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Comment & Response
March 2, 2020

We Dropped the Reflex Hammer on Hypertension 20 Years Ago—Reply

Author Affiliations
  • 1Department of Neurology, University of California, San Francisco, San Francisco
  • 2Web Editor, JAMA Neurology
  • 3Zuckerberg San Francisco General Hospital, Division of General Internal Medicine and Center for Vulnerable Populations, University of California, San Francisco, San Francisco
JAMA Neurol. Published online March 2, 2020. doi:10.1001/jamaneurol.2020.0083

In Reply We thank Estol for his interest in our Viewpoint1 discussing the call for neurologists to accept the challenge of diagnosing and managing hypertension to prevent neurologic disease. We applaud their efforts to study hypertension within their health system, in particular the effort made to change the culture of young neurologists by educating them on the importance of measuring blood pressure.

Poor hypertension control often stems from missed opportunities rather than lack of knowledge.2 To avoid these missed opportunities, it is important to identify which neurologic conditions carry the highest prevalence of comorbid hypertension and which are primarily managed by neurologists rather than primary care physicians. Further understanding of patient and physician preferences for successfully managing hypertension is also needed. While in Estol’s particular health system hypertension was more successfully managed by neurologists than primary care physicians, evidence also suggests that large-scale hypertension interventions involving nursing and pharmacy staff can be highly successful and adapted to varied practice settings.3,4 We recognize that one size does not fit all but hope that over time health care systems will recognize the importance of studying and successfully implementing novel, individualized hypertension management strategies.

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Article Information

Corresponding Author: John Betjemann, MD, Zuckerberg San Francisco General Hospital, Department of Neurology, University of California, San Francisco, 1001 Potrero Ave, Bldg 1, Room 101, San Francisco, CA 94110 (john.betjemann@ucsf.edu).

Published Online: March 2, 2020. doi:10.1001/jamaneurol.2020.0083

Conflict of Interest Disclosures: Dr Betjemann received personal compensation from JAMA Neurology that is not associated with this work as well as payment from the National Football League to serve as an unaffiliated neurotrauma consultant and consulting fees from Marinus Pharmaceuticals. No other disclosures were reported.

References
1.
Betjemann  J, Hemphill  JC  III, Sarkar  U.  Time for neurologists to drop the reflex hammer on hypertension.  JAMA Neurol. 2019;76(11):1277-1278. doi:10.1001/jamaneurol.2019.2588PubMedGoogle ScholarCrossref
2.
Fontil  V, Bibbins-Domingo  K, Kazi  DS,  et al.  Simulating strategies for improving control of hypertension among patients with usual source of care in the United States: the blood pressure control model.  J Gen Intern Med. 2015;30(8):1147-1155. doi:10.1007/s11606-015-3231-8PubMedGoogle ScholarCrossref
3.
Jaffe  MG, Lee  GA, Young  JD, Sidney  S, Go  AS.  Improved blood pressure control associated with a large-scale hypertension program.  JAMA. 2013;310(7):699-705. doi:10.1001/jama.2013.108769PubMedGoogle ScholarCrossref
4.
Fontil  V, Gupta  R, Moise  N,  et al.  Adapting and evaluating a health system intervention from Kaiser Permanente to improve hypertension management and control in a large network of safety-net clinics.  Circ Cardiovasc Qual Outcomes. 2018;11(7):e004386. doi:10.1161/CIRCOUTCOMES.117.004386PubMedGoogle Scholar
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