Multicomponent strategies could be key to improving hypertension control worldwide

A combination of team-based care, non-physician guidance and clinical treatment could be an important means of diminishing global rates of uncontrolled hypertension, research out of Tulane University suggests.

Hypertension control rates have remained stagnant for four decades, first author Katherine T. Mills, PhD, and colleagues wrote in a comparative effectiveness review published in Annals of Internal Medicine. For dozens of years they’ve hovered between 25 and 40 percent, despite climbing rates of hypertension in the U.S. and worldwide.

Mills and co-authors reviewed published research to assess the effectiveness of eight implementation strategies. Their data spanned 100 articles and 55,920 hypertensive patients, according to the study, and resulted in 121 comparisons total. MEDLINE and Embase databases were both combed without language or year restrictions, though for a study to meet review criteria it had to be a randomized, controlled trial of at least six months.

The greatest differences in blood pressure management came from multilevel, multicomponent strategies, the research stated. Team-based care with medication titration by a non-physician clinician, team-based care with medication titration by a physician and multilevel strategies without team-based care led to decreases in systolic blood pressure of 7, 6 and 5 mm Hg, respectively. Patient-level strategies also proved useful—health coaching resulted in a reduction of around 4 mm Hg and home blood pressure monitoring saw a 3 mm Hg drop. 

The patterns were similar for diastolic blood pressure decreases, as well, the authors wrote, though multilevel, multicomponent strategies were most effective for reducing systolic blood pressure. 

Limitations like sparse data from low- and middle-income countries, as well as a lack of information about certain implementation strategies, could have hindered the results, Mills et al. wrote, but the authors stood firm in their conclusion.

“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,” they wrote.

In an Annals editorial accompanying Mills’ study, Liam G. Glynn, MD, MMSc, and Richard J. McManus, PhD, wrote that while extensive recent research has helpfully confirmed the strong link between hypertension and cardiovascular risk, the recent publication of new, lower blood pressure guidelines could pose a challenge for clinicians. 

“Blood pressure control is a key public health challenge in terms of morbidity and mortality from stroke and cardiovascular events and associated health care costs,” they wrote. “Blood pressure goals are achieved in only 25 to 40 percent of patients who receive antihypertensive drug treatment, a percentage that has remained unchanged for the past 40 years. This situation may worsen with the recent publication of new, lower blood pressure targets, which are particularly concerning because hypertension is the leading risk factor contributing to global disease burden.”