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| |  Study Shows Hypertension Management Needs Improvement BOSTON, MA -- Dec. 30, 1998 -- According to a new study by the United States Department of Veterans Affairs (VA) and Boston University School of Medicine (BUSM) researchers, doctors may not be aggressive enough in managing hypertension. Results of the study appear in tomorrow’s issue of The New England Journal of Medicine. The VA/BUSM study found physicians failed to increase or start new antihypertension therapies in patients with high blood pressure, although they had ample opportunity (an average of six medical visits per year) to do so. Increases in therapy occurred in only seven percent of those visits. "We found wide differences in the intensity of treatment that hypertension patients received," said lead author Dan Berlowitz, MD, MPH, associate director of the VA Center for Health Quality, Outcomes and Economic Research at the VA New England Health Care System and an associate professor of medicine at BUSM. "Furthermore, those patients receiving more intensive therapy had significantly better blood pressure control.” Berlowitz and his colleagues, including co-author Mark Moskowitz, MD, chief of the section of general internal medicine at Boston Medical Center and professor of medicine and public health at BUSM, examined hypertension care provided to 800 predominately elderly, white, male veterans from five VA medical centres over a two-year period. Approximately 40 percent of these patients had elevated blood pressure readings of 160/90 mmHg or greater. The connection between treatment intensity and blood pressure control was of primary concern in the study. The study's major finding was the failure of physicians to increase medication despite evidence of higher blood pressure readings. The authors believe these findings are probably applicable to the general population. "We can all agree that hypertension is a condition that needs to be treated and the failure to do so results in serious consequences,” Moskowitz said. “Yet our study clearly demonstrates that physicians are not aggressively treating hypertension or taking the simple, necessary steps to reduce high blood pressure in a patient.” "If we are to improve hypertension care, we need to understand how physicians practice in the real world,” Berlowitz said. “This study actually looked at how physicians managed the disease and whether treatment decisions affect blood pressure control.” The research team could not exactly pinpoint why doctors delayed increases in medication, but based on some of the study results, it was hypothesised that patient and physician expectations do play a role. Lack of access to care and medication costs were ruled out as possible causes for less aggressive treatment. They did, however, acknowledge that their data on patient adherence to prescribed therapy was limited and that this may have some impact on the reluctance to change hypertension treatment. Because so many clinical trials have proven the efficacy of treating hypertension to prevent cardiovascular disease and stroke, the study findings are significant in their call to physicians to reassess their treatment for and management of hypertensive patients. "We've shown that improved blood pressure control is possible,” Berlowitz said. “Poor control can no longer be attributed just to the lack of access or non-adherence to drug therapies." Physicians may want to examine their practices during individual encounters with these patients and identify cases where a more aggressive approach would be appropriate.
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