After decades of steady improvement in blood-pressure control, the U.S. has been backsliding since at least 2017. In fact, according to a scientific statement issued by the American Heart Association (AHA) and the AMA, there is a “widening disconnect between what hypertension experts recommend and actual BP control in practice.”
The statement, published in the journal Hypertension, identifies nine key strategies for improving blood pressure control in the U.S.
“Closing the gap between scientific evidence, expert recommendations and achieving BP control, particularly among disproportionately affected populations, is urgently needed to improve cardiovascular health,” wrote the authors, from the AHA and the AMA, including Brent M. Egan, MD, an internist and vice president of cardiovascular disease prevention at the AMA.
The statement cites the AMA MAP™ framework, AMA MAP BP (Hypertension), Target: BP™ and related resources among the strategies. AMA MAP Hypertension is a leading evidence-based quality improvement program that provides a clear path to significant, sustained improvements in BP control. With AMA MAP BP, health care organizations can increase BP-control rates quickly. The program has demonstrated a 10% increase in BP control in six months with sustained results at one year.
Where to focus efforts
“Barriers to BP control exist across multiple levels of the socioecological framework, including individual, organization, community and policy levels,” the authors wrote, calling out these nine key areas where stakeholders should focus their efforts.
Antiracism. Adverse social determinants of health “can be mitigated through partnership with underrepresented racial and ethnic groups or historically excluded communities, and mitigation efforts can be paired with multilevel strategies that support wider adoption of evidence-based interventions for BP control to increase access to high-quality health care services within communities.”
Accurate BP measurement and greater use of self-measured BP (SMBP) monitoring with relay and advice. The authors recommended a three-pronged approach: Better training in how to select validated BP measurement devices and measure BP inside and outside the office; boosting use of SMBP in clinical practice; and creating a health IT infrastructure that can efficiently relay patient SMBP data to the care team and closing the loop with advice back to the patient.
Team-based care. Research has shown pharmacists, nurses and community health workers are effective in improving BP control. In addition, team-based care has been shown to be “effective in various community settings, including barbershops, faith-based organizations, pharmacies and home outreach visits.”
Policies and programs to facilitate lifestyle change. This includes use of individual- and system-level strategies to reduce sodium levels in food, increase access to healthy food and ensure safe areas for physical exercise.
Standardized treatment protocols using team-based care. The authors recommend encouraging use of standardized antihypertensive medication treatment protocols and once-daily, low-cost, effective BP medications and single-pill combination regimens.
Medication acceptance and adherence. “Optimize antihypertensive medication adherence through multicomponent interventions that optimize prescribing and dispensing methods,” they wrote, adding: “Ask patients to communicate their preferences about antihypertensive medication.”
Continuous quality improvement. This involves clear, time-defined, standardized metrics, coupled with reminders and ongoing feedback, such as the support offered through AMA MAP Hypertension.
Financial strategies. These include removing cost barriers to medications and validated home blood-pressure monitors as well as improving payment for physician and staff time supporting SMBP monitoring. Payment models and incentives are needed to promote team-based care in practice settings and provide services for lifestyle counseling.
Large-scale dissemination and implementation. These should be multilevel, sustainable, adaptable and culturally appropriate while providing equitable health care. “Support of large-scale implementation and dissemination efforts by national partners would help accelerate the translation of evidence-based best practices into care,” such as Target: BP, an initiative of the American Heart Association and the AMA.
Target: BP™ leverages the AMA MAP framework to help care teams organize their approach to providing evidence-based care and helps health care organizations improve and sustain BP control with professional education, practice tools and resources. Annually, Target: BP recognizes health care organizations by awarding those that have commitment to improvement, adopted evidence-based BP activities, and achieved BP-control rates of 70% or greater among the patients they serve.
