Implementation of a large-scale hypertension program was associated with a significant increase in hypertension control compared with state and national control rates, according to a new study published in the Journal of the American Medical Association.

In 2001, Kaiser Permanente in Northern California (KPNC) established a multifaceted hypertension program that included “a comprehensive hypertension registry, development and sharing of performance metrics, evidence-based guidelines, medical assistant visits for blood pressure measurement, and single-pill combination pharmacotherapy.”

Between 2001 when the program was established and 2009, the hypertension control rates within KPNC nearly doubled from 43.6 percent to 80.4 percent. The total number of patients included in the registry also increased from 349,937 to 652,763. Moreover, the hypertension control rates among KPNC patients continued to improve after 2009 from 83.7 percent in 2010 to 87.1 percent in 2011, according to the study authors.

In contrast, the study authors noted only modest improvements in hypertension control statewide and nationally. The mean U.S. national hypertension control rates increased from 55.4 percent to 64.1 percent from 2001 to 2009 (p = 0.24) and the California-wide control rates increased from 63.4 percent to 69.4 percent between 2006 and 2009 (p = 0.37).

The authors highlighted several possible reasons behind the success of the hypertension program, including the fact that “single-pill combinations have important advantages, including improved adherence and lower patients cost.” They also credit regularly scheduled performance feedback reports for facilitating the identification of high-performing medical centers “in which successful practices or innovations were identified and then disseminated program-wide.” Finally, they pointed out that while feedback at the clinician level has long been touted as a means to promote change, focusing on clinical-level feedback was able to bring about operational and system-level change.

Keywords: Blood Pressure, Feedback, Blood Pressure Determination, Hypertension