Barriers to and strategies for effective blood pressure control

David Siegel, David Siegel

Abstract

There are major differences between the current knowledge of the treatment of cardiac conditions derived from evidence-based medicine and the widespread application of this knowledge. This is particularly true in the treatment of hypertension. Hypertension is the most common chronic cardiovascular condition, affecting more than 50 million Americans and approximately 1 billion individuals worldwide. However, many hypertensive patients are not receiving treatment, and of those that are, many are not adequately controlled. There is evidence that there are methods to improve blood pressure control and improve compliance with expert recommendations for the treatment of hypertension. These methods range from local initiatives such as academic detailing to national performance measures as have been developed by the US Department of Veterans Affairs. A challenge for the future will be to identify and broadly apply these and other programs to improve the quality and efficiency of hypertensive treatment.

References

    1. Amsterdam EA, Laslett L, Diercks D, et al. Reducing the knowledge-practice gap in the management of patients with cardiovascular disease. Prev Cardiol. 2002;5:12–15.
    1. Bailey JE, Lee MD, Somes GW, et al. Risk factors for antihypertensive medication refill failure by patients under Medicaid managed care. Clin Ther. 1996;18:1252–62.
    1. Barreuther A. Academic detailing to influence prescribing. J Manag Care Pharm. 1997;3:631–8.
    1. Berlowitz DR, Ash A, Hickey EC, et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med. 1998;339:1957–63.
    1. Blood Pressure Lowering Treatment Trialists' Collaboration Effects of different blood-pressure-lowering regimens on major cardiovascular events; results of prospectively-designed overviews of randomized trails. Lancet. 2003;362:1527–35.
    1. Bourgalt C, Rainville B, Suissa S. Antihypertensive drug therapy in Saskatchewan: patterns of use and determinants in hypertension. Arch Int Med. 2001;161:1873–9.
    1. Buring JE, Glynn RJ, Hennekens CH. Calcium channel blockers and myocardial infarction: a hypothesis formulated but not yet tested. JAMA. 1995;274:654–5.
    1. Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension. 1995;25:305–13.
    1. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–72.
    1. Clause SL, Hamilton RA. Medicaid prescriber compliance with Joint National Committee VI hypertension treatment guidelines. Ann Pharmacother. 2002;36:1505–11.
    1. Conti CR. Re-examining the clinical safety and roles of calcium antagonists in cardiovascular medicine. Am J Cardiol. 1996;78(Suppl 9A):13–18.
    1. Davis DA, Thomson MA, Oxman AD, et al. Changing physician performance: a systematic review of the effect of continuing medical education strategies. JAMA. 1995;274:700–5.
    1. Department of Veterans Affairs Medical Advisory Panel . Pharmacologic management of hypertension. Washington: Department of Veterans Affairs; 1996. Publication nr 96-0003.
    1. Egan BM, Basile JN. Controlling blood pressure in 50% of all hypertensive patients: an achievable goal in the healthy people 2010 report? J Invest Med. 2003;51:373–85.
    1. Girvin B, McDermott BJ, Johnston D. A comparison of enalapril 20 mg once daily vs 10 mg twice daily in terms of blood pressure lowering and patient compliance. J Hypertens. 1999;17:1627–31.
    1. Glynn RJ, Brock DB, Harris T, et al. Use of antihypertensive drugs and trends in blood pressure in the elderly. Arch Intern Med. 1995;155:1855–60.
    1. Goldstein AO, Carey TS, Levis D, et al. Variations in hypertension control in indigent rural primary care clinics in North Carolina. Arch Fam Med. 1994;3:514–19.
    1. Hobbs FDR. Is the calcium antagonist debate having an effect on clinical practice? Am J Cardiol. 1997;79(10A):20–3.
    1. Hyman DJ, Pavilk VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med. 2001;345:479–86.
    1. Jackson JH, Bramley TJ, Chiang TH, et al. Determinants of uncontrolled hypertension in an African-American population. Ethn Dis. 2002;12:53–7.
    1. Jha AK, Perlin JB, Kizer KW, et al. Effect of the transformation of the Veterans Affairs health care system on the quality of care. N Engl J Med. 2003;348:2218–27.
    1. [JNC] Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure The fifth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure (JNC V) Arch Intern Med. 1993;153:154–83.
    1. [JNC] Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med. 1997;157:2413–44.
    1. Lenfant C. JNC guidelines is the message getting through? JAMA. 1997;278:1178–9.
    1. Meier J, Lopez J, Siegel D. Prevalence and treatment of hypertension complicated by comorbid conditions. J Clin Hypertens. 1999;1:209–11.
    1. Nelson CR, Knapp DA. Trends in antihypertensive drug therapy of ambulatory patients by US office-based physicians. Hypertension. 2000;36:600–3.
    1. Nelson MR, Reid CM, Krum H, et al. Factors influencing family physician adherence to hypertension treatment guideline recommendations on the initiation of pharmacotherapy: questionnaire survey. Am J Cardiovasc Drugs. 2003;3:437–41.
    1. [NHLBI] National Heart, Lung, and Blood Institute National High Blood Pressure Education Program [online] 2003. Accessed 9 Mar 2004.
    1. Pahor M, Guralnik JM, Furberg CD, et al. Risk of gastrointestinal haemorrhage with calcium antagonists in hypertensive persons over 67 years old. Lancet. 1996;347:1061–5.
    1. Pahor M, Guralnik JM, Salive ME, et al. Do calcium channel blockers increase the risk of cancer? Am J Hypertens. 1996;9:695–9.
    1. Pearson TA, McBride PE, Miller NH, et al. Organization of preventive cardiology service. JACC. 1996;27:1039–47.
    1. Psaty BM, Heckbert SR, Koepsell TD, et al. The risk of myocardial infarction associated with antihypertensive drug therapies. JAMA. 1995;274:620–5.
    1. SHEP Cooperative Research Group Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP) JAMA. 1991;265:3255–64.
    1. Siegel D. The gap between knowledge and practice in the treatment and prevention of cardiovascular disease. Prev Cardiol. 2000;3:167–71.
    1. Siegel D, Lopez J. Trends in antihypertensive drug use in the United States: do the JNC V recommendations affect prescribing. JAMA. 1997;278:1745–8.
    1. Siegel D, Lopez JR, Meier JL. Pharmacologic treatment of hypertension in the department of Veterans Affairs during 1995 and 1996. Am J Hypertens. 1998;11:1271–8.
    1. Siegel D, Lopez J, Meier J, et al. Changes in the pharmacologic treatment of hypertension in the department of Veterans Affairs 1997–1999: decreased use of calcium antagonists and increased use of β-blockers and thiazide diuretics. Am J Hypertens. 2001;14:957–62.
    1. Siegel D, Lopez J, Meier J, et al. Academic detailing to improve antihypertensive prescribing patterns. Am J Hypertens. 2003;16:508–11.
    1. Soumerai SB. Factors influencing prescribing. Aust J Hosp Pharm. 1988;18(Suppl):9–16.
    1. Soumerai SB, McLaughlin TJ, Avorn J. Improving drug prescribing in primary care: a critical analysis of the experimental literature. Milbank Q. 1989;67:268–317.
    1. Steiner JF, Koepsell TD, Fihn SD, et al. A general method of compliance assessment using centralized pharmacy records. Med Care. 1988;26:814–23.
    1. The ALLHAT Offices and Coordinators for the ALLHAT Collaborative Research Group Major outcomes in high-risk hypertensive patients randomized to angiotensin-coverting enzyme inhibitor or calcium channel blocker vs diuretic; the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALHAD) JAMA. 2002;288:2981–97.
    1. Veterans Administration Cooperative Study Group on Antihypertensive Agents Effect of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressures averaging 90 through 114 mmHg. JAMA. 1970;213:1143–52.
    1. Walley T, Duggan AK, Haycox AR, et al. Treatment for newly diagnosed hypertension: patterns of prescribing and antihypertensive effectiveness in the UK. J R Soc Med. 2003;96:525–31.
    1. Wilkes MS, Doblin BH, Shapiro MF. Pharmaceutical advertisements in leading medical journals: experts' assessments. Ann Intern Med. 1992;116:912–19.
    1. Ziegler MG, Lew P, Singer BC. The accuracy of drug information from pharmaceutical sales representatives. JAMA. 1995;273:1296–8.

Source: PubMed

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