How do we fix the high blood pressure problem?

It’s a leading cause of death and disability in the U.S., leading to hundreds of thousands of preventable heart attacks, strokes and failed kidneys each year. About one-third of all American adults have it, according to the Centers for Disease Control, and it costs the nation about $50 billion annually to treat it and its complications.

“It” is high blood pressure, also known as hypertension. It is a symptomless, silent killer.

There are effective medications for it. But physicians across the U.S. don’t do a great job helping their patients control it.

Fixing the problem starts with education — answering questions about what high blood pressure is and how Americans can better control it.

Blood pressure is the force of blood pushing against the artery walls as the heart pumps. If this pressure rises too high and stays elevated over time, it damages the body.

Why is this so important?

Every day, nearly 1,000 people in the U.S. die on average from a condition for which high blood pressure was the leading or contributing cause. This includes killers like stroke, heart attack, congestive heart failure and end-stage kidney disease.

What’s staggering is that even among people with elevated blood pressure who have health insurance and personal physicians, only 55 percent have had it successfully treated.

And while this problem affects everyone, high blood pressure is most prevalent among African Americans, according to the CDC, with approximately 42 percent developing hypertension compared to 29 percent nationally. African Americans also develop high blood pressure at an earlier age than whites and Hispanics do. Today, more black women than men have high blood pressure.

Physicians know how to bring most of their patients’ blood pressure back to a normal range. They’re just not able to accomplish it. The reason isn’t totally clear.

It’s not the cost. There are effective and relatively inexpensive medications to help treat high blood pressure.

It’s not that it can’t be done. There are plenty of physicians in this country doing so at dramatically higher rates than others. But when they fail, there are massive emotional consequences for families and major economic consequences for America.

Why do treatment results vary so much?

Some medical groups are helping their patients achieve high levels of control.

The health systems seeing the most success are the ones that focus on this problem during every patient’s medical visit, not just when patients see their primary care physician. They’re also able to access each patient’s complete clinical information via an electronic medical record (EMR) during every visit.

As a result, physicians in the Veterans Administration health care system have returned patient blood pressures back to normal in 76 percent of cases and Kaiser Permanente in Northern California has achieved an 87 percent level of success.

How do we fix the high blood pressure problem?

Reducing sodium intake (read: less salt), exercising regularly and moderating alcohol consumption can help control blood pressure. However, most people living with high blood pressure also need medication. And many need to take more than one drug to achieve optimal control.

The best approach for people with this condition is being proactive. Waiting until the next doctor’s visit and hoping to be more relaxed rarely solves anyone’s blood pressure problem.

A particularly effective technique, which many of the most successful physicians use, is to begin treatment with two medications. This allows a doctor to prescribe a lower dose of each, reducing or avoiding bothersome side effects.

But it is difficult for individual physicians to manage an entire population of patients. To achieve the best results, doctors need support from care teams of nurses and pharmacists using advanced information technology (IT) systems.

In this way, all patients can be monitored between visits to their primary care physicians. And their medication doses can be increased or reduced as needed. In addition, these care teams can track test results and ensure adherence to prescribed medication. They can check on levels of control more frequently and provide health coaching in areas like diet and exercise.

Why we should take this personally

All of us know someone with uncontrolled high blood pressure. It might be our parents, our spouses or our colleagues. It might be many of the people reading this article.

According to the Million Hearts campaign, if we could get high blood pressure under control in 70 percent of Americans – combined with other actions such as decreasing smoking, taking a daily baby aspirin and lowering cholesterol — the U.S. could avoid 1 million heart attacks and strokes by 2017.

This topic deserves national attention. Any other epidemic leading to more than 300,000 deaths a year would dominate headlines. But high blood pressure remains our nation’s silent killer.

Some of the reasons are clinical, others economic.

Physicians in fee-for-service medicine, a payment model that rewards doctors for quantity of care rather than quality, are paid more to care for the consequences of high blood pressure than to prevent them in the first place.

And many community physicians don’t have care teams assisting them. Combine this with the reality that high blood pressure has no evident symptoms — and that people are hesitant to take medications for a condition with no immediate consequences — and these dismal rates of control become more understandable.

But regardless of the reasons, not effectively treating this problem represents a failure of our medical care system.

My plea to you: Get yourself checked and begin treatment if your blood pressure is elevated. Work with your physician to ensure your results return to the recommended normal range for your age and associated medical conditions.

If you won’t do it for yourself, do it for your family and for those who love you.

Robert Pearl is a physician and CEO, The Permanente Medical Group. This article originally appeared on Forbes.com

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  • Thomas D Guastavino

    It appears that Dr Pearl is convinced that the main reason HTN is not being controlled is the “perverse” financial incentives under the private practice, FFS system. I guess the financial incentives under a “quality” based, top down, captitated system that Dr Pearl represents are acceptable. After all, the VA has done such a stellar job. I guess we can also disregard compliance issues, unacceptable side effects, and the fact that we can’t even decide at what level to declare a patient hypertensive as factors.
    We can at least agree on one thing. Get your BP checked.

  • guest

    With all due respect,blood pressure readings are a metric, not an actual health outcome. The actual health outcomes would be rates of stroke, myocardial infarction, and renal failure within the population in question.
    It’s great that the VA and Kaiser, with their capitated approach to population health management, using IT and “care teams” as a substitute for the doctor-patient dyad, have both succeeded in reducing blood pressures in their target population. But what does it really mean?:

    What we don’t know is whether or not the patients in question actually enjoy better health. And we can suspect that the patients may somewhat resent having themselves as well as their doctors turned into widgets to be manipulated by an assembly-line style healthcare system.

    • Thomas D Guastavino

      Maybe the VA put their hypertensive outliners on a secret list.

  • John C. Key MD

    Can the VA data be trusted? In the courtroom a witness caught in one lie may be disbelieved in others.

    At this point I suppose there is no reason to question the Kaiser data.

    Paternalism over patient education cannot be a good solution.