Late-breaking new science presented Nov. 13 during AHA 2021 provided closer looks at the effectiveness of population strategies for hypertension management, as well as the benefits of focused local and regional programs using tactics like village doctors or digital monitoring. Another study looked at the impacts of the COVID-19 pandemic on patients with hypertension.

In a review of recent studies assessing population-based strategies, Anushka Patel, MBBS, SM, PhD, and colleagues found the common approach of starting hypertension patients on a first drug at a low dose, increasing that dose incrementally over two to three visits, and then adding a second medication at an even later date is a "recipe for under-treatment."

Their findings, suggest newer strategies involving initial or early fixed-dose dual combination therapy, evidence-based algorithms using clinical guideline recommendations, and medical assistant visits are increasingly being recommended and/or tested. They also note these strategies tend to foster greater patient engagement and involvement.

While the challenge of inadequate blood pressure management remains a problem for large populations globally, Patel, et al., note that progress is being made towards "potentially truly population-wide effective interventions." They add that "future focus on scalability and sustainability is needed."

A separate study of nearly 34,000 adults in 326 villages in three provinces in rural China showed success in treating patients with hypertension using "village doctors" armed with basic medical training, a simple standard protocol and health coaching, and offered an example of a localized management program that could be used as a model for elsewhere in the world.

A total of 57% of adults in the village doctor intervention group had blood pressure levels lower than 130/80 mm Hg, compared to 20% in the usual care group, while 77% of participants in the intervention group had blood pressure levels lower than 140/90 mm Hg, compared to 45% in the group who received usual care. Systolic and diastolic blood pressure levels were reduced 26.3 mm Hg and 14.6 mm Hg, respectively, from baseline to 18 months in the intervention group, compared to an average decrease of only 11.8 mm Hg for systolic blood pressure and 7.5 mm Hg for diastolic blood pressure in the usual care group.

"The magnitude of blood pressure reduction in the patients who were in the intervention group is quite impressive," said lead study author Jiang He, MD, PhD. "These results indicate the village doctor-led intervention was effective and is a feasible and sustainable implementation strategy that could be scaled up to achieve more intensive blood pressure control among people with hypertension in rural China and other low- and middle-income countries with limited health care access."

Another study out of the MassGeneral Brigham health system in Boston and led by Alexander J. Blood, MD, and Christopher P. Cannon, MD, FACC, demonstrated success with using a remote, algorithm-driven management program to improve hypertension and LDL-cholesterol (LDL-C) levels in high-risk patients. The free program monitored hypertension in patients identified by referral or electronic health records to be in need of hypertension management and LDL-C optimization using WiFi, cellular and Bluetooth devices.

According to the researchers, the program reduced the need for in-person visits and helped to optimize clinician time, while also demonstrating the ability to deliver "equitable remote care across traditionally underserved populations."

In another study of 1.7 million hypertension patients across 24 U.S. health systems, researchers led by Alanna M. Chamberlain, PhD, MPH, found a substantial decrease in blood pressure control during the COVID-19 pandemic that was also accompanied by a corresponding reduction in follow-up health care visits from patients with uncontrolled hypertension.

According to Chamberlain, et al., there was large variability across health systems in terms of blood pressure control metrics, meaning there is also substantial opportunity for improvement. They stress the need for continued surveillance to determine whether the decline in blood pressure control will result in future adverse cardiovascular events.

Clinical Topics: COVID-19 Hub, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Stable Ischemic Heart Disease, Hypertension, Chronic Angina

Keywords: AHA Annual Scientific Sessions, American Heart Association, AHA21, Hypertension, Metabolic Syndrome, Primary Prevention, Angina, Stable, Dyslipidemias, Blood Pressure, COVID-19, SARS-CoV-2, ACC International

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