Department of Veterans Affairs hypertension meeting - A proposal for improved care

A major invitational hypertension meeting was hosted by the Department of V eterans Affairs (VA) in Washington, DC, on May 26 to 28, 1999. It followed a report that only 25% of hypertensive veterans had adequate levels of trea ted blood pressure and focused on how control of hypertension could be impr oved both immediately and in the future. After the presentation of brief ou tlines of 5 unresolved basic science questions, 2 general topics were consi dered: (1) 30 years of change in hypertension and its treatment and (2) cur rent healthcare delivery mechanisms and how to improve them. Since 1970, th e severity of hypertension has decreased, malignant hypertension has disapp eared, and the prognostic roles of systolic and diastolic blood pressure ha ve been reversed as hypertension became milder. Five VA Cooperative Studies have provided important data: the 1970 Freis Trial report demonstrated the value of treatment, 2 trials showed that some controlled patients can decr ease or even discontinue pharmacological treatment without recrudescent hyp ertension, a blinded trial was performed on the efficacy of different antih ypertensive drugs, and an unblinded trial showed that diuretics and P-block ers are the most effective agents when caregivers choose the agent and dose . Two healthcare models were considered: (1) the patient-friendly VA Hypert ension Screening and Treatment Program that was introduced in 1972, which c ontrols 80% of patients at the goal of the Joint National Committee on Dete ction, Evaluation, and Treatment of High Blood Pressure with diuretics and keeps patients in the program an average of 7.5 years, and (2) the newer pr imary care health maintenance organization-like model in the VA and through out the United States. Choosing a regimen and monitoring control of blood p ressure and compliance with therapy were discussed, The meeting was closed with 6 general recommendations for improving the care of hypertensive patie nts.