Helping Patients Manage Their Own Blood Pressures: A Strategy to Address Hypertension Control in the United States

Abstract

Hypertension is highly prevalent in the United States and is a leading cause of myocardial infarction, stroke, and death. Despite its importance and the widespread availability of medication treatment, less than half of patients with hypertension have controlled blood pressures.1 National efforts, such as the Million Hearts initiative, have helped, but there remains much work to be done. The prevalence of poor hypertension control is not surprising given that it is typically managed with episodic in-person visits for blood pressure measurement, laboratory checks, and medication adjustments. No-show rates for ambulatory visits can be high, and attended visits are still typically months apart. Blood pressure values are influenced by pain, exercise, and stress, which can make interpretation of office-based measurements difficult. Home blood pressure measurements can help, but systems to easily link home readings to the electronic health record are uncommon. Even with accurate blood pressure values, physicians frequently fail to intensify treatment when clinically indicated, often referred to as clinical inertia.2 Given the challenges with the current model of hypertension care, alternative strategies to manage blood pressure have emerged. Interventions combining home blood pressure monitoring with systematic medication titration, for example, by a pharmacist through collaborative practice agreements with physicians, results in greater blood pressure reductions compared with usual care.3 However, establishing and maintaining these programs is still subject to human resource constraints, can be costly, and the ability for pharmacists to prescribe varies by state.