Hypertension, or high blood pressure, increases the risk of heart attacks, stroke and even death. Patients can avoid these serious health effects by lowering their blood pressure (BP) by using medications and adjusting their diets. Unfortunately, the blood pressure of almost half of the Americans who have hypertension is above the recommended goals set by professional groups and their doctors.

Well-funded healthcare systems are generally able to lower BP levels and keep them under control in as many as 90 percent of their patients. It's a different story at “safety-net” clinics in poorer areas with fewer resources. Not only are socioeconomically disadvantaged populations more likely to have hypertension, they are more likely to develop hypertension early in life, and to have uncontrolled hypertension, than other segments of the population.

Cardiovascular disease is the leading cause of death in the world, and it particularly affects low-income populations and minorities. So it makes a good case study for ways chronic diseases can be monitored and treated when funding is an issue.

Closing these gaps in blood pressure treatment among those with hypertension-related conditions could prevent tens of thousands of cardiovascular events and deaths annually and save billions of dollars. Researchers from the University of California, San Francisco set out to develop a simplified intervention program to monitor and lower patients' blood pressure that could significantly improve rates of BP control in safety-net clinics.

As Kirsten Bibbins-Domingo, senior author on the study, said in a statement, “We know what works, but we need to adapt our strategies to the communities that need it most.”

The researchers modified a treatment program to fit the needs of patients seen in the San Francisco Health Network (SFHN), a group of 12 clinics catering to poorer patients and run by the San Francisco Department of Public Health. Aspects of patients’ domestic situations which could make it hard for them to monitor medication use and blood pressure were taken into account, as were food insecurity and health conditions that could increase the risk of side effects from medications.

Simplifying Treatment and Cutting Costs

The team came up with a treatment plan that saved money and improved monitoring in a number of ways:

1. They encouraged the use of drugs that combine two or more medicines in one pill. This means fewer trips to the pharmacy for patients, and a treatment regimen that is simpler and easier to manage for both patients and doctors.

2. To minimize the financial burden of treatment, they used blood pressure medications that insurers who commonly covered SFHN patients reimbursed.

3. Pharmacists and nurses took all BP measurements and transmitted them to patients' doctors. This gave patients access to regular monitoring without having to see a doctor, and it gave doctors regular blood pressure readings they had confidence in, allowing them to be proactive in adjusting patients’ medications when they did have an appointment. As Valy Fontil, the study's first author, put it, “We took some things out of the doctors' hands so that they could concentrate on patient care.”

At first the program was tested in one pilot clinic. Blood pressure control rates across all racial and ethnic groups at the site increased from 68 percent to 74 percent, over 24 months. Based on these promising initial results, the program, dubbed Bring it Down San Francisco, was expanded to all 12 SFHN locations. The control rates increased from 69 percent to 74 percent over a 15-month period at these clinics, too.

Cardiovascular disease is the leading cause of death in the world, and it particularly affects low-income populations and minorities, said Fontil, an assistant professor of medicine at the University of California, San Francisco. So it makes a good case study for ways chronic diseases such as diabetes and kidney disease can be monitored and treated, even when funding is an issue.

The study is published in Circulation: Cardiovascular Quality and Outcomes.