SAN FRANCISCO, CA — Primary-care practices using the "MAP" hypertension quality-improvement program saw improved blood-pressure control in their patients in just 6 months[1].

MAP is an acronym that stands for:

  • Measure blood pressure accurately every time it's measured.

  • Act rapidly to manage uncontrolled blood pressure.

  • Partner with patients to promote blood-pressure self-management.

"The MAP improvement program was adopted by a diverse group of ambulatory-practice settings in the real world. It's an easy-to-implement improvement approach that is minimally disruptive to existing practice workflows and can create big improvement in blood-pressure control in short periods of time—months, not years," study author Dr Michael Rakotz (American Medical Association, Chicago, IL) told theheart.org | Medscape Cardiology.

The MAP BP improvement program is a central part of Target: BP, a joint initiative between the American Heart Association (AHA) and the American Medical Association (AMA) aimed at reducing the number adults who die each year from MI and stroke.

"Clinical guidelines typically recommend a large number of actions to manage each disease condition. In fact, estimates suggest that primary-care physicians would spend nearly 22 hours each day implementing evidence-based guidelines," said study presenter Dr Brent M Egan (University of South Carolina School of Medicine, Greenville).

"The MAP program focuses on an accurate BP, intensifying treatment when an elevated BP is confirmed, and partnering with the patient in selecting and carrying out the treatment plan. MAP focuses on three key factors that are known to significantly impact BP control, and it works," Egan told theheart.org | Medscape Cardiology.

The study was presented September 16 at the 2017 American Heart Association (AHA) Council on Hypertension, AHA Council on Kidney in Cardiovascular Disease, American Society of Hypertension Joint Scientific Sessions.

Pre-/Postintervention

For this analysis, the research team used a quasi experimental, pre-/postintervention study design to compare BP measurements taken at baseline and 6 months after the MAP intervention in roughly 21,000 hypertensive patients from 16 practices.

With MAP, office staff are trained to measure BP accurately. If the initial office BP is ≥140/90 mm Hg, three unattended automated office BP measurements are obtained, and the average of the readings is entered into the health record. BP control is defined as an automated office reading of <140/90 mm Hg.

The act-rapidly protocol includes intensification of antihypertensive medication when unattended automated office BP is ≥140/90 mm Hg. Partnering with patients includes helping patients to control their BP through self-monitoring and use of low-priced generic antihypertensive medications.

Over 6 months, MAP was associated with significant improvement in hypertension control, from 65.6% to 74.8% in participating practices. In patients with uncontrolled BP at baseline, average BP fell from 149/85 mm Hg to 139/80 (P<0.001), Egan reported.

The observed decrease in systolic BP (-12.8 mm Hg) and improved control were largely explained by "measure accurately" and "partner with patients," as therapeutic inertia ("act rapidly") did not change, he noted. There was no notable change in physicians increasing the number of or dosage of antihypertensive medications to treat patients with uncontrolled blood pressure.

"Any clinic interested in improving BP control would do well to master the three steps of measuring BP accurately, prescribing adequate treatment to control BP, and partnering with the patient (patient-centered care) in treatment selection, adherence, and follow up," Egan told theheart.org | Medscape Cardiology.

"I believe that all practices would find benefits from implementing the MAP improvement program," added Rakotz.

"Of course, where practices choose to focus will vary," he added. "Some may already be doing improvement work in hypertension in some of the focus areas in the MAP improvement program. It is very unlikely, though, that they will have covered all three areas, including all of the components contained within each of the three main focus areas."

Egan has disclosed relationships with Boehringer Ingelheim, AstraZeneca, Inside Edge, Medtronic, and Valencia. Rakotz has no relevant financial relationships.

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