In just a decade, Kaiser Permanente was able to double the percentage of Northern California patients who got their high blood pressure down to healthy levels, using a deceptively simple program that involved close monitoring and the use of cheaper, more efficient drugs.
Results of the program were published Tuesday in the Journal of the American Medical Association. Over the course of an eight-year study, the percentage of patients with high blood pressure who had it under control increased from 44 percent in 2001 to 80 percent in 2009.
The rate continued to climb after the study ended, and as of 2011, 87 percent of patients had their high blood pressure at healthy levels. That's about as close to perfect as any health care provider could expect to get, said doctors at Kaiser and other institutions.
"We focused on things that make care more convenient to patients - alternatives to the traditional way of patients visiting the doctor, giving them c reative options, offering medications that are easy to take and effective," said Dr. Marc Jaffe, lead author of the high blood pressure study and head of the Kaiser Northern California Cardiovascular Risk Reduction Program.
"I'm excited to see how this model plays out" in programs outside of Kaiser, Jaffe said.
A general decline
Control of high blood pressure has improved both across the nation and the state over the past decade, although not as remarkably as it has at Kaiser. In the United States, about 64 percent of people with high blood pressure have it under control; in California, about 69 percent of patients are under control.
High blood pressure, or hypertension, affects about 65 million adults in the United States, or about 29 percent of all adults. It's a main cause of cardiovascular disease and can contribute to heart attacks and strokes. During the years of the Kaiser study, the number of heart attacks and strokes fell su bstantially, although Jaffe said it's impossible to say that was a direct result of the efforts to control high blood pressure.
Doctors have long known how to improve high blood pressure - mainly through healthy eating, plenty of exercise and reduced stress. And drugs that are proven to be effective have been widely prescribed and available for decades.
But high blood pressure - much like diabetes, high cholesterol and other conditions that may require patients to make lifestyle changes and to adhere to daily medications - has remained difficult to treat.
"Anyone can Google and find out what the solution is to high blood pressure," Jaffe said. "But getting that solution to the right person, getting that person the help they need and encouraging them to be successful - that takes a deliberate, ongoing and persistent effort."
The project
The Kaiser program began with the creation of a registry of all Northern California members d iagnosed with high blood pressure, which is considered any reading higher than 140 over 90.
The number of patients included on the registry climbed dramatically during the study, from 350,000 in 2001 - or 15 percent of the total adult membership - to 653,000, or 28 percent, in 2009. Most of that increase came from doctors being made aware of the registry and adding their patients to it, although there also was an increase in diagnoses, Kaiser researchers said.
In addition to creating the registry, Kaiser designed a formal process for providing feedback to physicians about how their patients were doing in controlling their high blood pressure. Kaiser also developed a new system allowing patients to visit medical assistants, and not doctors, more frequently and at no cost to get regular blood pressure checks.
About halfway through the study, Kaiser also switched to a generic pill that combined two common drugs used to treat high blood pressure. The two-in-one pill is less expensive, and easier to swallow, for patients than taking two separate pills, and that likely led to increased medication adherence, the Kaiser researchers said.
Diet and exercise
Dr. Don Conkling, a 63-year-old Kaiser member who was part of the study, managed to get his blood pressure into a normal, healthy range for the first time since his early 40s. He lost about 60 pounds, cut out sugar and meat from his diet, and started walking several times a day, often for miles at a time, with his dog Sophie. Conkling, a veterinarian in San Bruno, also meditates every day for 45 minutes or longer to help reduce stress from his job.
Not all patients have to make such drastic lifestyle changes to lower their blood pressure, Conkling said. But what helped him the most, he said, was simply feeling part of a team - made up of his primary care doctor, nurses, medical assistants and Conkling himself - focused on one goal.
"My high b lood pressure was something I was aware of for a long time. But I kind of needed somebody to boot me in the seat to motivate me," Conkling said. "I needed someone to tell me that this is something you need to do, and that you have do have the ability to fix it."
Erin Allday is a San Francisco Chronicle staff writer. E-mail: eallday@sfchronicle.com
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