Hypertension clinics offer a
specialized approach to high blood pressure management, particularly for those
whose blood pressure is resistant to control. Denver Health’s Eastside Adult Medicine
Clinic is a hypertension clinic serving high-risk clients with hypertension.
To find out why this was an effective
approach to hypertension management in Colorado, we talked with Joel C. Marrs, PharmD and Sarah L. Anderson,
PharmD, both of the University of Colorado Skaggs School of Pharmacy and
Pharmaceutical Sciences and Denver Health Medical Center; and Rebecca Hanratty, MD, of the Denver Health
Medical Center and the University of Colorado School of Medicine.
Tell us about the organization.
Denver Health (DH) is an integrated,
efficient, high-quality health care system serving as a model for other safety
net institutions across the nation. The
Eastside Adult Medicine Clinic is one of DH’s federally qualified healthcare
centers (FQHC). A resistant hypertension
clinic was developed in 2010 by two clinical pharmacy specialists at the
Eastside Adult Medicine Clinic.
What did you do?
We developed a clinical pharmacy
specialist hypertension clinic focused on patients with resistant hypertension.
It is an effective way to improve BP goal attainment in this high-risk
population. This approach can increase
the utilization of recommended antihypertensive medications such as
chlorthalidone, spironolactone, and mixed alpha-beta blockers.
What was your goal?
Our goal was to determine whether a
clinical pharmacy specialist (CPS) Resistant hypertension (HTN) clinic is an
effective way to improve blood pressure goal attainment in patients with
documented resistant hypertension. We evaluated the change in blood pressure from
pre- to post-CPS intervention via the Resistant Hypertension Clinic along with
prescribed antihypertensive medications.
Describe your intervention. How did you
accomplish your goal?
Patients were referred to the CPS
hypertension clinic during 2011 if they were prescribed 3 or more
antihypertensive medications and were not at their blood pressure goal; this
was how we defined resistant hypertension. Patients seen in the CPS hypertension
clinic had their blood pressure assessed and antihypertensive therapy modified
in order to achieve their targets. Most
patients needed to be seen multiple times in hypertension clinic in order to
achieve their blood pressure goal.
What were the outcomes of your intervention or
process and did you reach your goal?
The average blood pressure at the
first visit in the CPS hypertension clinic was 146/86 ± 20/13 mm Hg compared to
138/80 ± 17/11 mm Hg at the last visit (p < 0.0001). Blood pressure goal attainment had improved
to 43.7% by the end of 2011 compared to baseline (p = 0.0261). Most patients (46/87) had diabetes mellitus
and/or chronic kidney disease.
What are your next steps or future plans?
Next steps are to expand this CPS hypertension
clinic module to other Denver Health Federally Qualified Healthcare Clinics to
optimize blood pressure control across the Denver Health system in patients
with and without resistant hypertension.
What
advice would you give to a provider, clinic or partner seeking to replicate
what you’ve done?
A key piece to the success of this CPS
HTN clinic module was the structured referral process which included triggers
for patients on at least 3 antihypertensive medications and not at goal. Secondly, setting up a system to evaluate pre
and post values in order to show benefit over time as it relates to blood
pressure control.
What was your biggest lesson learned?
One of the biggest lessons learned
through the development of the CPS hypertension clinic was the complex nature
of reasons for lack of blood pressure control which ranged from socioeconomic
to cultural to chronic co-morbidities as reasons for lack of blood pressure
control.
How can partners contact you to learn more?
Joel.marrs@ucdenver.edu
or (303)724-5780
Denver Health Medical Center, University of Colorado School of Medicine and Skaggs School of Pharmacy are partners in Colorado’s Million Hearts Initiative, an effort to prevent 1 million heart attacks and strokes over five years. You can participate too. Be one in a million - make your commitment and pledge today.
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