How to best manage HTN in the population? VA vs Regular Care vs etc.

[Guest guest]

What we need is a randomized controlled trial of HTN treatment in VA and by the usual health care team. The NIH funded Hypertension Detection and Followup Program (HDFP) did a proper study of this in a different way. They randomized patients with clear HTN to either the NIH "special care" program or sent folks back to their personal MD "usual care". The special care program was free and patients were seen by nurses specially trained in BP measurement and management. The average time of visit from the time of signing to leaving with BP meds in had was 30 minutes. They did recheck the BP on those referred back to their regular source of care and it the BP was elevated notified their Dr that BP was not under control but did not intervene.At the end of 5 years the special care group had had 17% fewer deaths from all causes in those going to the special care HTN clinics Note this was 30 years ago. We did not have BB, ACEs, ARBs, CCBs or renin inhibitors and few took spironolactone.How many ways do we know how to reduce all causes of death in 80 million people (HTN) in the US?For more details do a PUBMED on HDFP study.If interested recommend downloading and reading this article completely. Drs I have taught since time have been assigned this as required reading. CE Grim MDThe first report is below;JAMA. 1979 Dec 7;242(23):2562-71.Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program ative Group.[No authors listed]AbstractThe Hypertension Detection and Follow-up Program (HDFP), in a community-based, randomized controlled trial involving 10,940 persons with high blood pressure (BP), compared the effects on five-year mortality of a systematic antihypertensive treatment program (Stepped Care [sC]) and referral to community medical therapy (Referred Care [RC]). Participants, recruited by population-based screening of 158,906 people aged 30 to 69 years in 14 communities througout the United States, were randomly assigned to SC or RC groups within each center and by entry diastolic blood pressure (DBP) (90 to 104, 105 to 114, and 115 + mm Hg). Over the five years of the study, more than two thirds of the SC participants continued to receive medication, and more than 50% achieved BP levels within the normotensive range, at or below the HDFP goal for DBP. Controls of BP was consistently better for the SC than for the RC group. Five-year mortality from all causes was 17% lower for the SC group compared to the RC group (6.4 vs 7.7 per 100, P less than .01) and 20% lower for the SC subgroup with entry DBP of 90 to 104 mm Hg compared to the corresponding RC subgroup (5.9 vs 7.4 per 100, P less than .01). These findings of the HDFP indicate that the systematic effective management of hypertension has a great potential for reducing mortality for the large numbers of people with high BP in the population, including those with "mild" hypertension. I think it is the people who are uninsured that wants this "doling that mediocrity out to everyone" Even if s thinks he is not getting the 'best', at least it is something. Hell, I had supposedly the best insurance for 15 years Blue Cross and Blue Shield and got mediocre service. I still say it is the doctor and not the plan administrator. I always find it interesting that people that have insurance, private, medicaid or medicare are against everyone else being covered. I have worked at VA's and private hospitals and the outcome 's are nearly the same. Phyllis 3.) About not being able to get proper treatment through the government program you're in, it figures, and it boggles my mind to think people want government doling that mediocrity out to everyone. Whatever happened to doctors treating patients? Val