Community-based hypertension program linked with improved blood pressure control

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1. A large-scale community based hypertension control program resulted in reported hypertension control rates higher than both the mean California rate and the national rate (43.6 to 80.4% in program; vs. 63.4-69.4% in California; and 55.4 to 64.1% nationally). 

Evidence Rating Level: 2 (Good) 

Study Rundown: Despite the availability of effective therapy for the past 50 years, control of hypertension has been difficult to attain in the general population. This study reports the results of the implementation of one of the first large, sustained, multifactorial, community-based hypertension programs. The Kaiser Permanente Northern California (KPNC) program included usage of a single-pill combination pharmacotherapy, medical assistant follow-up visits, and increased performance metrics. In comparison to state-wide (California) and national rates, the KPNC program allowed for a higher rate of blood pressure control with improvement from 43.6% to 80.4% over the study period.

Certain aspects of the program contributed to its significant increase in control, including an electronic medical record system, internal hypertension registry to track control rates, brief evidence based hypertension guidelines suitable for clinical implementation, medical assistant conducted follow-up visits, and a single-pill combination therapy consisting of thiazide-ACE inhibitor. As the US evolves to a value-based models and delivery of best outcomes at the cheapest cost, other system-level quality improvement approaches should take after this model of hypertension control. The fully integrated nature of the Kaiser Permanante system facilitated the implementation of the program, but the foundational elements of the program may serve as a model given its notable efficacy in increasing blood pressure control among hypertensives in the study sample.

Click to read the study, published today in JAMA

Click to read the accompanying editorial in JAMA

Relevant Reading: US Trends in Prevalence, Awareness, Treatment, and Control Hypertension, 1988-2008

In-Depth [prospective cohort]: The KPNC (Kaiser Permanente Northern California) hypertension program included all patients within the system having hypertension between 2001-2009. Components of the program included establishing a comprehensive hypertension registry, implementation of a single-pill combination pharmacotherapy, along with medical assistant follow-up visits, and performance metrics. One comparison group included insured patients in other California plans (BP< 140 and <90 mmHg) and a secondary group was the national mean of hypertension control rate. Healthcare Effectiveness Data and Information Set (HEDIS) measures were used to determine blood pressure control, and this was the primary outcome measure. In a total of 652,763 patients enrolled, hypertension control increased from 43.6% to 80.4% during the study period for the KPNC sample (P<0.001; 95% CI, 39.4-48.6%). This control rate was higher than the mean California rate of hypertension control at 63.4-69.4% during the study period and the national mean control rate, which increased from 55.4% to 64.1% during the study period.

By Elizabeth Park and Rif Rahman

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