As you may have read in the latest edition of the Fruit Street Physician, the
MGPO Blood Pressure: Less is More project is successfully underway. This
project is a collaborative effort between the MGPO, Preventive Cardiology and
Primary Care Operations Improvement to measure and help improve hypertension
care at MGH. Thus far, we have held four screening programs at the MGH and the
Charlestown Navy Yard, visited eleven Primary Care Practices to introduce the
project and gain feedback, and conducted chart reviews of hypertension care
in the MGPO.
We would like to take this opportunity to highlight a few important aspects of our project.
An employee screening will be held this March for Food and Nutrition Services and the Environmental Services departments. Departments interested in holding a blood pressure screening for their employees may contact us at the number below. We can provide you with educational documents and information on how to set up and advertise for the screening.
We will be conducting another screening in April that will be held in the main corridor of the White building and this will be open to everyone. We are again asking for volunteers. If there are any nurses, nurse practitioners, or medical assistants willing to volunteer any of their time to this screening, please call the number below.
The Blood Pressure: Less is More project advocates the guidelines for goal blood pressures as well as the therapeutic approach of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The designation of different blood pressure goals for different risk groups is an important new concept. We hope to make caregivers more aware of this aspect of these guidelines. In the presence of diabetes, renal failure or heart failure, the goal blood pressure should be less than 130/85, and in the presence of proteinuria of more than 1 g/day, blood pressure should be 125/75. More frequent use of thiazides and beta blockers should be considered because of their proven efficacy and their cost advantages. In the presence of diabetes and heart disease, ACE inhibitors have proven benefits. Among the ACE inhibitors, we are recommending the lower-cost agents classified in the green and yellow sections of the PCHI therapeutic grid, such as captopril, trandolapril (Mavik), moexipril (Univasc), fosinopril (Monopril), and quinapril (Accupril). We hope to help clinicians improve their care of hypertensive patients by providing useful tools, and we hope to make it easier for patients to adhere to their regimens and to understand their disease by providing easier access to targeted information. By completing a second chart review in a year or so, we expect to be able to see improvements resulting, at least in part, from these efforts.
To hear more about this on-going project and to obtain additional information about the JNC-VI guidelines, we invite you to look on the PCOI web page for the Blood Pressure: Less is More section under Primary Care Guidelines. If you have any questions, please contact Sybil Harcourt, project manager, at 724-6336.