For Many People, Lowering Blood Pressure Will Take A Village
There are 78 million people in the United States with high blood pressure, and half of them don't have it under control.
Hypertension remains a difficult problem to solve, despite decades of persuading and prodding from doctors and health authorities.
So it may be time to try a different tack, one that involves giving people more support and less badgering, according to the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention.
Think of it as the "it takes a village" approach to high blood pressure.
Rather than approaching blood pressure control as a task just for doctor and patient, the plan is to bring in many more players, including insurers, pharmacists, community organizations and family members.
"It's not just about an individual patient or an individual doctor or provider," says Dr. Alan Go, the lead author of the advisory and director of clinical research at Kaiser Permanente. Think of a road map for helping people throughout the community.
There's good reason to try harder. High blood pressure is a major cause of stroke and heart disease, so increasing the number of people who lower their blood pressure even slightly would have huge health benefits overall.
Over the past decade Kaiser has tried to do just that. In 2001, just 44 percent of Kaiser patients in Northern California had their blood pressure under control.
So the health system decided to try five things: create an electronic registry of patients with hypertension; use that registry to alert doctors when they have patients with out-of-control blood pressure; write guidelines that make it easy for doctors to tailor treatment for a patient; get medical assistants to help patients monitor their blood pressure; and put multiple drugs in a single pill, so it's easy to remember.
It worked. From 2001 to 2011, Kaiser increased the number of patients meeting blood pressure goals from 44 percent to 87 percent.
But exporting Kaiser's success to the rest of America won't be easy. Kaiser is both a provider of health care and the insurer paying the bill. It's also huge! The organization can standardize care for millions of people.
Most Americans still get their health care from individual doctors or small clinics, many of which are just starting to adopt electronic medical records and other tools key to the Kaiser effort.
"You need the system to cooperate with you," says Dr. Willie Lawrence, a cardiologist in Kansas City, Mo., and a spokesman for the American Heart Association. For starters, he'd like to see insurers get rid of copays for hypertension visits.
"If I want to manage someone's hypertension, it could take three, four, five visits," Lawrence told Shots. "If they have to pay me $30 or $40 every time, they're going to have a hard time coming back."
Eliminating copays is also something that Kaiser did as part of its hypertension control project.
"The question is for insurers," Lawrence says. "If they can prevent one stroke in their population of patients, would that not help compensate for eliminating some of these copays?"
Cardiologists have started talking with insurers on making that happen, Lawrence says, because they could affect the care of large numbers of people.
Guidelines for hypertension treatment have become a hot topic in public health this year. The federally backed Million Hearts campaign to prevent a million heart attacks and strokes by 2017 lists several, including Kaiser's and another used successfully by the Department of Veterans Affairs.
Go says that should help make those tools accessible to doctors and health systems around the country. Curious civilians can look to see what's considered state-of-the-art treatment.
The Million Hearts site also provides information on the patient's part in all this, including using diet and exercise to control high blood pressure or prevent it altogether.