{"id":95068,"date":"2016-12-12T09:00:57","date_gmt":"2016-12-12T14:00:57","guid":{"rendered":"https:\/\/www.bu.edu\/sph\/?p=95068"},"modified":"2020-09-17T10:26:29","modified_gmt":"2020-09-17T14:26:29","slug":"more-progress-needed-in-addressing-uncontrolled-hypertension","status":"publish","type":"bu-article","link":"https:\/\/www.bu.edu\/sph\/news\/articles\/2016\/more-progress-needed-in-addressing-uncontrolled-hypertension\/","title":{"rendered":"More Progress Needed to Address Uncontrolled Hypertension"},"content":{"rendered":"\n
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December 12, 2016<\/div>\n\t\t\n\t\t\t\t
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\"blood-pressure-gauge\"The management of hypertension has been a major public health success in the US, with large healthcare systems now able to control blood-pressure rates in 80 percent of their hypertension patients.<\/p>\n

But further improvements in hypertension control rates will require \u201ctailored interventions\u201d that address unique characteristics and barriers for specific subpopulations, a School of Public Health researcher says in a recent commentary in The<\/em> Journal of Clinical Hypertension<\/em><\/a>.<\/p>\n

\u201cUncontrolled hypertension can no longer be considered to have a single cause. As a result, we cannot expect that one-size-fits-all interventions, which have contributed to the current success, will lead to substantial further improvements in control rates at already high-performing integrated healthcare systems,\u201d writes Dan Berlowitz, professor of health law, policy, and management. He also is a professor of medicine at the School of Medicine and a researcher with the Center for Healthcare Organization & Implementation Research at the Bedford VA Hospital.<\/p>\n

Berlowitz said characteristics of patients with uncontrolled hypertension have been consistently identified in studies going back more than two decades\u2014factors such as obesity, diabetes, increased creatinine, and being older or African American. But the reasons behind uncontrolled hypertension appear to vary, he says.<\/p>\n

\u201cClinical inertia,\u201d or a reluctance to intensify treatment, is particularly common in cases involving patients with diabetes, possibly because of \u201ccompeting demands\u201d in which physicians invest time and effort into managing glycemic control, rather than blood pressure. Uncontrolled hypertension in obese patients might be caused by obstructive sleep apnea, Berlowitz says. Meanwhile, community-based support through \u201cinfluential peers\u201d may help to promote healthier behaviors in some subpopulations.<\/p>\n

Further improvements, Berlowitz says, \u201cwill require considerable effort on the part of clinicians, both to understand why hypertension control is not being achieved in individual patients and in determining how best to improve control in these smaller subpopulations.\u201d<\/p>\n

He notes that expected changes to national guidelines for systolic blood pressure thresholds will pose additional challenges.<\/p>\n

\u201cWhile the hypertension community has much to be proud of, there still is a long way to go,\u201d he concludes.<\/p>\n

Berlowitz\u2019 work was supported by the Edith Nourse Rogers Memorial VA Medical Center in Bedford.<\/p>\n

\u2014Lisa Chedekel<\/a><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

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