Depending on definition 30% to 46% of the world’s popuation has hypertension. It is a primary risk factor for MI, stroke, CHF, A Fib, CRD, and vascular dementia. It causes $76 Billion of the $351 Billion/year spent on cardiovascular disease. It generates 42 Million outpatient visits/year in the US. Even as dangerous, expensive and time consuming as it is, only 48.3% are controlled. More than 20% are mislabeled and more than 20% are misdiagnosed. With A4M’s decision support you can do much better for your patients.
The A4M CDST addresses 5 major obstacles to BP control:1
1. Lifestyle issues
Obesity, drugs (oral contraceptives, NSAIDs, alcohol) sedentary lifestyle.
2. Compliance / Adherence
Patient & Provider compliance to a relatively asymptomatic problem is suboptimal.
3. Diagnostic inertia
Failure to recognize secondary causes.
4. Therapeutic inertia
Failure to increase meds when goals are not reached or match the drug to the mechanism of HTN.
5. Large time commitment, 14,000,000 provider hours per year in US.
TeAM-HTN2 was a feasability study of the CDST published in Military Med. Sept 2020. The program of peak diurnal home BP monitoring with every10-day reminders, templated Virtual Visists, a diagnsotic Matrix and a drug sequencing algorithm improved control rates in resistant HTN (rHTN) from 0% to 58%. 45% of patients were mislabeled with apparent resistant HTN (white coat HTN-high in the office but normal at home and were excluded from the study), 20% had AM masked HTN (high in AM but normal in PM) and 22% had PM masked HTN. 45% of resistant patients had abnormal renin and aldosterone levels. Overall the rate of control for all “uncontrolled patients” (apparent resistant HTN and rHTN) was 76%. Provider management time was reduced by 75% compared to “usual care”. This study empahsizes the importance of definiton and measurement of HTN using peak durnal home BP monitoring to exclude white coat HTN and identifiy masked HTN.
1. Spence JD. Controlling resistant hypertension. Stroke and Vascular Neurology. 2018;0:e000138. doi: 10.1136/svn-2017-00013
2. Leilani A Siaki, PhD, FNP-BC, FAANP, AN, USA, Victor LIN, MD, MS, MC, USN, Robert Marshall, MD, MPH, MISM, FAAFP, FAMIA (CAPT USN Ret), Robert Highley, MD, MPH, FACC emeritus, CEO & Medical Director A4M. Feasibility of a Clinical Decision Support Tool to Manage Resistant Hypertension: Team-HTN, a Single-arm Pilot Study. Military Medicine, usaa255, https://doi.org/10.1093/milmed/usaa255