The quarterback of hypertension control – how’s the score look?

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Hypertension has been and still is a significant public health problem.  Today’s Vital Signs  from the Centers for Disease Control and Prevention highlights the magnitude of the problem and provides some common sense approaches to improve the poor performance on the part of the healthcare delivery system.  One of our story reviewers on, Harold DeMonaco, read a quote from the director of the CDC in a story in USA Today that inspired this guest blog post.  Here are DeMonaco’s thoughts:


Dr. Thomas Frieden is quoted as saying, “…major progress could be made with pharmacists, nurse practitioners, physicians and other health care providers working together with the doctor “as the quarterback.” Webster’s Dictionary defines the quarterback as, “a person who leads or directs a group or activity.”

I am not a sports fan and only occasionally watch football games.  But even with my limited understanding of the game, I don’t think that a quarterback who only completes 50% of his passes would stay in the game for very long.  That’s just about the hypertension control rate that the physician “quarterbacks” are capable of achieving at the moment.  While it has improved over the past decade, the rate of success is pretty poor.  The reasons for the poor showing are likely complex and exist on both sides of the exam table.

Patients with chronic illness deal with the disease on a daily basis.  Management of hypertension requires dedication and perseverance on the part of the patient and their family members.  Life style changes along with medication compliance and adherence are required for decades if the value of treatment is to be realized.  Most patients with hypertension see their physician twice a year, are not provided with any real education on the disease or necessary lifestyle changes.  Further, most are not encouraged or taught how to self monitor their blood pressure.  Unlike the quarterback in a game, the physician is not at the patient’s side on a daily basis.  So, while the physician may be the head coach, it is really the patient calling the plays.

The CDC is trying to change the approach with its Team Up Pressure Down program.  It remains to be seen if the program is truly different or merely rearranges the proverbial deck chairs.  Einstein’s definition of insanity comes to mind: “Doing the same thing over and over again and expecting different results.”

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