Christianne L. Roumie, MD, MPH; Tom A. Elasy, MD, MPH; Robert Greevy, PhD; Marie R. Griffin, MD, MPH; Xulei Liu, MD, MS; William J. Stone, MD; Kenneth A. Wallston, PhD; Robert S. Dittus, MD, MPH; Vincent Alvarez, MD; Janice Cobb, RN; Theodore Speroff, PhD
Grant Support: By the Veterans Affairs Clinical Research Center of Excellence (Drs. Roumie, Elasy, Greevy, Griffin, Dittus, and Speroff); VA Career Development Award 04-342-2 (Dr. Roumie); HSR&D Targeted Research Enhancement Program Center for Patient Healthcare Behavior TRP 03-073 (Drs. Roumie, Elasy, Greevy, Griffin, Wallston, Dittus, Alvarez, and Speroff and Ms. Cobb); Geriatric Research Education and Clinical Center, Veterans Affairs, Tennessee Valley Healthcare, Nashville, Tennessee (Drs. Roumie, Elasy, Griffin, Wallston, Dittus, and Speroff); and Health Services Research–VISN Cooperative Grant for Improving Implementation of Best Practices (IMV 04-091-1) (Drs. Roumie, Wallston, Alvarez, and Speroff and Ms. Cobb).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Christianne L. Roumie, MD, MPH, Tennessee Valley Healthcare System, 1310 24th Avenue South, GRECC 4A120, Nashville, TN 37212; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Roumie, Elasy, Griffin, Stone, Alvarez, and Speroff and Ms. Cobb: Tennessee Valley Healthcare System, 1310 24th Avenue South, GRECC 4A120, Nashville, TN 37212.
Drs. Greevy and Liu: Vanderbilt University, 1161 21st Avenue South, S-2323 MCN, Nashville, TN 37232.
Dr. Wallston: Vanderbilt University, 421 Godchuk Hall, Nashville, TN 37240.
Dr. Dittus: Vanderbilt University, 1215 21st Avenue South, Suite 6000, Medical Center East, Nashville, TN 37232.
Author Contributions: Conception and design: C.L. Roumie, T.A. Elasy, M.R. Griffin, W.J. Stone, K.A. Wallston, R.S. Dittus, V. Alvarez, J. Cobb, T. Speroff.
Analysis and interpretation of the data: C.L. Roumie, T.A. Elasy, R. Greevy, M.R. Griffin, X. Liu, K.A. Wallston, R.S. Dittus, T. Speroff.
Drafting of the article: C.L. Roumie, R. Greevy.
Critical revision of the article for important intellectual content: C.L. Roumie, T.A. Elasy, R. Greevy, M.R. Griffin, X. Liu, W.J. Stone, K.A. Wallston, R.S. Dittus, V. Alvarez, J. Cobb, T. Speroff.
Final approval of the article: C.L. Roumie, T.A. Elasy, R. Greevy, M.R. Griffin, X. Liu, W.J. Stone, K.A. Wallston, R.S. Dittus, V. Alvarez, J. Cobb, T. Speroff.
Provision of study materials or patients: V. Alvarez, J. Cobb.
Statistical expertise: R. Greevy, X. Liu, T. Speroff.
Obtaining of funding: T.A. Elasy, M.R. Griffin, R.S. Dittus, T. Speroff.
Administrative, technical, or logistic support: T.A. Elasy, M.R. Griffin, W.J. Stone, R.S. Dittus, V. Alvarez, J. Cobb, T. Speroff.
Collection and assembly of data: C.L. Roumie, V. Alvarez, J. Cobb.
Clinicaltrials.gov Identifier: NCT00265044
Roumie C., Elasy T., Greevy R., Griffin M., Liu X., Stone W., Wallston K., Dittus R., Alvarez V., Cobb J., Speroff T.; Improving Blood Pressure Control through Provider Education, Provider Alerts, and Patient Education: A Cluster Randomized Trial. Ann Intern Med. 2006;145:165-175. doi: 10.7326/0003-4819-145-3-200608010-00004
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Published: Ann Intern Med. 2006;145(3):165-175.
Currently, more than 50 million persons in the United States have hypertension (1). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) promotes blood pressure goals of less than 140/90 mm Hg (2-5). Providers, however, often delay changes in therapy or use higher blood pressure thresholds for the treatment of hypertension ((2), (4), (6-7)), which leads to a variance in guideline adherence that contributes to a quality gap in care. Despite widespread guideline promotion, 65% of persons in the United States have poorly controlled hypertension ((1), (6), (8-9)).
Munir E Nassar
An academician, without portfolio
August 2, 2006
Comments on importance of drug therapy for hypertension
It is interesting to read the paper of Christianne, L. Roumie,Tom A. and co-workers, and the "importance of improving blood pressure control through provider education...",(Ann Intern Med 2006;145:165-175), however primary care physicians and healthcare providers may be lulled that this is a completely satisfactory treatment along with monodrug therapy in treating hypertension.In addition the paper leaves a lot to be desired as far as follow up and feed back. Hence, it is important to emphasize the following points extracted from the 7th report of the Joint Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension : That drug treatment, and combination of drugs is most important to control Hypertension. Monotherapy (various individual drug therapy) showed control on average in 50 % of patients at the end of one year. Age appears to be an important factor in increasing the risk of elevating the Systolic Blood pressure Hence, combination drug therapy up to three or four drugs appear to be necessay to satisfactorily control blood pressure.
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Cardiology, Nephrology, Hypertension, Coronary Risk Factors, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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