Intervention or medication, who benefits more?
There are more than 50 million Americans being treated with hypertension medications, but more than a quarter still do not have blood pressure low enough to meet the national standards. A recent study by doctors and researchers from Baylor College of Medicine and other institutions found that when doctors used interventional tools to monitor patients and help them properly take their medication, overall blood pressure was lower and those needing more medication were identified.
The results are in the current edition of the Journal of General Internal Medicine.
Uncertainty may delay treatment changes
"One of the reasons some people still do not have recommended blood pressure levels is because doctors put off making treatment changes even though the patient’s blood pressure is too high," said Dr. David Hyman, professor of medicine and family and community medicine at BCM and lead investigator on the study. "The reason they put off treatment changes is because they are not sure if the patient will really benefit from more medicine. Are they taking the medications already prescribed regularly? Are they taking the correct amount prescribed? Is their blood pressure while at the doctor’s office reflective of their overall numbers? This uncertainty frequently causes doctors to delay increasing the dose of medication."
Hyman, along with researchers from Kelsey-Seybold Clinic and The University of Texas Health Science Center, both in Houston, followed 665 patients with uncontrolled hypertension from 10 clinics around the Houston area for up to three years.
Tool kit helps identify patient behavior Doctors for about half of the patients were given the opportunity to use what is called "uncertainty reduction tools," which includes 24-hour blood pressure monitoring, electronic monitoring to follow medication usage, telephone counseling for patients to overcome issues that prevented regular medication usage, and lifestyle counseling to help patients make changes to improve their health.
"We found that patients in the clinics that provided these tools kept their blood pressure significantly lower than the patients in the clinics not using the tools," said Hayman. "However, while their numbers were indeed lower, they still did not meet the recommended treatment target."
While the "uncertainty reduction tools" were being used and monitored, doctors found that some patients were in fact not taking their medications as recommended or really did have controlled blood pressure at home. Hyman said this shows that doctors are often right in suspecting that a patient will not benefit from getting a prescription for more blood pressure medicine. The process also helps identify those who would benefit from more medication.
"Controlling high blood pressure is one of the most important things doctors can do to prevent heart attacks and strokes, but getting all patients to the recommended control level has been difficult," said Dr. Valory Pavlik, associate professor of family and community medicine and a study co-investigator. "We hope our results motivate health care providers to adopt tools such as the ones used in our study to identify those hypertensive patients who will benefit from an increase in their blood pressure medicine."
Others who contributed to the study include Dr. Anthony Greisinger, Kelsey-Seybold Clinic; Drs. Chan Wenyaw, Jose Bayona and Victor Simms, all from UT Health Science Center Houston; Dr. James Pool, BCM; and Dr. Carol Mansyur, formerly BCM, currently Old Dominion University, Norfolk, Virginia.
Funding for this research was provided by National Heart Lungs and Blood Institute.