New Orleans—When it comes to lowering patients’ blood pressure to safe levels, physicians can’t—and shouldn’t try—to do it alone, a new comparative effectiveness review finds.

The article in Annals of Internal Medicine points out that, while current clinical guidelines recommend lower blood pressure (BP) targets for the general population, relatively few achieve control. The study also notes that hypertension control rates generally range between 25% and 40%, remaining relatively unchanged for the past 4 decades.

Tulane University–led researchers emphasize that, based on their results, patients with hypertension can best achieve blood pressure control with a multilevel, multicomponent approach that includes physician interventions, as well as those by other clinicians, including pharmacists. The study team looked at eight implementation strategies for blood pressure control in adults with hypertension, comparing them with regular care. 

To do that, the researchers conducted systematic searches of MEDLINE and Embase from inception to September 2017 with no language restrictions, supplemented with manual reference searches. Selected were randomized, controlled trials lasting at least 6 months comparing the effect of implementation strategies versus usual care on BP reduction in adults with hypertension.

The answer they found was that multilevel, multicomponent strategies, such as team-based care with medication titration by a nonphysician clinician, team-based care with medication titration by a physician, and multilevel strategies without team-based care, lead to reductions in systolic blood pressure of around 7, 6, and 5 mmHg, respectively. 

At the same time, patient-level strategies resulted in systolic blood pressure reductions of around 4 mmHg for health coaching and 3 mmHg for home BP monitoring, with similar trends for diastolic blood pressure reduction.

“Multilevel, multicomponent strategies, followed by patient-level strategies, are most effective for BP control in patients with hypertension and should be used to improve hypertension control,” study authors conclude, stating that those approaches should be recommended in clinical practice and public health policy for hypertension control in communities.
« Click here to return to Weekly News Update.