AHA: Step Care Hypertension Algorithm Gets Patients to Goals

ORLANDO, Nov. 8 -- The use of a simplified, four-step algorithm was more effective in getting Canadian patients to blood pressure goals than following the nation's guidelines, researchers found.After six months, 64.8% of patients in practices where the algorithm was followed achieved blood pressure control compared with only 52.7% of patients in practices using guideline-directed care to lower high blood pressure (P=0.03), Ross Feldman, M.D., of the University of Western Ontario in London, Ontario, told attendees at the American Heart Association meeting here.
Action Points
Point out that this study only followed patients for 6 months and longer follow-up is necessary to validate the findings.
Note that this study was published as an abstract at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed publication.
"We felt that the complexity of the guidelines for the treatment of hypertension might be a barrier to effective therapy," Dr. Feldman said.
So he and colleagues recruited 45 family practices in southwestern Ontario -- for a total of 2,104 patients -- to participate in the Simplified Therapeutic Intervention to Control Hypertension (STITCH) program. The Canadian Hypertension Education guidelines, which include 12 options for hypertension management, were followed by 27 practices; the other 18 were provided a simplified algorithm:
Initiate therapy with a half-tab, low-dose combination of either an angiotensin-converting enzyme inhibitor/diuretic or an angiotensin receptor blocker/diuretic.
After one month, increase the dosage of the combination to the highest tolerated dose if hypertension goals have not been achieved.
Add a calcium channel blocker and increase to the highest tolerated dose.
Add one of the non-first line antihypertensive agents.
Typically, said Dr. Feldman, doctors and patients met each month until blood pressure control was achieved. The researchers evaluated how well each practice did in getting patients to the hypertensive goal.
In Canada, overall, it is estimated that about 15% of patients with hypertension are treated to control. In the United States, perhaps one-third of people with high blood pressure are being treated to control, Dr. Feldman said.
He noted that the Canadian guidelines and United States guidelines are similar.
While acknowledging differences in the health care delivery system between the U.S. and Canada, Robert Bonow, M.D., chief of cardiology at Northwestern University, and a past president of the American Heart Association, said, "I think a simple algorithm is quite helpful. We certainly are not doing that great."
Dr. Bonow said the he would be interested to see if the patients in the Canadian study were still controlled after a year or two. He said a six-month finding is encouraging but further follow-up is needed.
Dr. Bonow disclosed possible financial conflicts of interest with Bristol-Myers Squibb Medical Imaging and Edwards Lifesciences. Dr. Feldman disclosed possible financial conflicts of interest with Bayer, Pfizer, Merck, Boehringer-Ingelheim, GlaxoSmithKline, Solvay, Servier, and sanofi-aventis.
Primary source: American Heart Association Meeting 2007Source reference: Feldman R, "Simplified Therapeutic Intervention to Control Hypertension (STITCH) Trial: Final Results" AHA Meeting 2007.