Physicians Neglecting Hypertension Guidelines : An IOM report suggests hypertension 'has dropped off the radar screen. It's time to bring it back on.'

WASHINGTON — Poor physician adherence to hypertension treatment guidelines is a significant reason why hypertension is undiagnosed and uncontrolled at “alarming rates” in the United States, according to an Institute of Medicine report.

Multiple studies have shown that physicians are not providing treatment consistent with the current Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure guidelines. In particular, physicians are less aggressive about treating older patients, who are most likely to have the condition and who do benefit from therapy. They also are less aggressive in treating isolated systolic hypertension, according to the report.

“We really didn't find any information about why clinicians are not adhering to the most recent guidelines,” commented Dr. Corinne Husten, a member of the Committee on Public Health Priorities to Reduce and Control Hypertension in the U.S. Population, which wrote the report.

“It was quite striking, actually, that physicians do a pretty good job at controlling diastolic blood pressure…. It's systolic blood pressure that they're not aggressively treating, and especially isolated systolic hypertension,” she said at a briefing announcing their findings.

In the report, which was sponsored by the Centers for Disease Control and Prevention, the authors urge the CDC to give high priority to research on guideline adherence, and then to work with accreditation programs, providers, and health care quality organizations to improve providers' adherence to such recommendations.

The IOM committee urged the CDC to move away from a focus on individual and health care–based approaches in favor of taking population- and systems-based approaches that encourage people to lower their sodium intake, increase consumption of potassium, lose weight, and increase physical activity.

The CDC must ensure, they continued, that such population-based efforts—from those involving industry to various state and local projects—are properly targeting those at greatest risk. It also must work with health insurance plans and the Medicare and Medicaid programs to find ways to eliminate or reduce deductibles and co-pays for antihypertensive medications.

“This is where, in a time of limited resources, there's the greatest bang for the buck,” said Dr. David W. Fleming, who chaired the committee.

About three-quarters of Americans already recognize the importance of having their blood pressure checked, leading Dr. Fleming to emphasize that “we're not simply calling for better health education of the public.”

For example, the committee suggested that the CDC consider advocating for “greater use of potassium/sodium chloride combinations.”

In a recent report from the CDC, only about 2% of adults met the current guidelines for dietary potassium intake. Furthermore, more than 8 in 10 Americans consume more salt than is recommended, said Dr. Fleming, director of the department of public health in Seattle and a former deputy director of the CDC.

One in three Americans have hypertension, according to the IOM report, which calls hypertension a “neglected disease.” The disorder accounts for about one in six adult deaths annually, triggering more than one-third of heart attacks and almost half of heart failures.

Hypertension “has dropped off the radar screen,” Dr. Fleming said at the briefing. “It's time to bring it back on.”

Data show that 85% of individuals with uncontrolled hypertension have insurance and visit their physicians, the report noted.

Physicians may not adhere to current recommendations due to a lack of awareness about them or because they don't realize guidelines have been updated. Some physicians may still be waiting for patients to reach the previous 160 mm Hg/95 mm Hg thresholds before treating systolic and diastolic blood pressure, respectively. Current guidelines recommend starting treatment if systolic blood pressure is greater than 140 mm Hg or diastolic blood pressure is greater than 90 mm Hg. Physician may also doubt the benefit of treatment, or may have concerns about drug side effects.

Dr. Husten was executive vice president for program and policy at the Partnership for Prevention in Washington during her work with the committee and has recently been appointed senior medical adviser to the Center for Tobacco Products at the Food and Drug Administration.

Disclosures: All committee members were screened and do not have any conflicts of interest, according to an IOM spokesperson.

WASHINGTON — Poor physician adherence to hypertension treatment guidelines is a significant reason why hypertension is undiagnosed and uncontrolled at “alarming rates” in the United States, according to an Institute of Medicine report.

Multiple studies have shown that physicians are not providing treatment consistent with the current Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure guidelines. In particular, physicians are less aggressive about treating older patients, who are most likely to have the condition and who do benefit from therapy. They also are less aggressive in treating isolated systolic hypertension, according to the report.

“We really didn't find any information about why clinicians are not adhering to the most recent guidelines,” commented Dr. Corinne Husten, a member of the Committee on Public Health Priorities to Reduce and Control Hypertension in the U.S. Population, which wrote the report.

“It was quite striking, actually, that physicians do a pretty good job at controlling diastolic blood pressure…. It's systolic blood pressure that they're not aggressively treating, and especially isolated systolic hypertension,” she said at a briefing announcing their findings.

In the report, which was sponsored by the Centers for Disease Control and Prevention, the authors urge the CDC to give high priority to research on guideline adherence, and then to work with accreditation programs, providers, and health care quality organizations to improve providers' adherence to such recommendations.

The IOM committee urged the CDC to move away from a focus on individual and health care–based approaches in favor of taking population- and systems-based approaches that encourage people to lower their sodium intake, increase consumption of potassium, lose weight, and increase physical activity.

The CDC must ensure, they continued, that such population-based efforts—from those involving industry to various state and local projects—are properly targeting those at greatest risk. It also must work with health insurance plans and the Medicare and Medicaid programs to find ways to eliminate or reduce deductibles and co-pays for antihypertensive medications.

“This is where, in a time of limited resources, there's the greatest bang for the buck,” said Dr. David W. Fleming, who chaired the committee.

About three-quarters of Americans already recognize the importance of having their blood pressure checked, leading Dr. Fleming to emphasize that “we're not simply calling for better health education of the public.”

For example, the committee suggested that the CDC consider advocating for “greater use of potassium/sodium chloride combinations.”

In a recent report from the CDC, only about 2% of adults met the current guidelines for dietary potassium intake. Furthermore, more than 8 in 10 Americans consume more salt than is recommended, said Dr. Fleming, director of the department of public health in Seattle and a former deputy director of the CDC.

One in three Americans have hypertension, according to the IOM report, which calls hypertension a “neglected disease.” The disorder accounts for about one in six adult deaths annually, triggering more than one-third of heart attacks and almost half of heart failures.

Hypertension “has dropped off the radar screen,” Dr. Fleming said at the briefing. “It's time to bring it back on.”

Data show that 85% of individuals with uncontrolled hypertension have insurance and visit their physicians, the report noted.

Physicians may not adhere to current recommendations due to a lack of awareness about them or because they don't realize guidelines have been updated. Some physicians may still be waiting for patients to reach the previous 160 mm Hg/95 mm Hg thresholds before treating systolic and diastolic blood pressure, respectively. Current guidelines recommend starting treatment if systolic blood pressure is greater than 140 mm Hg or diastolic blood pressure is greater than 90 mm Hg. Physician may also doubt the benefit of treatment, or may have concerns about drug side effects.

Dr. Husten was executive vice president for program and policy at the Partnership for Prevention in Washington during her work with the committee and has recently been appointed senior medical adviser to the Center for Tobacco Products at the Food and Drug Administration.

Disclosures: All committee members were screened and do not have any conflicts of interest, according to an IOM spokesperson.

WASHINGTON — Poor physician adherence to hypertension treatment guidelines is a significant reason why hypertension is undiagnosed and uncontrolled at “alarming rates” in the United States, according to an Institute of Medicine report.

Multiple studies have shown that physicians are not providing treatment consistent with the current Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure guidelines. In particular, physicians are less aggressive about treating older patients, who are most likely to have the condition and who do benefit from therapy. They also are less aggressive in treating isolated systolic hypertension, according to the report.

“We really didn't find any information about why clinicians are not adhering to the most recent guidelines,” commented Dr. Corinne Husten, a member of the Committee on Public Health Priorities to Reduce and Control Hypertension in the U.S. Population, which wrote the report.

“It was quite striking, actually, that physicians do a pretty good job at controlling diastolic blood pressure…. It's systolic blood pressure that they're not aggressively treating, and especially isolated systolic hypertension,” she said at a briefing announcing their findings.

In the report, which was sponsored by the Centers for Disease Control and Prevention, the authors urge the CDC to give high priority to research on guideline adherence, and then to work with accreditation programs, providers, and health care quality organizations to improve providers' adherence to such recommendations.

The IOM committee urged the CDC to move away from a focus on individual and health care–based approaches in favor of taking population- and systems-based approaches that encourage people to lower their sodium intake, increase consumption of potassium, lose weight, and increase physical activity.

The CDC must ensure, they continued, that such population-based efforts—from those involving industry to various state and local projects—are properly targeting those at greatest risk. It also must work with health insurance plans and the Medicare and Medicaid programs to find ways to eliminate or reduce deductibles and co-pays for antihypertensive medications.

“This is where, in a time of limited resources, there's the greatest bang for the buck,” said Dr. David W. Fleming, who chaired the committee.

About three-quarters of Americans already recognize the importance of having their blood pressure checked, leading Dr. Fleming to emphasize that “we're not simply calling for better health education of the public.”

For example, the committee suggested that the CDC consider advocating for “greater use of potassium/sodium chloride combinations.”

In a recent report from the CDC, only about 2% of adults met the current guidelines for dietary potassium intake. Furthermore, more than 8 in 10 Americans consume more salt than is recommended, said Dr. Fleming, director of the department of public health in Seattle and a former deputy director of the CDC.

One in three Americans have hypertension, according to the IOM report, which calls hypertension a “neglected disease.” The disorder accounts for about one in six adult deaths annually, triggering more than one-third of heart attacks and almost half of heart failures.

Hypertension “has dropped off the radar screen,” Dr. Fleming said at the briefing. “It's time to bring it back on.”

Data show that 85% of individuals with uncontrolled hypertension have insurance and visit their physicians, the report noted.

Physicians may not adhere to current recommendations due to a lack of awareness about them or because they don't realize guidelines have been updated. Some physicians may still be waiting for patients to reach the previous 160 mm Hg/95 mm Hg thresholds before treating systolic and diastolic blood pressure, respectively. Current guidelines recommend starting treatment if systolic blood pressure is greater than 140 mm Hg or diastolic blood pressure is greater than 90 mm Hg. Physician may also doubt the benefit of treatment, or may have concerns about drug side effects.

Dr. Husten was executive vice president for program and policy at the Partnership for Prevention in Washington during her work with the committee and has recently been appointed senior medical adviser to the Center for Tobacco Products at the Food and Drug Administration.

Disclosures: All committee members were screened and do not have any conflicts of interest, according to an IOM spokesperson.