August 20, 2013
Fewer than 50% of Americans with high blood pressure have their condition under control despite effective available treatments, but according to a new study published in the Journal of the American Medical Association, large-scale programs aimed at helping patients with hypertension can improve control by more than 80%. Experts say that the findings show that if the program was widely implemented, it could vastly improve this often poorly controlled disease.
"Hypertension affects 65 million adults in the U.S. (29%) and is a major contributor to cardiovascular disease,” wrote the researchers, led by Marc Jaffe, M.D., an internist at the Kaiser Permanente South San Francisco Medical Center. “Although effective therapies have been available for more than 50 years, fewer than half of Americans with hypertension had controlled blood pressure in 2001 to 2002. Many quality improvement strategies for control of hypertension exist. But until now, no successful, large-scale program sustained over a long period has been described.”
The researchers looked at more than 350,000 people with hypertension and followed them between 2001 and 2009. The patients were given a multifaceted approach to their high blood pressure, which included the sharing of performance metrics, medical assistant visits for regular blood pressure readings and combination drug therapy.
Throughout the study, blood pressure control improved from 43.6% in 2001 to 80.4% in 2009, compared to the national control rate, which improved from 55.4% to 64.1% over that same period.
"This is the first successful, large-scale program sustained over a long period of time," Dr. Jaffe said in a statement. "Following the study period, our hypertension control rates have continued to improve from nearly 84% in 2010 to 87% in 2011. This has huge implications for the health of our members because this success translates into reduced risk of stroke and heart disease."
Jeffrey Borer, M.D., chief of cardiovascular medicine at SUNY Downstate Medical Center in New York City, said this type of large-scale program could help increase control rates across the country.
“I have no doubt that the program is an effective way to lower blood pressure,” Dr. Borer said. “If it could be applied to a lot of people, then the outcomes would be even better. “
Hypertension is an extremely difficult disease to treat, Borer said, and the major reason is that not everyone responds to treatment.
“There’s a certain segment of the population, which may be as much as 15%, with drug-resistant hypertension,” he said. “They have a very hard time controlling the disease, if they even can.”
And even in people who do respond to treatment, getting them to take their medicine regularly has proven to be a big problem for doctors, Borer added.
“Treatment adherence is often poor for hypertension, mainly because of side effects, which include frequent urination, erectile dysfunction and weakness,” he said. “An additional problem is that doctors are giving drugs to people who usually feel well. Hypertension is an asymptomatic disease, so they question why they need to take the drug.”
One of the best ways to not only prevent hypertension but to help control it as well is to have your blood pressure taken often, Borer said.
"People often don’t go to their doctor and have their blood pressure checked annually," he said. "Many times they may not even know they have a problem."
In addition, exercising and eating a healthy diet can go a long way towards reducing your risk of high blood pressure and heart disease, said Andrea Frank, R.D., L.D.N., a registered dietitian at Mount Sinai Hospital in Chicago.
“Making a commitment to consume a diet that is rich in fruits, vegetables and whole grains and low in fat and sodium can make play a huge role in reducing or even preventing high blood pressure,” she said.
Cutting down on sodium is one of the best things you can do to reduce your risk of hypertension, said Kathryn Y. McMurry, M.S., a nutrition coordinator with the National Heart, Lung and Blood Institute.
“Consuming more fresh foods—vegetables, fruits, legumes, lean meats and fish and low-fat dairy products—and fewer foods that are processed will help decrease sodium intake,” McMurry said. “Eat more home-prepared foods where you have more control over sodium. And use herbs and spices to add flavor to foods instead of salt and ingredients high in sodium.”
Ultimately, Borer said that while the program is effective at helping to treat a difficult disease, there is nothing magical about it. It all comes down to monitoring high blood pressure effectively.
“There’s no question that if people are paying attention to their blood pressure, taking medication and getting screened regularly, control is going to improve,” he said.
By Amir Khan, Everyday Health Staff Writer