$3.7 million to improve high blood pressure control

The National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, has launched a $3.7 million, three-year educational effort to improve high blood pressure control nationwide.

About 150 physicians in 34 states and Washington, DC, have completed training to educate other physicians in their communities with the goal: of helping doctors and patients prevent and better treat high blood pressure.

The new public information campaign is a follow-up to the landmark Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) and is being implemented in collaboration with the National High Blood Pressure Education Program (NHBPEP).

ALLHAT, the largest clinical trial of hypertension treatment ever conducted, is based at The University of Texas School of Public Health at Houston. Study findings first announced in 2002 showed that diuretics - rather than newer, more expensive drugs such as ACE inhibitors, calcium channel blockers, or beta-blockers - should be preferred as a first therapy for most patients with high blood pressure.

"The key is to get the results out to the medical community and to patients with high blood pressure, so both can understand and apply the benefits of being on a diuretic and controlling hypertension," said ALLHAT principal investigator Barry R. Davis, M.D., Ph.D., professor of biostatistics and director of the Coordinating Center for Clinical Trials at the UT School of Public Health.

In the outreach program, "investigator educators" will lead small, face-to-face educational sessions with their physician peers. Educators are asked to make at least one presentation per month. The sessions include discussions of the study results, current hypertension treatment guidelines, and common concerns in clinical practice.

Each educator receives training, presentation slides and handouts, and materials such as posters and brochures for clinicians to use in their offices. The educators expect to reach nearly 30,000 physicians by Sept. 2006.

The campaign also provides materials to encourage patients to ask their health care providers about their blood pressure control and the medicines they take. Brochures, recipe books, and other tools to help patients adopt healthier lifestyles are also available.

An estimated 65 million American adults - nearly one in three - have high blood pressure. For more than two-thirds of them, blood pressure remains out of control. High blood pressure leads to more than half of all heart attacks, strokes, and heart failure cases in the United States each year, and it increases the risk of kidney failure and blindness.

"Possibly, we could save 40,000 to 50,000 serious illnesses per year, including heart failures and strokes, if people with high blood pressure or those newly diagnosed with high blood pressure have a diuretic incorporated into their regimen or started on a diuretic," Davis said.

Davis said that ALLHAT's landmark findings will have a great impact beyond improving cardiovascular health. As diuretics generally cost less per pill than the other drugs, prescribing them first could dramatically reduce health care costs.

Analyses of prescribing trends suggest that prescriptions for diuretics have slowly begun to rise since the study ended and clinical guidelines have encouraged the use of diuretics either alone or in combination with other blood-pressure lowering medications.

"The guidelines were simplified and strengthened to emphasize the most effective ways to control blood pressure - starting with lifestyle changes and including diuretics when medication is needed," said Jeffrey Cutler, MD, NHLBI senior advisor and ALLHAT project director.