registry, providing regular feedback on hypertension control rates to providers, implementing and frequently updating an evidence-based treatment algorithm, using single-pill combination therapies and using medical assistants for follow-up blood pressure checks in order to help patients receive necessary treatment adjustments efficiently. Lifestyle changes for patients were strongly recommended as well.

The advisory provides 8 principles for developing an effective high blood pressure treatment algorithm (and uses them to provide a usable example of such an algorithm):
1. Base the components and processes on the best available science;
2. Format the algorithm in a manner that is simple to update as new evidence becomes available;
3. Use a feasible, simple implementation strategy;
4. Include a patient version at appropriate scientific and language literacy level;
5. Consider costs of diagnosis, monitoring and treatment;
6. Use a format easily incorporated within a team approach to health care;
7. Use a format able to be incorporated into electronic health records for clinical decision support; and
8. Include a disclaimer to ensure that the algorithm is not used to counter the treating health care provider’s best clinical judgment.

Several existing algorithms for hypertension treatment in large health care settings are available for public use in the resources and tools section of the Million Hearts initiative website.