Improving Blood Pressure Control With Strategic Workflows
Setting a goal, identifying the right patients, and implementing team care can help bring hypertension under control.
Fam Pract Manag. 2016 May-June;23(3):23-28.
Author disclosure: no relevant financial affiliations disclosed.
The Centers for Disease Control and Prevention (CDC) reports that only about 52 percent of the 70 million U.S. adults with high blood pressure have their condition under control. It costs an estimated $46 billion each year to address issues related to hypertension such as health care services, medications, and missed work. Seven to eight out of every 10 people have their first heart attack or stroke or develop congestive heart failure because of uncontrolled blood pressure.1 It is clear that blood pressure control is essential to preventing multiple medical conditions from occurring or worsening. This article discusses how our office of 11 employed physicians, working within an integrated health system, implemented strategic workflows to improve blood pressure control among our 2,800 patients with hypertension.
Scripps Health, the integrated health system in San Diego that my site is part of, participates in the “Measure Up/Pressure Down” campaign, a three-year effort created by the American Medical Group Foundation to reduce high blood pressure.2 As part of the campaign, a coalition of local primary care leaders, cardiologists, and nephrologists – including participants from Scripps – reviewed guidelines from the Seventh and Eighth Reports of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7 and JNC 8)3,4 and formulated a recommended blood pressure control treatment algorithm and an accompanying list of medications to help manage patients with hypertension. (See “Adult hypertension treatment algorithm” and “Selected generic antihypertensive medications.”)
ADULT HYPERTENSION TREATMENT ALGORITHM
Medication up-titrations are recommended at no greater than 30-day intervals (for most patients) until control is achieved. Consider follow-up labs when up-titrating or adding lisinopril, hydrochlorothiazide, or losartan.
SELECTED GENERIC ANTIHYPERTENSIVE MEDICATIONS
|Drug class||Generic name||Usual dosage range|
12.5 – 25 mg daily
25 – 50 mg daily
10/12.5; 20/12.5; 20/25 mg daily
25/25 mg daily
ACE inhibitors (ACEIs)
10 – 40 mg daily
12.5 – 50 mg twice daily
Long-acting dihydropyridine calcium channel blockers
2.5 – 10 mg daily
2.5 – 10 mg daily
30–90 mg daily
25 – 100 mg daily
3.125 – 25 mg twice daily
25 – 100 mg twice daily
25 – 200 mg daily
Aldosterone receptor blocker
12.5 – 25 mg daily
amiloride hydrochloride or amiloride-HCTZ
Referencesshow all references
1. High blood pressure facts. Centers for Disease Control and Prevention. 2015. http://www.cdc.gov/bloodpressure/facts.htm. Accessed March 7, 2016....
2. Measure Up/Pressure Down website. American Medical Group Association. 2012. http://www.measureuppressuredown.com. Accessed Feb 25, 2016.
3. 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(19):2560–2572.
4. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–520.
5. Pickering TG, Miller NH, Ogedegbe G, et al. Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. J Cardiovasc Nurs. 2008;23(4):299–323.
6. McCormack T, Krause T, O'Flynn N. Management of hypertension in adults in primary care: NICE guideline. Br J Gen Pract. 2012;62(596):163–164.
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