Blood pressure control best achieved with a multilevel, multicomponent approach

Originally Published By 2 Minute Medicine®. Reused on Clinical Advisor with permission.
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1. Team-based, multilevel implementation strategies were the most effective at reducing systolic blood pressure (BP).

2. Team-based care with medication titration by non-physicians, health coaching, and home BP monitoring shown to be effective at improving diastolic BP among patients.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Hypertension is the leading risk factor for cardiovascular disease (CVD). Current clinical guidelines recommend lower BP targets for the general population; however, achieving these targets remains challenging. In fact, BP rates have not changed for the past 40 years. Evidently, developing better strategies for BP control is paramount to reducing the rates of CVD. The authors of this study, therefore, conducted a meta-analysis to compare effectiveness of different BP reduction strategies involving both physician-led and non-physician-led strategies. It was observed that multilevel, multicomponent approaches resulted in the best BP control. This study is limited with respect to its patient population demographics. Little data was acquired from low-to-middle income countries (LMICs). As hypertension remains a major contributor to morbidity and mortality within LMICs, better data from these countries will be necessary to evaluate how to best control BP within other settings. One of the strengths of this study lie in its methodology, where no language restrictions were included in the meta-analysis, potentially resulting in more robust data collection. In general, the results of this study may be utilized to inform different organizations to improve efforts of achieving population BP targets.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Community-based interventions in hypertensive patients: a comparison of three health education strategies

In-Depth [meta-analysis]: The authors identified a total of 6697 references that underwent full text review, of which 100 articles, with a total of 121 comparisons, met inclusion criteria and were included in the final analysis. It was observed that the 3 multilevel BP control implementation strategies included in this meta-analysis were the most effective for decreasing systolic BP. In particular, multilevel strategies with team-based care resulted in the greatest systolic BP reduction (change, -7.1 mmHg [CI, -8.9 to -5.2 mmHg]; p < 0.001). Physician and multi-level strategies were still effective at reducing systolic BP, but less effective than when team-based strategies were included. Team-based care with medication titration by a non-physician also had the greatest improvement in diastolic BP (change, -3.1 mmHg [CI, -4.1 to -2.2 mmHg]; p < 0.001). Other effective strategies for reducing diastolic BP included health coaching, home BP monitoring, and electronic decision-support systems.

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