Original Papers. Success and Predictors of Blood Pressure Control in Diverse North American Settings: The Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

Cushman, William C.; Ford, Charles E.; Cutler, Jeffrey A.; Margolis, Karen L.; Davis, Barry R.; Grimm, Richard H.; Black, Henry R.; Hamilton, Bruce P.; Holland, Joanne; Nwachuku, Chuke; Papademetriou, Vasilios; Probstfield, Jeffrey L.; Wright, Jackson T.; Alderman, Michael H.; Weiss, Robert; Piller, Linda B.; Bettencourt, Judy; Walsh, Sandra M.

doi:10.1111/j.1524-6175.2002.02045.x

Cited by 815 publications

(117 citation statements)

References 21 publications

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“…Similarly, Medicare beneficiaries were more often aware of their hypertension and receiving treatment, but had relatively high rates of uncontrolled hypertension. Besides the confounding effect of age, this may be due in part to treatment‐resistant hypertension being more prevalent among older patients 24, 25. In addition, despite being insured and receiving relatively low‐cost medications, Medicare patients may still face a financial barrier to adherence and, hence control, when they enter the Medicare prescription drug plan coverage gap, also known as the “donut hole.”26, 27 We also found that younger individuals and those with few or no visits for health care in the last year were often unaware of their hypertension, and when aware they were less likely to receive treatment.…”

Section: Discussionmentioning

confidence: 99%

Hypertension Control Cascade: A Framework to Improve Hypertension Awareness, Treatment, and Control

Wozniak

Khan

Gillespie

et al. 2015

J of Clinical Hypertension

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Evidence‐based interventions differ for increasing hypertension awareness, treatment, and control and should be targeted for specific patient panels. This study developed a hypertension control cascade to identify patients with a usual source of care represented at each level of the cascade using the 2007–2012 National Health and Nutrition Examination Survey. Overall, 10.7 million adults in the United States were unaware of their condition, 3.8 million were aware but untreated, and 15.8 million were treated but uncontrolled. The results also suggest that failure to attain hypertension control because of lack of awareness or lack of treatment despite awareness occurs mainly among younger individuals and those with no annual healthcare visits, while the elderly and minorities are more likely to remain uncontrolled when aware and treated. Opportunities to leverage population health management functions in electronic health information systems to align the specific patient subgroups facing barriers to hypertension control at each level of the cascade with targeted hypertension management interventions are discussed.

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Section: Discussionmentioning

confidence: 99%

Hypertension Control Cascade: A Framework to Improve Hypertension Awareness, Treatment, and Control

Wozniak

Khan

Gillespie

et al. 2015

J of Clinical Hypertension

View full text Add to dashboard Cite

show abstract

“…Indeed, in the most recent hypertension trials, such as the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT [5]), the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial (6) and the AngloScandinavian Cardiac Outcomes Trial (ASCOT [7]), as well as in older hypertension trials, a large proportion of patients required two or even three antihypertensive medications to achieve target BPs. For example, at the conclusion of the ALLHAT, in controlled patients, approximately 30% of patients were on dual therapy and 20% of patients were on triple therapy (8). Accordingly, one can anticipate needing to use multiple antihypertensive medications in patients with Achieving blood pressure targets in hypertension can be challenging.…”

mentioning

confidence: 99%

More medications, fewer pills: Combination medications for the treatment of hypertension

Lewanczuk¹,

Tobe²

2007

Canadian Journal of Cardiology

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“…[1][2][3] An important part of this problem is current prescribing practices. Unfortunately, most patients require Ն2 medications to achieve optimal control, 4 and these multidrug regimens are associated with lower adherence. 5,6 This has been suggested to be the most important contribution to inadequate blood pressure control.…”

mentioning

confidence: 99%

A Simplified Approach to the Treatment of Uncomplicated Hypertension

et al. 2009

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Abstract-Notwithstanding the availability of antihypertensive drugs and practice guidelines, blood pressure control remains suboptimal. The complexity of current treatment guidelines may contribute to this problem. To determine whether a simplified treatment algorithm is more effective than guideline-based management, we studied 45 family practices in southwestern Ontario, Canada, using a cluster randomization trial comparing the simplified treatment algorithm with the Canadian Hypertension Education Program guidelines. The simplified treatment algorithm consisted of the following: (1) initial therapy with a low-dose angiotensin-converting enzyme inhibitor/diuretic or angiotensin receptor blocker/diuretic combination; (2) up-titration of combination therapy to the highest dose; (3) addition of a calcium channel blocker and up-titration; and (4) addition of a non-first-line antihypertensive agent. The proportion of patients treated to target blood pressure (systolic blood pressure Ͻ140 mm Hg and diastolic blood pressure Ͻ90 mm Hg for patients without diabetes mellitus or systolic blood pressure Ͻ130 mm Hg and diastolic blood pressure Ͻ80 mm Hg for diabetic patients) at 6 months was analyzed at the practice level. Key Words: hypertension management Ⅲ randomized, controlled trial Ⅲ fixed-dose combination therapy Ⅲ cluster randomization Ⅲ hypertension T reatment of hypertension remains suboptimal despite the development of novel therapies and the widespread implementation of education programs. Although multiple barriers exist to achieving better control of blood pressure, these mainly consist of patient-and practitioner-centered factors.From the patient perspective, poor adherence to antihypertensive regimens is a significant component of the "treatment gap." 1-3 An important part of this problem is current prescribing practices. Unfortunately, most patients require Ն2 medications to achieve optimal control, 4 and these multidrug regimens are associated with lower adherence. 5,6 This has been suggested to be the most important contribution to inadequate blood pressure control. 7 Furthermore, switching medications, a strategy featured prominently in most national treatment guidelines, has also been linked to poor adherence. 8 Thus, the use of simpler, more effective drug regimens might improve blood pressure control.From a practitioner perspective, a number of behavioral factors have been associated with poor blood pressure control. One of the most important factors is "therapeutic inertia," whereby practitioners fail to appropriately escalate the intensity of therapy despite the presence of poorly controlled hypertension. 9 We speculate that the increasingly complex treatment regimens currently advocated by experts, national guidelines, and the pharmaceutical industry might contribute to this undesirable behavior.Given these issues, a simple, step-care-based algorithm for the pharmacological management of hypertension (Simplified Treatment Intervention to Control Hypertension [STITCH]) was developed. This algorithm...

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Original Papers. Success and Predictors of Blood Pressure Control in Diverse North American Settings: The Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

Abstract: Context. Blood pressure control (<140/90 mm

Cited by 815 publications

References 21 publications

Hypertension Control Cascade: A Framework to Improve Hypertension Awareness, Treatment, and Control

Hypertension Control Cascade: A Framework to Improve Hypertension Awareness, Treatment, and Control

More medications, fewer pills: Combination medications for the treatment of hypertension

A Simplified Approach to the Treatment of Uncomplicated Hypertension

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