When it comes to managing high blood pressure, Canadian doctors have found that a simple treatment strategy is best.
Dr. Ross Feldman of the University of Western Ontario in London says new approaches to treating high blood pressure, or hypertension, are badly needed because even the guideline-recommended strategies aren’t working for many people. “Despite the fact hypertension is easy to diagnose and there are very effective therapies … only about one in three patients with high blood pressure actually achieves a blood pressure target.”
Feldman and his colleagues randomly assigned more than 2,000 southern Ontario residents to standard high blood pressure treatment or a simplified regimen called STITCH, for Simplified Treatment Intervention to Control Hypertension.
After six months, nearly 65 per cent of STITCH patients had reached blood pressure targets compared with only 53 per cent of guideline-treated patients.
In the STITCH regimen, patients are started on a low-dose combination of a diuretic and either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. If blood pressure is still too high, three additional treatment steps provide for dosage increases and the addition of further blood pressure medications. The STITCH protocol is much simpler than guideline recommendations, which can provide up to a dozen therapy options, Feldman says.
“It’s becoming clear that how we prescribe drugs is a significant issue and presents a significant barrier in managing these patients,” he says. “From a patient perspective, we know that the more complex a dosing regimen is, the more likely patients are not to take the medication … (and) health-care professionals in busy family practices, especially in primary care, are faced with having increasingly complex treatment regimens and more choices to manage hypertension.”