These 8 drivers of BP control reflect study of high-performing health systems and the strategies that have led to successful large scale hypertension management.
Elevated systolic blood pressure (BP) is the most significant modifiable risk factor that contributes to the impact of cardiovascular disease (CVD) on premature morbidity and mortality. Equally significant is the size of the gap in diagnosis, treatment, and control of hypertension worldwide, including in high-income countries. (Please begin slides)
Driver #1. BP measurement accuracy. Incorrect measurement techniques and/or use of inaccurate BP measurement device (BPMD) are common in clinical practice.
Improve BP measurement accuracy by retraining on BP measurement technique regularly and taking a second measurement if the first is high.
BP Control Driver #2. CVD risk assessment
Improve BP control by assessing CVD risk in all patients with hypertension to guide BP goal and frequency of follow-up.
BP Control Driver #3. Standardized treatment protocols lacking
Establish a standardized hypertension treatment protocol that prescribes specific medications and doses and includes initial treatment with FDC.
BP Control Driver #4. Treatment intensification. Clinical inertia contributes to significant delay in medication intitation and intensification
Improve hypertension treatment intensification by starting medication immediatly upon diagnosis and following standardized medication protocol thereafter.
BP Control Driver #5. Continuity of care & follow-up. Poor outcomes associated with delayed follow-up after clinic visit with elevated BP.
Improve continuity of care for hypertension and follow-up by adhering to shortest recommended intervals for evaluation after diagnosis.
BP Control Driver #6. Team-based care & task-shifting
Improve efficacy of team-based care by shifting tasks where possible to nonphysician health care workers, under supervision and guided by protocol.
BP Control Driver #7. Medical refill frequency
Improve medication adherence by implementing standard 3-month refill intervals for all BP medication prescriptions.
BP Control Driver #8. Peformance evaluation with feedback
Improve clinician/system peformance evaluation with process measures that include regular standardized reporting of quality metrics and feedback mechanisms.