Elsevier

American Heart Journal

Volume 162, Issue 3, September 2011, Pages 405-411
American Heart Journal

Progress in Cardiology
The need for transformative innovation in hypertension management

https://doi.org/10.1016/j.ahj.2011.06.010Get rights and content

Despite multiple available effective therapies for hypertension, many patients with high blood pressure in the United States are not adequately controlled. This inability to effectively manage hypertension can be attributed to patient, provider, and system failures. To create an effective model for hypertension management, current care delivery systems must be reorganized around the following principles: improved patient engagement and patient-provider communication, increased use of nonphysician providers, better performance monitoring and feedback systems, and better aligned reimbursement models. Transformation of care around these principles would lead to marked improvements in cost, quality, and access to care.

Section snippets

Failure of the current care model

Hypertension currently affects 1 of 6 Americans, costing approximately $45.7 billion annually. Control of blood pressure among hypertensive patients has been demonstrated to decrease the lifetime risk of myocardial infarction, stroke, and all-cause mortality.10, 11 Despite the fact that up to 90% of patients' blood pressures can be controlled if prescribed adequate pharmacotherapy, only half of patients have their blood pressure treated to target levels.1, 10 This wide gap has propelled

Transformative hypertension management

In the past decade, there has been a progressive evolution from hospital-based management of chronic disease to office-based care. This ambulatory-based model of disease management provides a potentially more efficient and more effective care model. Monitoring and management of blood pressure provide an ideal test case for this process. Accurate and affordable home blood pressure cuffs are now widely available and allow individuals to monitor daily blood pressures in their homes. Moreover,

Incentive changes needed for transformation

Transformation of the current clinical paradigm for hypertension to a non–office-based, collaborative care model faces significant hurdles that require simultaneous alignment from the patients, providers, and payers. For patients, there must be increased accountability for disease management and health maintenance because long-term improvement in clinical outcomes will not be the driver for patients to engage in blood pressure control. Instead, patient incentives must focus on extrinsic rewards

Conclusion

There are numerous possibilities for transformative innovations in hypertension care. We have discussed model components that would break the current boundaries defined by cost, access, and quality. This disruption is predicated on the simultaneous existence and prevalence of intercommunicating information systems, alignment of incentives for all stakeholders, improvements in the quality and frequency of interactions between patients and the health care system, increased patient responsibility

References (45)

  • M.A.M. Rogers et al.

    Home monitoring service improves mean arterial pressure in patients with essential hypertension

    Ann Intern Med

    (2001)
  • S. Rinfret et al.

    The impact of a multidisciplinary information technology–supported program on blood pressure control in primary care

    Circ Cardiovasc Qual Outcomes

    (2009)
  • D.L. McLean et al.

    A randomized trial of the effect of community pharmacist and nurse care on improving blood pressure management in patients with diabetes mellitus: study of cardiovascular risk intervention by pharmacists-hypertension (SCRIP-HTN)

    Arch Intern Med

    (2008)
  • H.B. Bosworth et al.

    Two self-management interventions to improve hypertension control

    Ann Intern Med

    (2009)
  • B.L. Carter et al.

    Physician and pharmacist collaboration to improve blood pressure control

    Arch Intern Med

    (2009)
  • B.B. Green et al.

    Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial

    JAMA

    (2008)
  • A.V. Chobanian et al.

    Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure

    Hypertension

    (2003)
  • Committee on Leading Health Indicators for Healthy People 2010 IoM

    Leading Indicators for Healthy People 2010: First Interim Report

    (1998)

  • Healthy People 2010: understanding and improving health

  • D.W. Jones et al.

    Improving hypertension control rates: technology, people, or systems?

    JAMA

    (2008)
  • L.S. Phillips et al.

    Clinical inertia

    Ann Intern Med

    (2001)
  • P.M. Ho et al.

    Importance of therapy intensification and medication nonadherence for blood pressure control in patients with coronary disease

    Arch Intern Med

    (2008)

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    Gregory Y.H. Lip, MD, served as guest editor for this article.

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