Monday, December 2, 2013

What Works in Colorado: Hypertension Clinics

Over one million Coloradans have high blood pressure, or hypertension. High blood pressure is one of the most important risk factors for developing heart disease or having a stroke, which, together account for 1 in 4 deaths in our state every year.

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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