Programs that use a team-based approach to care and multiple resources, including an evidence-based hypertension treatment algorithm, are needed to effectively control high blood pressure, according to a new scientific advisory from the ACC, American Heart Association, and the Centers for Disease Control and Prevention published Nov. 15 in the Journal of the American College of Cardiology.

The advisory is a call to action for health care systems and providers to work in closer partnership with patients, and recommends the prioritization of patients with high blood pressure who are receiving treatment but haven’t achieved their target blood pressure. According to the advisory, "for most people, the goal is <140 and <90; however, lower targets may be appropriate for some populations such as African-Americans, the elderly, or patients with left ventricular (LV) hypertrophy, systolic or diastolic LV dysfunction, diabetes mellitus or chronic kidney disease."

Specifically, the advisory encourages use of enhanced, evidence-based, blood pressure treatment systems for providers, including standardization of protocols and algorithms, incentives for improved performance based on achieving and maintaining patients at blood pressure goals, and technology-facilitated clinical decision support and feedback.

The key principles recommended for creating an effective hypertension management algorithm include:

1. Base algorithm components and processes on the best available science.
2. Format to be simple to update as better information becomes available.
3. Create feasible, simple implementation strategy.
4. Include patient version at appropriate scientific and language literacy level.
5. Consider costs of diagnosis, monitoring, treatment.
6. Develop algorithm in format easily used within a team approach to health care.
7. Develop algorithm in a format able to be incorporated into electronic health records for use as clinical decision support.
8. Include a disclaimer to ensure that the algorithm is not used to counter the treating health care provider’s best clinical judgment.

"The tools to control blood pressure have long been available, but hypertension control requires patient and physician involvement within a supportive system," said John Gordon Harold, MD, MACC, president of the ACC. "We are advocating a team approach that reduces barriers for patients and leverages the power of electronic health records to improve cardiovascular health."

The statement authors add that moving forward, "arming health care providers, health systems, and communities with proven tools, algorithms, strategies, programs, and other best practices along with expertise and technical assistance for improving blood pressure awareness, treatment, and control is essential to reducing the tremendous burden of cardiovascular risk."

Keywords: Centers for Disease Control and Prevention, U.S., Electronic Health Records, Delivery of Health Care, Cardiovascular Diseases, Risk Factors, Hypertrophy, Hypertension, Systole, Diabetes Mellitus, Renal Insufficiency, Chronic