Controlling Hypertension: A Multi-Level Approach Gets Best Results

By Jane Farrell

Patients with high blood pressure can best achieve control of the condition via both physician and non-physician treatment approaches, according to a review published in the journal Annals of Internal Medicine.

High blood pressure, or hypertension, is the leading risk factor for cardiovascular disease. Despite strong evidence that antihypertensive medications and lifestyle modifications reduce blood pressure and subsequent morbidity and mortality from cardiovascular disease, hypertension control rates hover between 25 and 40 percent, a rate that has remain unchanged for the past 40 years. As such, strategies are needed to increase control rates.

For the journal article, researchers from Tulane University reviewed published studies to assess the effectiveness of eight implementation strategies for blood pressure control in adults with hypertension compared with regular care. They found that multilevel, multicomponent strategies, such as team-based care with medication titration (adjustment) by a nonphysician clinician; team-based care with medication titration by a physician; and multilevel strategies without team-based care, lead to reductions in systolic blood pressure (the higher number) of around 7, 6, and 5 mm Hg, respectively. Patient-level strategies resulted in systolic blood pressure reductions of around 4 mm Hg for health coaching and 3 mm Hg for home blood pressure monitoring. Trends were similar for diastolic (the lower figure) blood pressure reduction.

According to the researchers, these findings provide evidence that multilevel, multicomponent implementation strategies are most useful and should be recommended in clinical practice and public health policy for hypertension control in communities.