Physician-Related Barriers to the Effective Management of Uncontrolled Hypertension

Oliveria, Susan A.; Lapuerta, Pablo; McCarthy, Bruce D.; L’Italien, Gilbert; Berlowitz, Dan R.; Asch, Steven M.

doi:10.1001/archinte.162.4.413

Cited by 430 publications

(328 citation statements)

References 53 publications

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“…There are several common reasons for therapeutic ineffectiveness in these groups that might be remedied by changing improvement targets 40. For instance, failure to change or increase therapy for patients who are not at goal (“therapeutic inertia”)41, 42 can be addressed by leveraging EHRs to implement treatment algorithms and protocols,16, 28, 38 utilizing clinical decision support tools embedded within EHRs including a 2‐week follow‐up process and patient reminders,19 and changes in team care 43, 44, 45, 46. Treatment‐resistant hypertension is related to age, patient factors, and medical causes of secondary hypertension47 and can be explored by implementing streamlined referral pathways35 and pushing EHR alerts to providers when the BP is elevated 30…”

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

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“…The difference in achieving the goal for SBP or DBP for the male population was less remarkable. A recently published descriptive survey study by Oliveria et al 31 found that physicians do not treat hypertension more aggressively because they are willing to accept an elevated SBP in their patients. This has an important impact on public health because of the positive association between SBP and cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, awareness, treatment, and control of hypertension in the Czech Republic. Results of two nationwide cross-sectional surveys in 1997/1998 and 2000/2001, Czech Post-MONICA Study

et al. 2004

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Hypertension is an easily diagnosed and eminently modifiable risk factor for the development of all clinical manifestations of atherosclerosis. Despite the availability of a simple, non-invasive, and rather accurate method of measuring blood pressure (BP), and overwhelming evidence that reducing BP effectively prevents cardiovascular events, hypertension at the population level is not managed optimally. In 1997/ 1998 and 2000/2001, two surveys for cardiovascular risk factors were conducted in nine districts of the Czech Republic, involving a 1% population random sample aged 25-64 years in each district. In concordance with the MONICA Project, the present study confirms a high prevalence of hypertension in the Czech population, detecting an increase in prevalence for the male population over a period of 3 years (males from 38.8 in

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“…From the physicians' point of view, inappropriate or ineffective treatments, lack of acceptance or knowledge of hypertension treatment guidelines, costs and side-effects, and dosing schedules of drugs have been suggested to play a role in poor management [52,53,54]. As a result physicians have been shown to initiate treatment at higher BP thresholds than existing guidelines, are less attentive to controlling BP because they are satisfied with the existing BP, seldom intensify drug therapy for BP above target levels and are more likely to treat or control increased diastolic BP than systolic BP [53,54,55].…”

Section: Observational Studies On Hypertension Treatment and Controlmentioning

confidence: 99%

“…As a result physicians have been shown to initiate treatment at higher BP thresholds than existing guidelines, are less attentive to controlling BP because they are satisfied with the existing BP, seldom intensify drug therapy for BP above target levels and are more likely to treat or control increased diastolic BP than systolic BP [53,54,55].…”

Section: Observational Studies On Hypertension Treatment and Controlmentioning

confidence: 99%

Trends in hypertension management in Type I diabetes across Europe, 1989/1990 – 1997/1999

et al. 2002

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Aims/hypothesis Our aim was to examine the change in the management of hypertension in patients with Type I (insulin-dependent) diabetes mellitus in Europe, between 1989Europe, between -1990Europe, between and 1997Europe, between -1999.Methods Seven-year changes in hypertension treatment and control (defined as blood pressure <130/85 mmHg) were examined in a large sample of Type I diabetic patients recruited from 26 centres involved in the EURODIAB Prospective Complications Study. Hypertension was defined as a systolic and/or diastolic blood pressure greater than 140 and/or 90 mmHg respectively, and/or use of blood pressure lowering drugs. 1Results Of 1866 Type I diabetic patients, 412 had hypertension at baseline and 631 at follow-up.A greater proportion of hypertensive patients were treated at follow-up (69% vs 40%, p<0.0001), which persisted after adjustment for age or centre. Of those who were treated, a modest increase in the proportion of those controlled for hypertension was found (41% vs 32%, p=0.048), which disappeared after adjustment for age. Among hypertensive patients with albuminuria, the proportions treated also increased, from 35% to 76% (p<0.0001) in microalbuminuric and 64% to 95% (p<0.0001) in macroalbuminuric patients. Control of hypertension in albuminuric patients did not change significantly and was below 50%. The use of more than one anti-hypertensive drug increased over a 7-year period, from 19% to 33% (p<0.0001), and a marked increase was shown in the proportion of those taking an ACE inhibitor (from 57% to 82%, p<0.0001). Conclusion/interpretationThe management of hypertension in Type I diabetic patients acrossEurope has improved over a 7-year follow-up period. Optimal levels of blood pressure treatment and optimal levels of control have not yet been achieved.Keywords Hypertension · Type I diabetes mellitus · albuminuria · control · blood pressure · treatment Abbreviations CCB Calcium channel blockerAn erratum to this article can be found at http://dx.doi.org/10.1007/s00125-003-1210-9In Type I (insulin-dependent) diabetes mellitus, raised blood pressure has been shown to be related to an increased risk of retinopathy [1,2,3], and cardiovascular disease [4,5] in several prospective studies independent of other risk factors. It is estimated that 30 to 75% of diabetic complications can be attributed to hypertension, which is twice as common in diabetic patients than in non-diabeticSeveral BP lowering trials have shown a reduction in microvascular and macrovascular complications in patients with Type II (non-insulin-dependent) diabetes mellitus [7,8]. Other recent trials have shown that, independent from BP lowering effects, the progression of diabetic nephropathy can be reduced by angiotensin II receptor blockers in Type II diabetic patients with hypertension and albuminuria [9,10,11]. In Type I diabetes, the progression of retinopathy [12]

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Physician-Related Barriers to the Effective Management of Uncontrolled Hypertension

Cited by 430 publications

References 53 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

Prevalence, awareness, treatment, and control of hypertension in the Czech Republic. Results of two nationwide cross-sectional surveys in 1997/1998 and 2000/2001, Czech Post-MONICA Study

Trends in hypertension management in Type I diabetes across Europe, 1989/1990 – 1997/1999

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