By – Gilad Glick
According to latest CDC data, 1 in 3 American adults suffers from hypertension[1], and only about 54% have their condition under control[2]. This is surprising, given the extensive research on Hypertension as a cardiovascular risk factor and the wide variety of hypertensive drugs available. Patients also have numerous home BP measurement devices they can use. Despite all this, cardiologists and primary care providers still struggle with drug-resistant hypertension or simply badly controlled blood pressure.
Recently the AHA launched a major initiative called TargetBP committed to reducing the number of Americans with uncontrolled blood pressure. TargetBP focuses on 3 key areas with M.A.P framework: M-Measurement – accurate measurement every time; A- Action taken rapidly to address high readings; and P – Partnering with patients, families and communities to promote self-management. The program uses latest science in blood pressure control and has already shown promising results.
Starting at home
There are simple actions you can take today to improve the way hypertension is managed and how patients self-manage their condition and they both can be done at home: (1) Get blood pressure measured at home and (2) control for Sleep Apnea
Help your patients accurately measure their Blood Pressure at home
The American Heart Association recommends home monitoring for all hypertensive patients to help healthcare providers determine whether treatments are effective. And accurate measurement is at the heart of TargetBP.
The advantages of blood pressure home monitoring are known. Self-tracking of blood pressure helps empower patients to take ownership of their treatment. Clinically, a single reading at the doctor’s office is not enough, as blood pressure fluctuates and one measurement is not enough to ascertain patient’s response to medication. “White-coat” syndrome leading to higher readings at the doctor’s office is another reason to add home monitoring, where the patient is more relaxed.
Recently, though, a study in the American Journal of Hypertension showed that some home monitors can be quite inaccurate.[3]
This is the reason why many cardiologists now encourage patients to bring their automated blood pressure devices to their clinic visits once or even twice to measure their accuracy against the clinic-standard manual measurement. While they do this, patients learn how to accurately use the device.
TargetBP prepared a set of educational materials to help clinicians communicate with their patients and teach them about proper BP measurement and management:
7 simple tips to get an accurate blood pressure reading
Other TargetBP resources for patients can be found here.
Screen your patients for Sleep Apnea
And for patients at risk – refer to a home sleep test
Sleep Apnea is a major comorbidity to hypertension. In fact, sleep apnea was found in 83% of adults with drug-resistant hypertension.[4]
A meta-analysis published in the Journal of Hypertension in 2014 suggests that untreated sleep apnea may be a major factor in why medications appear to be less effective in reducing high blood pressure in some people. Further, the study shows that CPAP therapy may be the key to helping those with difficult to treat hypertension get their blood pressure under control.[5]
Already in 2008, Prof. VK Somers and colleagues published the AHA/ACCF scientific statement, Sleep Apnea and Cardiovascular disease. This statement was published by the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing, in collaboration with NIH.[6]
In this statement, authors review the evidence related to Sleep Apnea and CVD and proposed to treat OSA as an independent risk factor for the development of essential hypertension, since it can precede and predict the onset of hypertension (as demonstrated in the Wisconsin Sleep Cohort Study, which noted a consistent OSA-BP dose-response relationship, even after controlling for age, sex, BMI, and antihypertensive medications).6
Authors also noted that the weight of evidence has led the most recent Joint National Committee on the Detection and Management of Hypertension to identify OSA as an important identifiable cause of hypertension. 6
Also in 2008, AHA’s scientific statement: Resistant Hypertension: Diagnosis, Evaluation, and Treatment, listed Obstructive sleep apnea as a common secondary cause of resistant hypertension. It also recommended to screen for obstructive sleep apnea as a first step in screening for secondary causes of resistant hypertension. “Obstructive sleep apnea should be treated if present” according to statement. Treatment by CPAP is recommended, with the largest benefit in patients with severe sleep apnea and in patients already receiving antihypertensive treatment.[7]
You can easily identify patients at risk for sleep apnea with basic STOP-BANG questionnaire and can prescribe a home sleep test or an in-lab study when necessary. It’s also very easy to use our HIPAA-compliant Cloud-PAT platform to share the report with a sleep specialist or pulmonologist and get the interpretation.
Our simple screening methods can be easily integrated into any cardiac care pathway. Watch Prof. David Vorchheimer talk about his experience in successfully implementing CardioSleepSolutions in the cardiology clinics he manages.
We have tailored our solutions to suit all cardiologists and clinics of all sizes.
Contact us to arrange a discussion with one of our users or reps.
And just as a patient easily measures blood pressure at home, our WatchPAT home sleep test is one of the easiest most convenient sleep apnea tests on the market, while providing excellent clinically-validated data.
References:
[1] Merai R, Siegel C, Rakotz M, Basch P, Wright J, Wong B; DHSc., Thorpe P. CDC Grand Rounds: A Public Health Approach to Detect and Control Hypertension. MMWR Morb Mortal Wkly Rep. 2016 Nov18;65(45):1261-1264
[2] Yoon SS, Fryar CD, Carroll MD. Hypertension Prevalence and Control Among Adults: United States, 2011-2014. NCHS data brief, no 220. Hyattsville, MD: National Center for Health Statistics; 2015.
[3] Ringrose J et al; An Assessment of the Accuracy of Home Blood Pressure Monitors When Used in Device Owners, American Journal of Hypertension, Volume 30, Issue 7, 1 July 2017, Pages 683–689
[4] Logan AG et al, High prevalence of unrecognized sleep apnoea in drug-resistant .J Hypertension. 2001 Dec;19(12):2271-7.
[5] Iftikhar I et al, Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis, Journal of Hypertension: December 2014 – Volume 32 – Issue 12 – p 2341–2350
[6] Somers VK et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation scientific statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. Circulation. 2008;118:1080–1111.
[7] Calhoun et al, Resistant Hypertension: Diagnosis, Evaluation, and Treatment A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;51:1403-1419