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Program tied to system-wide blood pressure benefits

By Genevra Pittman

NEW YORK (Reuters Health) - A comprehensive high blood pressure program at one California health system led to a near doubling in the proportion of patients who had their blood pressure under control, according to a new study.

After the program was launched at Kaiser Permanente Northern California in 2001, the share of people with hypertension whose most recent blood pressure reading was in line with guidelines went from 44 percent to 80 percent by 2009.

"I think there are many parts of this program that would likely be applicable in other primary care settings," Dr. Marc Jaffe, an endocrinologist at Kaiser Permanente South San Francisco Medical Center and the study's lead author, said.

About one in three U.S. adults has hypertension, according to the National Institutes of Health. The goal of treatment is to get blood pressure below 140/90 millimeters of mercury (mmHg).

Jaffe said that in the early 2000s, at Kaiser and elsewhere, "the hypertension control had a lot to be desired."

As part of a program to address that, Kaiser Permanente Northern California set up a registry of all hypertension patients covered by the health system.

Doctors were given regularly updated evidence-based guidelines on blood pressure medicines that included which drugs to try first and sequential treatment alternatives if the initial treatment didn't work. In 2005, a combination drug offered in a single pill was added to that list.

Starting in 2007, all patients were offered a follow-up visit with a medical assistant a few weeks after their medications were adjusted, with no co-pay.

The number of patients with a diagnosis of hypertension grew from about 350,000 to 653,000 during the study period.

The researchers found that while blood pressure control increased significantly in their health system over that span, national rates of control improved more slowly: from 55 percent in 2001 to 64 percent in 2009, according to findings published Tuesday in the Journal of the American Medical Association.

"Since the end of the study, the hypertension control rates (at Kaiser) have continued to improve," Jaffe told Reuters Health.

"And as of 2011, our control rates were as high as 87 percent."

Hypertension researcher Dr. Brent Egan, from the Greenville Health System in South Carolina, said one of the key elements of the Kaiser program is bringing patients back quickly after a change in medication - and at no cost - to see if the adjustment was helpful.

"At a lot of practices, that's not part of their standard care. Sometimes three months or more go by from changing medication to follow-up," Egan, who wasn't involved in the new study, told Reuters Health.

What's more, he added, "There's pretty good evidence that engaging a broader healthcare team is one of the more effective strategies for (achieving) blood pressure control."

Jaffe said it's hard to estimate just how much the program cost to implement, and a cost-benefit analysis was not one of the goals of the study. But he thinks the impact of improved blood pressure control has been widespread.

"During that same period of time in our organization, we observed a reduction in heart attacks by 24 percent … and fatal strokes dropping by 42 percent," Jaffe said.

"I believe that they're related."

Egan said he encourages patients to monitor their own blood pressure at home and report back to him. He said that encourages people to take their medication, and can signal when a change in regimen is needed.

"These are things individuals can do pretty much irrespective of what health system they're in," he said.

SOURCE: http://bit.ly/MvXYT6 Journal of the American Medical Association, online August 20, 2013.

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