Hypertension Control Programs

High blood pressure is a widespread chronic condition, affecting 65 million Americans.  It has also been resistant to good control, even though diagnosis and treatment are relatively simple.  An article in the Journal of the American Medical Association reports on a program by Kaiser Permanente to improve treatment and control of the disease.   (JAMA Article)   The Kaiser system includes a health plan, as well as hospitals, clinics and almost every other needed medical service.  In 2000 the Kaiser system implemented a large scale program to improve blood pressure control, which centered around creation of a patient registry and development of a four-step clinical guideline, which was regularly updated based on new knowledge.  There was regular review of patients in the registry, with appropriate follow-up visits and promotion of a single-pill treatment that seemed to improve adherence.  Between 2001 and 2009, the number of patients in the registry increased from 15.4% of the Kaiser population to 27.5%.  The hypertension control rate increased from 43.6% to 80.4% over the same time period, better than either the national rate of 64.1% or the California rate of 69.4%.   The control rate continued to improve after the study, to 87.1% in 2011.  The study suggests that a comprehensive program can be effective in helping people control blood pressure.  But there are no statistics given on the effect on utilization or health spending, either for blood pressure or overall, or even on overall health status and outcomes.  The program itself had a cost, and it would seem possible that there was an uptick in utilization and spending for blood pressure treatment.  In the long run, the better control may result in lower utilization and spending, and hopefully the researchers are tracking that and working on a follow-up article.  The improvement in blood pressure is likely a good goal in itself, but it is useful to understand the cost implications.