Simulating Strategies for Improving Control of Hypertension Among Patients with Usual Source of Care in the United States: The Blood Pressure Control Model

Journal of General Internal Medicine
Valy FontilMark J Pletcher

Abstract

Only half of hypertensive adults achieve blood pressure (BP) control in the United States, and it is unclear how BP control rates may be improved most effectively and efficiently at the population level. We sought to compare the potential effects of system-wide isolated improvements in medication adherence, visit frequency, and higher physician prescription rate on achieving BP control at 52 weeks. We developed a Markov microsimulation model of patient-level, physician-level, and system-level processes involved in controlling hypertension with medications. The model is informed by data from national surveys, cohort studies and trials, and was validated against two multicenter clinical trials (ALLHAT and VALUE). We studied a simulated, nationally representative cohort of patients with diagnosed but uncontrolled hypertension with a usual source of care. We simulated a base case and improvements of 10 and 50%, and an ideal scenario for three modifiable parameters: visit frequency, treatment intensification, and medication adherence. Ideal scenarios were defined as 100% for treatment intensification and adherence, and return visits occurring within 4 weeks of an elevated office systolic BP. BP control at 52 weeks of follow-up was e...Continue Reading

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Citations

Dec 19, 2015·American Heart Journal·Kevin FiscellaJonathan N Tobin
Dec 23, 2016·Journal of the American Heart Association·Jing FangFleetwood Loustalot
Jun 6, 2019·Circulation. Cardiovascular Quality and Outcomes·Brandon K BellowsValy Fontil
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May 22, 2020·The Journal of Clinical Hypertension·Bharat NarangFrancesca Gany
Jul 23, 2020·Journal of the American Heart Association·Kelsey B BryantBrandon K Bellows
Mar 24, 2021·Journal of the American Heart Association·Timothy S AndersonKirsten Bibbins-Domingo
Apr 16, 2021·Circulation·Kelsey B BryantBrandon K Bellows

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