A Key to Improved Heart Health

This month we have included several articles focusing on the pharmacy management of cardiovascular disease. Cardiovascular disease is a major cost driver for employers, health plans, healthcare consumers, and society as a whole. We need to ask ourselves why this array of conditions is so hard to successfully treat.

Let’s focus on hypertension as an example. Hypertension affects up to 1 in 3 of US adults. It costs in excess of $73 billion annually. Left untreated or inadequately treated, hypertension can lead to stroke, heart attacks, kidney disease, and death. Nonetheless, in February 2010 the Institute of Medicine stated that we are failing miserably in controlling the condition. Although there may be many reasons why this is so, 3 explanations come to mind at once.

First is that prevention is probably the best way to treat hypertension. With little exception, prevention of heart disease begins and ends with lifestyle modifi cation. As any of us who have made that annual New Year’s resolution to modify our diet and exercise know, these are hard promises to keep. All 3 major stakeholders—payers, patients, and providers—have a responsibility in this area.

The second reason that we seem to be stymied by this condition is the lack of focus on “the numbers.” Many of us check our blood pressure only when we go to our physician’s office. Patients with a known diagnosis of hypertension often don’t know what their blood pressure numbers are or what they mean, or the implications of these numbers. Physicians may play a role in their patients’ lack of knowledge. How many of us have heard these words? “I’ll let you know if there is a problem.” “Your blood pressure is improving.” “We need to change your medicine because your blood pressure is still high.” As you notice, the actual numbers are never discussed.

The third reason that this condition is hard to combat relates to medication adherence. Several drugs, many of them generic, are used to treat hypertension. If physicians would prescribe generics as first-line treatments and if patients understood that their blood pressure can be largely controlled by these less costly medications, cost would rarely be a significant factor in adherence. I am not saying that the brand medications have no role in treating hypertension. I am saying that brand medications should not be a first-line choice. I also am not saying cost is the only barrier to medication adherence. In fact, it is rarely the primary reason. Those of you who have heard me speak on medication adherence know that my research has found upward of 30 reasons for nonadherence. However, cost is a contributor and one that can be easily addressed.

Recent studies have shown that hypertension can be better controlled when healthcare consumers are actively engaged in their own care. Active engagement could mean several things. Patients could regularly check their blood pressure and share those results with their provider or others on their healthcare team (including friends and family) through the use of technology. Education could be provided in ways that patients understand and that are in line with their own healthcare beliefs. Patients could even self-titrate medications with the support of their physician. We need to get serious and look at these and other unique programs to help us to control one of the most common and expensive conditions in the United States.