Developmental Biology - Regulating Blood Pressure|
Improving High Blood Pressure Management
New 'real world' data reveals opportunities for blood pressure improvement...
Large-scale analysis of electronic health record data from across the country reveals potential opportunities for improvement in how high blood pressure is managed, according to research presented today at the American Heart Association's Epidemiology and Prevention/Lifestyle and Cardiometabolic Health Scientific Sessions 2020.
The EPI Scientific Sessions, March 3-6 in Phoenix, is a premier global exchange of the latest advances in population-based cardiovascular science for researchers and clinicians.
The study, along with a description of the Blood Pressure Control Laboratory (BP Control Lab) platform, is publishing simultaneously in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.
Data (from nearly 1.5 million eligible patients who completed 5.8 million clinic visits over one year from 23 electronic health record datasets) found 60% of patients had blood pressure controlled to below 140/90 mmHg.
Readings above the 140/90 mmHg level are considered too high, increasing risk for heart attack and stroke.
Only 12% of patients who had a high reading during a clinic visit received an order for a new class of blood pressure-lowering medication. The 2017 American College of Cardiology/American Heart Association Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults recommended adjusting blood pressure medications and/or doses when readings are high. When the best practice was followed, the average reduction in blood pressure was relatively large at 15 mmHg.
Researchers' analysis also found that only 22% of visits with a high reading had a second reading to confirm an elevated blood pressure, as recommended by guidelines.
"Our analysis of real world data from PCORnet indicates marked room for improving blood pressure control and blood pressure medication management for many patients."
Mark J. Pletcher, MD, MPH, Principal Investigator BP Control Lab; Professor, Epidemiology and Biostatistics, University of California, San Francisco, USA.
"We were particularly struck by the low rates of medication intensification when high blood pressure is found during a clinic visit. If we can improve medication prescribing, our data suggest we could make a big difference in blood pressure control."
Rhonda M. Cooper-DeHoff, PharmD, MS, Associate Professor, College of Pharmacy, University of Florida, Gainesville, Florida, USA and lead author.
Uncontrolled blood pressure (BP) is a leading preventable cause of death that remains common in the US population despite the availability of effective medications. New technology and program innovation has high potential to improve BP but may be expensive and burdensome for patients, clinicians, health systems, and payers and may not produce desired results or reduce existing disparities in BP control.
Methods and Results
The PCORnet Blood Pressure Control Laboratory is a platform designed to enable national surveillance and facilitate quality improvement and comparative effectiveness research. The platform uses PCORnet, the National Patient-Centered Clinical Research Network, for engagement of health systems and collection of electronic health record data, and the Eureka Research Platform for eConsent and collection of patient-reported outcomes and mHealth data from wearable devices and smartphones. Three demonstration projects are underway: BP track will conduct national surveillance of BP control and related clinical processes by measuring theory-derived pragmatic BP control metrics using electronic health record data, with a focus on tracking disparities over time; BP MAP will conduct a cluster-randomized trial comparing effectiveness of 2 versions of a BP control quality improvement program; BP Home will conduct an individual patient-level randomized trial comparing effectiveness of smartphone-linked versus standard home BP monitoring. Thus far, BP Track has collected electronic health record data from over 826 000 eligible patients with hypertension who completed =3.1 million ambulatory visits. Preliminary results demonstrate substantial room for improvement in BP control (<140/90 mm Hg), which was 58% overall, and in the clinical processes relevant for BP control. For example, only 12% of patients with hypertension with a high BP measurement during an ambulatory visit received an order for a new antihypertensive medication.
The PCORnet Blood Pressure Control Laboratory is designed to be a reusable platform for efficient surveillance and comparative effectiveness research; results from demonstration projects are forthcoming.
Mark J. Pletcher, Valy Fontil, Thomas Carton, Kathryn M. Shaw, Myra Smith, Sujung Choi, Jonathan Todd, Alanna M. Chamberlain, Emily C. O’Brien, Madelaine Faulkner, Carlos Maeztu, Gregory Wozniak, Michael Rakotz, Christina M. Shay and Rhonda M. Cooper-DeHoff.
Valy Fontil, M.D., M.A.S.; Thomas Carton, Ph.D.; Kathryn M. Shaw, M.P.H.; Myra Smith, M.P.H.; Sujung Choi, Ph.D.; Jonathan Todd, Ph.D.; Alanna M. Chamberlain, Ph.D.; Emily C. O'Brien, Ph.D.; Madelaine Faulkner, M.P.H.; Carlos Maeztu, M.A.; Gregory Wozniak, Ph.D.; Michael Rakotz, M.D.; Christina M. Shay, Ph.D.; and Rhonda M. Cooper-DeHoff, Pharm.D., M.S. An additional author for the abstract is Linda Murakami, R.N., M.H.S.A. Author disclosures are in the article and the abstract.
The PCORnet Blood Pressure Control Laboratory Team would like to acknowledge the engagement, input, moral support, and other contributions of our patient advisory board (including author CM and also Kathi Sigona, Greg Merritt, Debbie Holmes, Patrice Williams, and Patty Poston) and our clinical nurse stakeholder (Judith Sansone).
Sources of Funding
The PCORnet Blood Pressure Control Laboratory is funded by a partnership including the Patient-Centered Outcomes Research Institute (PCORI Contract PaCR-2017C2-8153), the American Medical Association (funding and in-kind support), and the American Heart Association (in-kind support). The American Medical Association and the American Heart Association are represented on the Steering Committee. The findings and conclusions are those of the authors and do not necessarily represent the views of PCORI, the American Medical Association, or the American Heart Association.
Drs Rakotz and Wozniak are employees of the American Medical Association. Dr Shay is an employee of the American Heart Association. The funding sources described above partially support salaries (Drs Pletcher, Fontil, Carton, Todd, Chamberlain, and O’Brien, K.M. Shaw, M. Smith, M. Faulkner, C. Maeztu, and R.M. Cooper DeHoff) or consulting income (C. Maeztu) that allows us to complete the demonstration projects; and all authors hope to reuse the infrastructure developed here for other funding applications. The other authors report no conflicts.
The PCORnet BP Control Lab is supported by the Patient-Centered Outcomes Research Institute (PCORI), the American Medical Association and the American Heart Association.
About the American Heart Association
The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public's health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.
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“If we can improve medication prescribing, our data suggests we can make a big
difference in blood pressure control,” Rhonda M. Cooper-DeHoff, PharmD, MS.