Earlier this month, The Journal of the American Medical Association (JAMA) published a momentous study that demonstrated the efficacy of a brand new paradigm to controlling blood pressure in a community setting.
Before we delve into why this new research excites me, let's first change into student-mode and learn a little about high blood pressure and why it is such a big issue in the medical field.
The Facts
Persistently high blood pressure, also known as hypertension, is the most common chronic medical condition seen at a primary care physician's office. As Margolis and his colleagues remark in the introduction to this study, hypertension affects up to 30 percent of U.S. adults and is estimated to cost around $50 billion annually to manage.
Having chronically high blood pressure can set one up for serious health complications including strokes, heart attacks, heart failure, and kidney problems.
Suffice it to say, hypertension is a huge health and economic burden in our country.
The Set Up
Recognizing that only half of the U.S. population with hypertension have appropriate blood pressure control, Margolis et al sought to challenge the standard of care management of hypertension in a clinic setting by investigating a new longitudinal care plan.
Where most primary care doctors manage hypertension with routine office blood pressure checks, exercise/diet advice and optimization of medical therapy through scheduled visits, Margolis et al attempts to bring this management to the patient's home by providing study participants with home blood pressure monitors and scheduled phone conversations with trained pharmacists.
The goal of this study was to see if patients with hypertension had better control of their condition with this new form of management (home management) vs. standard of care (office management) and if this blood pressure control can be maintained several months after the trial is completed.
How They Did It
During a 12-month period, 450 study participants with uncontrolled high blood pressure were solicited from 16 clinics in Minnesota to be randomized, or arbitrarily placed, in either the home management "treatment group" vs. the office management "control group."
Briefly, participants are often randomized to study groups in a clinical trial is so that participant demographics that might otherwise complicate a study's results (e.g. smoking and obesity) are evenly distributed between the control and treatment group.
The two groups in this trial were followed over a 12-month treatment period, and data such as blood pressure, satisfaction with therapy and adverse medical events were all recorded in predetermined time periods. The authors of this study also collected patient data six months after the trial ended to see if the effect of the intervention persisted beyond the course of the trial.
The Results
Margolis et al found that after one year of intervention, the proportion of patients with appropriate blood pressure control was significantly greater in the home management group than the office management group. Furthermore, the participants in the home management group were found have significantly improved BP control from baseline compared to the office management group.
As a side note, the term significance in this context relates to the bar set by the research community that, through statistical proof, demonstrates a study's result to have less than a 5 percent chance of being purely due to chance.
The Bottom Line
The authors in this major trial did a great job in advocating for and suggesting a new method in managing an incredibly prevalent and costly chronic medical condition.
As responsible health care providers and consumers, we must now take a minute to think through how this new data relates to our lifestyle/practice and what we can learn from it.
For example, around 80 percent of the participants in this trial were Caucasian and the average blood pressure documented at baseline were uncontrolled by definition but not incredibly elevated.
In my own clinic at the county hospital, around 20 percent of my patients are Caucasian and I commonly see patients with much higher blood pressure readings. As a conscious medical provider I must ask myself if this study can be generalized to my own clinical practice given these differences.
As a conscious medical consumer, how does this study relate to you or your family? Would you be comfortable in having your blood pressure managed at home with the aid of a pharmacist? What would you ask the authors before committing to this new form of medical management?
Take Home Point
Hypertension is one of the biggest medical concerns in primary care medicine. Although further investigations may be useful in further legitimizing this innovative method in controlling blood pressure, this study demonstrates that there may be more effective ways in managing hypertension than the current standard of care.
And that's exciting.
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