A multifaceted program to control blood pressure implemented by Kaiser Permanente in Northern California in 2001 doubled the rates of blood pressure control among adult members over the next eight years.
The number of heart attacks and strokes among Northern California members fell substantially during roughly the same time. The dramatic success of the program is detailed in a study published Tuesday in the American Medical Association.
Key elements of the program included the development of a comprehensive registry of patients with hypertension, medical assistant visits for blood pressure measurement and use of a single pill to deliver multiple drugs.
Marc Jaffe, the lead author of the high blood pressure study and head of the Kaiser Permanente Northern California Cardiovascular Risk Reduction Program, said no one part of the program was responsible for its success.
"I think the most important part is all of the parts," Jaffe said. "It's the team, and let's include the patient in that team as well.
"What we learned at Kaiser Permanante is that in order to really get very high rates of high blood pressure control you have to pay attention to it all of the time," Jaffe said. "The patient and the doctor and the whole care system have to be persistent and methodical."
Georgianna Farren, chief medical officer of the Marin Community Clinic, said, "I thought their results were outstanding. There is a lot to be learned here about how to improve blood pressure management for our patients.
"We have just begun a focus on hypertension in our clinic and started to create lists of patients with hypertension," Farren said.
High blood pressure affects one in three U.S. adults, or 67 million people, and the condition caused or contributed to more than 348,000 deaths in 2009, according to the Centers for Disease Control and Prevention.
Normal blood pressure is considered a reading of less than 120 over 80; high blood pressure is 140 over 90 or higher. High blood pressure typically causes no symptoms, at least initially, and can sometimes be managed with a healthy lifestyle, including physical activity plus avoiding salty foods, heavy drinking and excess weight. But two or more prescription drugs are often needed to bring high blood pressure under control.
In 2001, the Kaiser group introduced a systemwide program involving its 1,800 primary care doctors to tackle the problem. It created a registry of adult members with high blood pressure, based on medical records.
At the start, about 44 percent of 235,000 registry patients had their blood pressure under control. The registry grew and by 2009, the portion under control reached 80 percent of 353,000 patients. That compares to 64 percent of people with blood pressure problems nationwide.
Two features likely played a big role in the program's success: In 2005, the region started using a single generic pill combining two common blood pressure drugs, lisinopril and a diuretic. The pill is less expensive than taking the two medicines separately, and easier to use.
And in 2007, the program began offering free follow-up visits with medical assistants, rather than doctors, checking blood pressure readings. Besides charging no insurance co-payment, these brief visits were available at more flexible times, increasing the chances that patients would stick with the program.
"Patients really liked it because it was shorter, more convenient and more affordable," Jaffe said. He did not provide information on patients' costs or overall program costs and said that wasn't part of the study.
Donna Arnett, president of the American Heart Association, said "it's well documented that compliance to medication increases" when it's simpler to take. She said the results suggest that other large medical systems could adopt similar programs and achieve similar success.
The Associated Press contributed to this story.
Contact Richard Halstead via e-mail at firstname.lastname@example.org