It Takes a Team to Beat High Blood Pressure

Hypertension control may work best if healthcare providers and patients work together

(RxWiki News) It's not always easy for people to control high blood pressure on their own. According to a new science advisory, a collaborative approach may lead to better blood pressure control.

The National Institutes of Health estimates that one in three US adults has high blood pressure (hypertension), which can lead to heart disease, heart failure, stroke and kidney failure. Those who have the condition often don’t know it, and rates of uncontrolled high blood pressure continue to rise despite availability of proven treatments.

The new science advisory from the American Heart Association, the American College of Cardiology and the Centers for Disease Control and Prevention recommends a team-based approach to effectively combat hypertension.

"Check your blood pressure regularly."

Alan Go, MD, director of the Comprehensive Clinical Research Unit at Kaiser Permanente Northern California, served as lead author of this advisory.

Dr. Go and colleagues reported that nearly 78 million adults in the US have high blood pressure. High blood pressure is defined as a measure of 140/90 millimeters of mercury or higher.

Systolic pressure (the top number) is the measurement of maximum force of the blood in the arteries as opposed to diastolic (the lower number), which is the pressure measurement when the heart is relaxed. The American Heart Association defines normal blood pressure as less than 120 for systolic and less than 80 for diastolic.

From their review of data from the National Health and Nutrition Evaluation Survey (NHANES) in 2007-2010, they observed that 81.5 percent of those with hypertension were aware they had it. While three out of four with high blood pressure were being treated for it, just over half actually had it under control.

Those who had uncontrolled blood pressure did not lack health care, according to the authors. Almost 90 percent of those who did not have their blood pressure under control reported having a usual source of health care, and 85 percent reported having health insurance.

“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 Dr. Go in a press release.

The advisory urges healthcare systems, healthcare providers and patients to work more closely together. The statement suggests that parties come together to prioritize treatment for patients with high blood pressure who are receiving treatment but haven’t achieved their target blood pressure.

Efforts to educate patients and providers have not been enough to bring hypertension under control, according to researchers.

The report highlighted programs that have successfully helped patients reach target blood pressure levels, and recommended eight principles for developing an effective high blood pressure treatment algorithm (step-by-step procedures):

  • Base the components and processes on the best available science.
  • Format the algorithm in a manner that is simple to update as new evidence becomes available.
  • Use a feasible, simple implementation strategy.
  • Include a patient version at appropriate scientific and language literacy level.
  • Consider costs of diagnosis, monitoring and treatment.
  • Use a format easily incorporated within a team approach to health care.
  • Use a format able to be incorporated into electronic health records for clinical decision support.
  • Include a disclaimer to ensure that the algorithm is not used to counter the treating healthcare provider’s best clinical judgment.

The authors said that there are several effective step-by-step procedures available to the public, including one from the Million Hearts Web initiative.

Million Hearts provides a flow chart on how to make decisions regarding lifestyle modifications and medications based on blood pressure readings.

Lifestyle modifications may include maintaining normal body weight; consuming a diet rich in fruits, vegetables and low-fat dairy products; reducing sodium intake; engaging in regular aerobic exercise; and limiting alcohol consumption to no more than two drinks a day for men and one drink a day for women.

“Arming healthcare providers, health systems, and communities with proven tools, algorithms, strategies, programs, and other best practices, along with expertise and technical assistance for improving blood pressure awareness, treatment and control is essential to reducing the tremendous burden of cardiovascular risk,” wrote the advisory authors.

The full text of the report, “An Effective Approach to High Blood Pressure Control," was published online in mid November and is available on the American Heart Association website.

Review Date: 
November 16, 2013