No copays, easier pills may reduce blood pressure

CHICAGO — New research suggests giving patients easier-to-take medicine and no-copay medical visits can help drive down high blood pressure, a major contributor to poor health and untimely deaths nationwide.

Those efforts were part of a big health care provider’s eight-year program, involving more than 300,000 patients with high blood pressure. At the beginning, less than half had brought their blood pressure under control. That increased to a remarkable 80 percent, well above the national average, the researchers said.

The research involved Kaiser Permanente in Northern California, a network of 21 hospitals and 73 doctors’ offices, which makes coordinating treatment easier than in independent physicians’ offices.

The number of heart attacks and strokes among Northern California members fell substantially during roughly the same time as the 2001-09 study. Dr. Marc Jaffe, the lead author and leader of a Kaiser heart disease risk reduction program, said it’s impossible to know if the blood pressure program can be credited for those declines, but he thinks it at least contributed.

Reductions continued even after the study ended; in 2011, 87 percent of roughly 350,000 Kaiser patients had recommended blood pressure levels.

The study was published Tuesday in the Journal of the American Medical Association.

“What’s unique about this is the sheer scale of what they’ve done,” said Dr. Goutham Rao, a family medicine specialist at NorthShore University HealthSystem, a group of four hospitals in Chicago’s northern suburbs. Rao is involved in research on reducing obesity and other risks for heart disease.

“If we were able to keep everyone’s blood pressure under control in the United States, the number of new strokes and heart attacks would go down just exponentially,” he said.

High blood pressure affects 1 in 3 U.S. adults, or 67 million people, and the condition caused or contributed to more than 348,000 deaths in 2009, according to the Centers for Disease Control and Prevention.

Normal blood pressure is considered a reading of less than 120 over 80; high blood pressure is 140 over 90 or higher. High blood pressure typically causes no symptoms, at least initially, and can sometimes be managed with a healthy lifestyle, including physical activity plus avoiding salty foods, heavy drinking and excess weight. But two or more prescription drugs are often needed to bring high blood pressure under control.

In 2001, the Kaiser group introduced a system-wide program involving its 1,800 primary care doctors to tackle the problem. It created a registry of adult members with high blood pressure, based on medical records.

At the start, about 44 percent of 235,000 registry patients had their blood pressure under control. The registry grew and by 2009, the portion under control reached 80 percent of 353,000 patients. That compares to 64 percent of people with blood pressure problems nationwide.

Two features likely played a big role in the program’s success: In 2005, the region started using a single generic pill combining two common blood pressure drugs, lisinopril and a diuretic. The pill is less expensive than taking the two medicines separately, and easier to use.

And in 2007, the program began offering free follow-up visits with medical assistants, rather than doctors, checking blood pressure readings. Besides charging no insurance copayment, these brief visits were available at more flexible times, increasing chances that patients would stick with the program.

“Patients really liked it because it was shorter, more convenient and more affordable,” Jaffe said. He did not provide information on patients’ costs or overall program costs and said that wasn’t part of the study.

Donna Arnett, president of the American Heart Association, said “it’s well documented that compliance to medication increases” when it’s simpler to take. She said the results suggest that other large medical systems could adopt similar programs and achieve similar success.

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Local News

A firefighter stands in silence before a panel bearing the names of L. John Regelbrugge and Kris Regelbrugge during the ten-year remembrance of the Oso landslide on Friday, March 22, 2024, at the Oso Landslide Memorial in Oso, Washington. (Ryan Berry / The Herald)
‘Flood of emotions’ as Oso Landslide Memorial opens on 10th anniversary

Friends, family and first responders held a moment of silence at 10:37 a.m. at the new 2-acre memorial off Highway 530.

Julie Petersen poses for a photo with images of her sister Christina Jefferds and Jefferds’ grand daughter Sanoah Violet Huestis next to a memorial for Sanoah at her home on March 20, 2024 in Arlington, Washington. Peterson wears her sister’s favorite color and one of her bangles. (Annie Barker / The Herald)
‘It just all came down’: An oral history of the Oso mudslide

Ten years later, The Daily Herald spoke with dozens of people — first responders, family, survivors — touched by the deadliest slide in U.S. history.

Victims of the Oso mudslide on March 22, 2014. (Courtesy photos)
Remembering the 43 lives lost in the Oso mudslide

The slide wiped out a neighborhood along Highway 530 in 2014. “Even though you feel like you’re alone in your grief, you’re really not.”

Director Lucia Schmit, right, and Deputy Director Dara Salmon inside the Snohomish County Department of Emergency Management on Friday, March 8, 2024, in Everett, Washington. (Ryan Berry / The Herald)
How Oso slide changed local emergency response ‘on virtually every level’

“In a decade, we have just really, really advanced,” through hard-earned lessons applied to the pandemic, floods and opioids.

Ron and Gail Thompson at their home on Monday, March 4, 2024 in Oso, Washington. (Olivia Vanni / The Herald)
In shadow of scarred Oso hillside, mudslide’s wounds still feel fresh

Locals reflected on living with grief and finding meaning in the wake of a catastrophe “nothing like you can ever imagine” in 2014.

Everett mall renderings from Brixton Capital. (Photo provided by the City of Everett)
Topgolf at the Everett Mall? Mayor’s hint still unconfirmed

After Cassie Franklin’s annual address, rumors circled about what “top” entertainment tenant could be landing at Everett Mall.

Everett
Everett man sentenced to 3 years of probation for mutilating animals

In 2022, neighbors reported Blayne Perez, 35, was shooting and torturing wildlife in north Everett.

Dorothy Crossman rides up on her bike to turn in her ballot  on Tuesday, Aug. 1, 2023 in Everett, Washington. (Olivia Vanni / The Herald)
Everett leaders plan to ask voters for property tax increase

City officials will spend weeks hammering out details of a ballot measure, as Everett faces a $12.6 million deficit.

Starbucks employee Zach Gabelein outside of the Mill Creek location where he works on Friday, Feb. 23, 2024 in Mill Creek, Washington. (Olivia Vanni / The Herald)
Mill Creek Starbucks votes 21-1 to form union

“We obviously are kind of on the high of that win,” store bargaining delegate Zach Gabelein said.

Lynnwood police respond to a collision on highway 99 at 176 street SW. (Photo provided by Lynnwood Police)
Police: Teen in stolen car flees cops, causes crash in Lynnwood

The crash blocked traffic for over an hour at 176th Street SW. The boy, 16, was arrested on felony warrants.

The view of Mountain Loop Mine out the window of a second floor classroom at Fairmount Elementary on Wednesday, Jan. 10, 2024 in Everett, Washington. (Olivia Vanni / The Herald)
County: Everett mining yard violated order to halt work next to school

At least 10 reports accused OMA Construction of violating a stop-work order next to Fairmount Elementary. A judge will hear the case.

Imagine Children's Museum's incoming CEO, Elizabeth "Elee" Wood. (Photo provided by Imagine Children's Museum)
Imagine Children’s Museum in Everett to welcome new CEO

Nancy Johnson, who has led Imagine Children’s Museum in Everett for 25 years, will retire in June.

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.