Doctors, other healthcare providers and hospitals need to collaborate on programs that help patients control high blood pressure, which is on the rise despite proven treatments being available, according to a new science advisory from the American Heart Association, 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 healthcare providers, achieving success in hypertension control is still a challenge,” said Alan S. Go, M.D., Director of the Comprehensive Clinical Research Unit at Kaiser Permanente Northern California and the advisory’s lead author.
High blood pressure – 140/90 millimeters of mercury or above – affects about one in three Americans and is a major risk factor for heart disease and stroke. Of those who have high blood pressure, also called hypertension, about 75 percent are being treated but only half have it controlled to a healthy level, according to national surveys.
Patients being treated, but still not reaching their target blood pressure should be a priority for collaborative programs, according to the advisory, which reported that 90 percent of people with uncontrolled blood pressure get regular healthcare and 85 percent have health insurance.
So what works? Doctors and patients working together.
“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, M.D., MACC, 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 cites a healthcare system that increased the percentage of people with controlled hypertension from 44 percent to more than 87 percent over 10 years. It strongly encouraged lifestyle changes, improved tracking of patient information, simplified drug therapies, made in-office blood pressure checks more accessible, provided doctors more feedback and overall, treated patients according to scientific evidence.
This program followed many of the eight principles that the advisory recommends that healthcare providers follow to improve the treatment of high blood pressure, which also includes cost considerations, simple approaches and the use of information that’s easy for patients to understand.
“The message for large and small practices and systems is: ‘Use an approach that includes an evidence-based treatment algorithm and you can improve blood pressure control for your patients,’” said CDC Director Tom Frieden, M.D., M.P.H. “Pick from any one of a number of available protocols, or develop your own—just use an evidence-based one.”
Eight principles for what makes an effective, systemic and team-based high blood pressure treatment formula for the healthcare setting:
- Basing the components and processes on the best available science.
- Formatting the algorithm in a manner that is simple to update as new evidence becomes available.
- Using a feasible, simple implementation strategy.
- Including a patient version at appropriate scientific and language literacy level.
- Considering costs of diagnosis, monitoring, and treatment.
- Using a format easily incorporated within a team approach to health care.
- Using a format able to be incorporated into electronic health records for clinical decision support.
- Including a disclaimer to ensure that the algorithm is not used to counter the treating healthcare provider’s best clinical judgment.