Clinical impact of guideline-based practice and patients’ adherence in uncontrolled hypertension

Background Chronic diseases like hypertension need comprehensive lifetime management. This study assessed clinical and patient-reported outcomes and compared them by treatment patterns and adherence at 6 months among uncontrolled hypertensive patients in Korea. Methods This prospective, observational study was conducted at 16 major hospitals where uncontrolled hypertensive patients receiving anti-hypertension medications (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg) were enrolled during 2015 to 2016 and studied for the following 6 months. A review of medical records was performed to collect data on treatment patterns to determine the presence of guideline-based practice (GBP). GBP was defined as: (1) maximize first medication before adding second or (2) add second medication before reaching maximum dose of first medication. Patient self-administered questionnaires were utilized to examine medication adherence, treatment satisfaction and quality of life (QoL). Results A total of 600 patients were included in the study. Overall, 23% of patients were treated based on GBP at 3 months, and the GBP rate increased to 61.4% at 6 months. At baseline and 6 months, 36.7 and 49.2% of patients, respectively, were medication adherent. The proportion of blood pressure-controlled patients reached 65.5% at 6 months. A higher blood pressure control rate was present in patients who were on GBP and also showed adherence than those on GBP, but not adherent, or non-GBP patients (76.8% vs. 70.9% vs. 54.2%, P < 0.001). The same outcomes were found for treatment satisfaction and QoL (P < 0.05). Conclusions This study demonstrated the importance of physicians’ compliance with GBP and patients’ adherence to hypertensive medications. GBP compliance and medication adherence should be taken into account when setting therapeutic strategies for better outcomes in uncontrolled hypertensive patients.

The Factors Correlated With the Blood Pressure Control Among the Elderly Hypertension in Hangzhou

Background To evaluate the effectiveness of community health management of elderly hypertension, and to describe the status and related risk factors of blood pressure control. Methods This was a cross-sectional study. Hypertensive patients aged 60 years and above who took part in community health management in Hangzhou were selected. Data on lifestyle, obesity, blood lipids, fasting plasma glucose, and blood pressure were collected. Systolic blood pressure ≥140 and/or diastolic blood pressure ≥90 mm Hg were used to calculate the blood pressure control rate. Results There were 209,768 subjects with mean age (70.7 ± 7.1) years in the present study. The mean value of systolic and diastolic blood pressures was (141.4 ± 16.9) and (80.2 ± 10.0) mm Hg, respectively. The blood pressure control rate was 48.39%. The rate of the subjects with unhealthy lifestyles, obesity (or central obesity), dyslipidemia, and abnormal fasting plasma glucose was 86.27%, 38.20%, 58.16%, and 14.72%, respectively. The unhealthy lifestyle, obesity, abnormal fasting plasma glucose, and dyslipidemia, affected blood pressure control rate, with an odds ratio (95% confidence interval) of 1.18 (1.15–1.21), 1.23 (1.21–1.25), 1.44 (1.40–1.48), and 1.10 (1.09–1.11), respectively. When 4 risk factors were combined, odds ratio (95% confidence interval) was 1.96 (95% confidence interval 1.83–2.09) for poor blood pressure control. Overall, the percentage of isolated systolic hypertension was 34.87% and increased with age. Conclusions The blood pressure control rate of the elderly hypertension patients in the community health management by national essential public health service was 48.39%. Obesity, unhealthy lifestyle, abnormal fasting blood glucose, and dyslipidemia are risk factors of poor blood pressure control and have cumulative effects.

Abstract P257: Taking Fresh Aim at Improving Blood Pressure Control

Nearly 70 million adults in the United States have hypertension, and only about 50% of those adults have a blood pressure reading below 140/90 mm Hg. Target: BP is a national initiative co-led by the American Heart Association and American Medical Association aimed at improving blood pressure control nationally to reduce the number of Americans who suffer the consequences of high blood pressure including myocardial infarctions, heart failure, strokes, and chronic kidney disease. Target: BP will equip physician practices and health care systems with the resources and technical assistance to achieve a minimum 70% blood pressure control rate with a target of reaching 80% or higher. Target: BP is a multi-faceted, evidence-based, data-driven quality improvement initiative that leverages the AMAs membership and strategic focus on improving health outcomes and the AHAs success in disseminating large scale improvement initiatives like Get With the Guidelines - Stroke, an effective cerebrovascular quality improvement and recognition program. This initiative offers participating healthcare systems, ambulatory clinical practices and individual clinicians the following: A mass communication campaign to raise public awareness about the importance of controlling high blood pressure A quality improvement program and relevant tools to help clinicians and care teams implement the latest hypertension guidelines and improve management and treatment of patients with hypertension, including check lists, treatment algorithms, protocols and fact sheets Opportunities to contribute data for tracking blood pressure control rates and benchmarking against other participants regionally and nationally Opportunities to be recognized formally for achieving a 70% blood pressure control rate, improving blood pressure control, reducing therapeutic inertia and using self-measured blood pressure monitoring Access to a national advisory group of experts in improving blood pressure control Since its initiation in November 2015, over 250 healthcare systems and clinics have committed to participate in Target: BP.