Clinical research examines the use of electronic alerts to control blood pressure

A push from an electronic health record system that reminds doctors to prescribe high blood pressure medications to patients with chronic kidney disease led to better blood pressure management, according to a clinical trial published in JAMA Internal Medicine.

Chronic kidney disease affects more than 35 million adults in the U.S., according to the Centers for Disease Control and Prevention. For patients with chronic kidney disease, hypertension is a major risk factor for adverse outcomes such as renal failure, cardiovascular events, and death.

In the trial, researchers sought to understand whether alerts from electronic health record systems that recommended that patients with chronic kidney disease and uncontrolled high blood pressure be prescribed medications to lower it were effective, said Jeffrey Linder, ’97 MD, MPH, the Michael A. Gertz professor of medicine and head of general internal medicine at the Department of Medicine, who co-authored the study.

“We were trying to design something that fits into the electronic health record to remind doctors to especially raise blood pressure with medications that have benefits including preventing strokes and heart attacks in patients with chronic kidney disease,” Linder said.

More than 2,000 patients and 170 primary care physicians participated in the study. Half of the patients received usual care, while the treating physicians received the other half customized, evidence-based recommendations from their electronic health record system.

Patients whose doctors received the nudges reported a drop in blood pressure of 14 mmHg, significantly more than patients in the usual care group, according to the study.

“We saw a significant increase in the use of blood pressure medications and a significant decrease in blood pressure itself, which should result in fewer kidney and cardiovascular problems over subsequent years,” Linder said.

Building intuitive alert systems into electronic health records can help doctors adhere to best practices, Linder said, and his lab will continue to study interventions designed around these alerts.

“This fits with the research theme that I and my colleagues are conducting at Northwestern and beyond around using the electronic health record to encourage the right care and discourage the wrong care,” Linder said. “We are now working on a trial to discourage the use of sleep medications and encourage the use of cognitive behavioral therapy, which is less toxic and more effective than commonly used sleep medications.”