Optimal Implementation Strategy for Blood Pressure Control Identified in Patients With Hypertension
A comparative effectiveness study analyzed various implementation strategies for blood pressure control in patients with hypertension, published in Annals of Internal Medicine (online December 26, 2017; doi:10.7326/M17-1805).
While the prevalence of hypertension continues to increase worldwide, the proportion of controlled hypertension remains low. Further research is needed to help identify the best implementation strategies for blood pressure control in adults with hypertension.
Katherine T Mills, PhD, department of epidemiology, Tulane University School of Public Health, and colleagues conducted a comparative effectiveness study involving eight implementation strategies for blood pressure control in this population. Researchers conducted systematic searches of MEDLINE and Embase through September 2017 for randomized controlled trials that compared the effects of implementation strategies versus usual care. A total of 121 comparisons from 100 articles with 55,920 patients with hypertension were included.
Results of the study showed that multilevel, multicomponent strategies were most effective for systolic blood pressure reduction, including team-based care with medication titration by a nonphysician (-7.1 mm Hg; 95% CI, -8.9 to -5.2), team-based care with medication titration by a physician (-6.2 mm Hg; 95% CI, -8.1 to -4.2), and multilevel strategies without team-based care (-5.0 mm Hg; 95% CI, -8.0 to -2.0).
Furthermore, patient-level strategies were found to result in systolic blood pressure changes of -3.9 mm Hg (95% CI, -5.4 to -2.3) for health coaching and -2.7 mm Hg (95% CI, -3.6 to -1.7) for home blood pressure monitoring.
Researchers noted that similar trends were observed for diastolic blood pressure reduction.
“Multilevel, multicomponent strategies, followed by patient-level strategies, are most effective for blood pressure control in patients with hypertension and should be used to improve hypertension control,” researchers concluded.
Among the acknowledged limitations of the study were sparse data from low- and middle-income countries, few trials of some implementation strategies (ie, provider training), and possible publication bias.—Zachary Bessette