Hypertension is Best Controlled With a Multilevel Approach

A multilevel, multicomponent approach, including physician- and non-physician-led interventions, is best for hypertension control, according to the results of a recent study.

Although the prevalence of hypertension in high, the proportion of patients with controlled hypertension remains low.

To assess the effectiveness of 8 implementation strategies for hypertension control, researchers conducted a meta-analysis of randomized controlled trials lasting at least 6 months that compared the effects of the strategies against usual care. Overall, 121 comparisons from 100 articles with 55,920 hypertension patients were included.

The researchers found that multilevel, multicomponent strategies were the most effective for systolic blood pressure reduction, including team-based care with medication titration by a non-physician (−7.1 mm Hg), team-based care with medication titration by a physician (−6.2 mm Hg), and multilevel strategies without team-based care (−5.0 mm Hg).

“Multilevel, multicomponent strategies, followed by patient-level strategies, are most effective for BP control in patients with hypertension and should be used to improve hypertension control.”

—Michael Potts

Reference:

Mills KT, Obst KM, Shen W, et al. Comparative effectiveness of implementation strategies for blood pressure control in hypertensive patients: a systematic review and meta-analysis [published online December 26, 2017]. Ann Intern Med. doi: 10.7326/M17-1805.