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New Concepts in Hypertension Management: A Population-Based Perspective
Richard V Milani1, Carl J Lavie1, Jonathan K Wilt1
1Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - University of Queensland School of Medicine, and the Center for Healthcare Innovation, Ochsner Health System, New Orleans, Louisiana.
Insights
Improving hypertension control requires new care models. Utilizing patient data, social determinants, and integrated teams can overcome barriers like therapeutic inertia and low engagement for better population-level blood pressure management.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Public Health
Background:
- Hypertension (HTN) affects millions, with suboptimal blood pressure (BP) control in about 50% of U.S. patients.
- Current office-based care models are insufficient, hindered by therapeutic inertia and low patient engagement.
- Effective population-level HTN management remains a significant public health challenge.
Purpose of the Study:
- To review the limitations of current hypertension care models.
- To propose a reengineered model for population-based HTN management.
- To highlight key components for transforming HTN care delivery.
Main Methods:
- Literature review on current HTN care models and emerging strategies.
- Analysis of factors contributing to poor BP control.
- Synthesis of evidence supporting new care delivery elements.
Main Results:
- Standard care models demonstrate suboptimal outcomes in population-level BP control.
- Therapeutic inertia and low patient engagement are primary barriers.
- New models integrating patient-generated data and multidisciplinary teams show promise.
Conclusions:
- Reengineered care models are essential for improving population-based HTN control.
- Key elements include patient-generated health data, social determinant assessment, algorithmic interventions, and integrated practice units.
- A shift towards proactive, patient-centered, and data-driven approaches is critical for success.
Abstract:
Hypertension (HTN) is the most common chronic disease in the U.S., and the standard model of office-based care delivery has yielded suboptimal outcomes, with approximately 50% of affected patients not achieving blood pressure (BP) control. Poor population-level BP control has been primarily attributed to therapeutic inertia and low patient engagement. New models of care delivery utilizing patient-generated health data, comprehensive assessment of social health determinants, computerized algorithms generating tailored interventions, frequent communication and reporting, and non-physician providers organized as an integrated practice unit, have the potential to transform population-based HTN control. This review will highlight the importance of these elements and construct the rationale for a reengineered model of care delivery for populations with HTN.
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Hypertension II: Pathophysiology

