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Societies call for use of evidence-based algorithms to treat hypertension
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Evidence-based hypertension treatment algorithms should be used as part of the effort to improve BP control, according to a science advisory from the American College of Cardiology, the American Heart Association and the CDC.
“We believe that identification of best-practice, evidence-based management algorithms leading to standardization of treatment is a critical element in helping to achieve” the AHA goal of improving the CV health of all Americans by 20% and reducing the death rate from CVD and stroke by 20% by 2020, Alan S. Go, MD, of Kaiser Permanente Northern California and the University of California, San Francisco, and colleagues wrote. “The direct and indirect costs of hypertension are enormous.”
According to the advisory, efforts focused on patient and provider education have not been sufficient to meaningfully improve hypertension control, nor have interventions that target only physicians.
“To reduce the prevalence of hypertension in the United States, system-level approaches will be needed,” they wrote. One example cited was the Kaiser Permanente Northern California Cardiovascular Risk Reduction Program.
Such approaches include:
- Identifying all patients eligible for management.
- Monitoring at the practice and population levels.
- Increasing patient and provider awareness.
- Providing an effective diagnosis and treatment guideline.
- Systematic follow-up of patients to begin and intensify therapy.
- Clarifying roles of health care providers to implement a team approach.
- Reducing barriers for patients to receive and adhere to medications and to implement lifestyle modifications.
- Leveraging electronic medical-record systems to support each initiative.
The authors reviewed existing algorithms for hypertension treatment in large health care settings and developed an outline of one that “balances … the largest number of hypertensive patients with the flexibility and level of detail to support individualization of therapy.”
Among other things, the outline suggests when to recommend lifestyle modifications and when to recommend drugs, when to recheck and review readings, and when to refer a patient to a specialist.
For more information:
Go AS. Hypertension. 2013;doi: 10.1161/HYP.0000000000000003.
Go AS. J Am Coll Cardiol. 2013;doi: doi:10.1016/j.jacc.2013.11.007.
Disclosure: See the full statement for the writing group’s relevant financial disclosures.