As health systems look to improve the health of the populations they serve, it's critically important for these entities to extend their influence beyond the walls of hospitals and clinics. To create healthier communities, healthcare organizations around the country are making population health a strategic priority.
During a July 24 webinar sponsored by Medecision and hosted by Becker's Hospital Review, Don Casey, MD, discussed the prevalence of high blood pressure in America and how newly published population health strategies can help address the issue. Dr. Casey is senior vice president and chief of clinical affairs at Medecision as well as president of the American College of Medical Quality. He is also a co-author of the 2017 American College of Cardiology and American Heart Association (ACC/AHA) joint guideline for high blood pressure management.
Failing to correctly diagnose and control high blood pressure can put many people at risk for cardiovascular disease, stroke and renal failure, among other health issues. Recent analysis suggests that more than100 million Americans currently have high blood pressure, and the 2013-14 U.S. National Health and Nutrition Examination Survey estimated that 46 percent of U.S. adults had uncontrolled high blood pressure. Of that proportion, 33.1 percent were unaware they had the condition.
Data from a study, published in May in the Journal of the American Heart Association, determined that individuals with hypertension face on average nearly $2,000 more in annual healthcare expenses compared to those without hypertension.
Dr. Casey said that health systems need to approach the issue of widespread hypertension from a population health standpoint, using recommendations from the ACC/AHA 2017 guideline for high blood pressure management.
While the guideline is a work in progress, Dr. Casey said those behind its creation are committed to getting the recommendations into practice sooner rather than later.
" I still hear an old adage in some presentations that it takes 17 years for evidence to reach practice —the life cycle of a cicada — but I would also posit now, with the clinical practice guideline modernization efforts undertaken by the AHA and ACC, that this statement is actually 17 years out of date," Dr. Casey said. "We are focused not just on publishing guidelines but on getting them into practice."
The guideline, recently published in Circulation and the Journal of the American College of Cardiology, includes more than 100 new recommendations for the diagnosis and treatment of high blood pressure. Dr. Casey highlighted several of these during the webinar that should become important priorities for the population health mission of hospitals and health systems:
1. New blood pressure classification system. The guideline recommends blood pressure "be categorized as normal, elevated, or stages 1 or 2 hypertension in order to prevent and treat high [blood pressure]." The new guideline also suggests changing the classification of stage 1 hypertension from the previous guideline for high blood pressure management produced by the National Heart, Lung, and Blood Institute of the National Institutes of Health in 2003. The 2003 NIH-backed guideline suggested those with systolic blood pressure between 130-139 and diastolic blood pressure between 80-89 be classified as prehypertension. However, the new 2017 ACC/AHA guideline suggests individuals with these blood pressure readings should be classified as stage 1 hypertension. Additionally, blood pressure should be based on an average of two or more careful readings obtained on more than one occasion.
2. Blood pressure measurement. The guideline recommendation is "for diagnosis and management of high [blood pressure], proper methods are recommended for accurate measurement and documentation of [blood pressure]." Inaccurate and inconsistent blood pressure measurement is more common than it should be. It is important that health systems use checklists and resources from the ACC/AHA high blood pressure guidelines to ensure they are completing all the steps necessary to accurately measure blood pressure. "If we are not doing this correctly, we are starting off on the wrong foot in terms of doing potential harm to our patients," Dr. Casey said.
3. Treatment of high blood pressure. There are several ACC/AHA guideline recommendations for treating high blood pressure. Recommendations pertain to the decision to use blood pressure-lowering medications and nonpharmacological interventions. For example, with regard to older adults, the guideline recommends "clinical judgment, patient preference and a team-based approach" when deciding whether to use blood pressure-lowering drugs. Nonpharmacological interventions include recommending weight loss and heart-healthy diets to those with elevated blood pressure or hypertension.
4. Strategies for high blood pressure control. Guideline recommendations include promoting lifestyle modification, implementing comprehensive care plans and monitoring patients on blood pressure medications. The guideline also recommends providing hypertension patients with structured, team-based care interventions. The team could include a combination of clinicians with knowledge about diagnosing and treating high blood pressure, such as primary care physicians, cardiologists, physician assistants, advanced practice nurses and clinical pharmacists. The team should promote guideline-based, patient-centered lifestyle modifications through shared decision making with patients.
"In the end … if you don't have a high-touch interaction with patients with high blood pressure, then it's going to be a lot harder, if not impossible, to engage them," said Dr. Casey.
To learn more about Medecision, click here, and view the full webinar here.