Abstract 7: Outcomes at Six Months of a Randomized Trial of Home Blood Pressure Telemonitoring with Pharmacist Case Management

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Karen L Margolis ◽  
Anna R Bergdall ◽  
Stephen E Asche ◽  
Joann M Sperl-Hillen ◽  
Michael V Maciosek ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Case Management ◽  
Usual Care ◽  
Randomized Trial ◽  
Uncontrolled Hypertension ◽  
Satisfaction With Care ◽  
Hypertensive Patients ◽  
Treatment Groups ◽  
The Difference

Background: Patients with high blood pressure (BP) visit a physician on average 4 times per year, though fewer than half achieve BP control. Practical, effective, and sustainable models are needed to improve BP management. Aims: Hyperlink is a clinic-randomized trial testing an intervention that combines home BP telemonitoring with pharmacist case management in patients with uncontrolled hypertension. Methods: We enrolled 450 patients with uncontrolled BP from 16 primary care clinics. Eight clinics (222 patients) were randomized to usual care and 8 clinics (228 patients) to intervention. Intervention patients received home telemonitors that transmit BP data to a secure database. Pharmacists consult with patients by phone and adjust antihypertensive therapy based on home BP data. The intervention lasts 12 months with follow-up to 18 months to observe durability. The primary outcome is BP control at 6 and 12 months, defined as BP ≤140/90 mm Hg (or ≤130/80 mm Hg in patients with chronic kidney disease or diabetes). Data on demographics, medication use and adherence, and satisfaction with care were also gathered. Here we report 6-month BP outcomes. General and generalized linear mixed models are used to accommodate the cluster-randomization. Results: Enrollees were 45% female, 83% white, and 13% black, with mean age of 61 years. Mean BP at baseline was 148/85 mm Hg in both treatment groups. Of the 403 attending the 6-month visit (197 usual care, 206 intervention), 45.2% in usual care and 71.8% in intervention achieved BP control (p<0.0001). In usual care, mean systolic BP decreased by 10.3 mm Hg and diastolic decreased by 3.4 mm Hg. In intervention, mean systolic BP decreased by 21.6 mm Hg and diastolic decreased by 9.3 mm Hg. The difference in change between groups was 11.3 mm Hg systolic (p<0.0001) and 5.8 mm Hg diastolic (p=0.003). Self-reported satisfaction with care in the six months following baseline was higher for intervention (mean=4.6) than usual care (mean=4.4, p<0.01), on a 5 point scale (1=worst care possible, 5=best care possible). Between baseline and 6 months mean number of antihypertensive drugs used per participant increased from 1.4 to 1.6 in usual care and from 1.5 to 2.3 in intervention. The difference between treatment groups in increased drug use from a particular class was largest among thiazide diuretics (4.6% increase usual care, 27.6% intervention) and ACE inhibitors (1.6% increase usual care, 13.6% intervention). Calcium channel blocker and beta blocker use also increased more among intervention patients, while loop diuretic use decreased. Self-reported adherence to BP medications indicated better adherence for intervention (mean=0.7) than usual care (0.3, p<0.01) measured on the Morisky scale (0-4, lower scores indicating better adherence) during the 6 months following the baseline visit. Conclusions: Home telemonitoring with pharmacist case management was effective at reducing BP for hypertensive patients over 6 months. This intervention may be cost-effective for managing hypertensive patients with uncontrolled BP, especially if results are sustained during the maintenance and post-intervention phases of follow-up.

Abstract P494: Long-term Outcomes of a Cluster-randomized Trial Testing the Effects Blood Pressure Telemonitoring and Pharmacist Management

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Karen L Margolis ◽  
Stephen E Asche ◽  
Anna R Bergdall ◽  
Steven P Dehmer ◽  
Beverly B Green ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Randomized Trial ◽  
Clinical Care ◽  
Cluster Randomized Trial ◽  
Home Blood Pressure ◽  
Uncontrolled Hypertension ◽  
Routine Clinical Care ◽  
Differential Reduction ◽  
Cluster Randomized

Background/Aims: Hypertension is a common condition and leading cause of cardiovascular disease. We previously reported results of a cluster-randomized trial evaluating a home blood pressure (BP) telemonitoring and pharmacist management intervention, with significant reductions in BP favoring the intervention arm over 18 months. This analysis examined the durability of the intervention effect on BP through 54 months of follow-up and compared BP measurements performed in the research clinic and in routine clinical care. Methods: The Hyperlink trial randomized 16 primary care clinics having 450 study-enrolled patients with uncontrolled hypertension to either Telemonitoring Intervention (TI) or usual care (UC) study arms. BP was measured as the mean of 3 measurements obtained at each research clinic visit. General linear mixed models utilizing a direct likelihood-based ignorable approach for missing data were used to examine change from baseline to 54 months in systolic and diastolic BP (SBP and DBP). Results: Research clinic BP measurements were obtained from 326 (72%) study patients at the 54 month follow-up visit. Routine clinical care BP measurements were obtained from 444 (99%) of study patients from 7025 visits during the follow-up period. For TI patients, based on research clinic measurements baseline SBP was 148.2 mm Hg and 54 month follow-up was 131.2 mm Hg (-17.0 mm Hg, p<.001). For UC patients, baseline SBP was 147.7 mm Hg and 54 month follow-up was 131.7 mm Hg ( -16.0 mm Hg, p<.001). The differential reduction by study arm in SBP from baseline to 54 months was -1.0 mm Hg (95% CI: -5.4 to 3.4, p=0.63). For TI patients, baseline DBP was 84.4 mm Hg and 54 month follow-up was 77.8 (-6.6 mm Hg, p<.001). For UC patients, baseline DBP was 85.1 mm Hg and 54 month follow-up was 79.1 mm Hg (-6.0 mm Hg, p<.001). The differential reduction by study arm in DBP from baseline to 54 months was -0.6 mm Hg (95% CI: -3.5 to 2.4, p=0.67). SBP and DBP results from routine clinical measurements closely approximated the pattern of results from research clinic measurements. Conclusion: Significant BP reductions in the TI arm relative to UC were no longer seen at 54 month follow-up. To maintain intervention benefits over a longer period of time additional intervention is needed.

Risk of Atrial Fibrillation in Masked and White Coat Uncontrolled Hypertension

2020 ◽  
Author(s):  
Francesca Coccina ◽  
Anna M Pierdomenico ◽  
Matteo De Rosa ◽  
Lorenzo Belli ◽  
Melissa Foglietta ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Confidence Interval ◽  
Sinus Rhythm ◽  
Ambulatory Blood Pressure ◽  
White Coat ◽  
Uncontrolled Hypertension ◽  
Hypertensive Patients ◽  
New Onset

Abstract Background Risk of atrial fibrillation (AF) in masked and white coat uncontrolled hypertension (MUCH and WUCH, respectively) has not yet been investigated. We assessed the risk of new-onset AF in MUCH and WUCH detected by ambulatory blood pressure (BP) monitoring. Methods The occurrence of AF was evaluated in 2135 treated hypertensive patients aged &gt;40 years, with baseline sinus rhythm, by electrocardiogram. Controlled hypertension (CH) was defined as clinic BP &lt;140/90 mmHg and daytime BP, regardless of nighttime BP, &lt;135/85 mmHg, MUCH as clinic BP &lt;140/90 mmHg and daytime BP ≥135 and/or ≥85 mmHg, WUCH as clinic BP &gt;140 and/or &gt;90 mmHg and daytime BP &lt;135/85 mmHg and sustained uncontrolled hypertension (SUCH) as clinic BP &gt;140 and/or &gt;90 mmHg and daytime BP &gt;135 and/or &gt;85 mmHg. Results MUCH was identified in 203 patients (9.5% of all the population, 29% of those with normal clinic BP) and WUCH in 503 patients (23.5% of all the population, 35% of those with high clinic BP). During the follow-up (mean 9.7 years), 116 cases of AF occurred. After adjustment for covariates, patients with MUCH (hazard ratio (HR) 2.02, 95% confidence interval (CI) 1.06-3.85) and SUCH (HR 1.83, 95% CI, 1.04-3.21) had higher risk of new-onset AF than those with CH, whereas those with WUCH (HR 1.12, 95% CI, 0.59-2.13) did not. Conclusions When compared to patients with CH, those with MUCH and SUCH are at higher risk (approximately doubled) of new-onset AF, whereas those with WUCH are not.

scholarly journals Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258406
Author(s):  
Mahesh Kumar Khanal ◽  
Pratiksha Bhandari ◽  
Raja Ram Dhungana ◽  
Pratik Bhandari ◽  
Lal B. Rawal ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Education ◽  
Usual Care ◽  
Reduce Blood Pressure ◽  
Uncontrolled Hypertension ◽  
Control Group ◽  
Community Based ◽  
Home Support ◽  
Cluster Randomized

Background Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal. Methods We conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months. Results 125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. The proportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01–4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63–2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (p<0.001). Conclusions Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal. Trial registration ClinicalTrial.gov: NCT02981251

scholarly journals Control of blood pressure and cardiovascular risk in Moroccan patients with newly diagnosed hypertension: a 3-month observational study in primary care

2016 ◽  
Vol 11 (2) ◽  
pp. 49-56 ◽  
Author(s):  
Mohamed Alami ◽  
Mustapha El Hattaoui ◽  
Mehdi Seqat ◽  
Jamaa Sadik ◽  
Aicha Aouad ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Uncontrolled Hypertension ◽  
Newly Diagnosed ◽  
High Cardiovascular Risk ◽  
Prospective Longitudinal Study ◽  
Hypertensive Patients ◽  
Prospective Longitudinal

Background: Control of blood pressure and reduction of cardiovascular risk factors are mandatory in patients with hypertension. The aim of this study was to determine the proportion of patients with controlled hypertension and to describe the cardiovascular risk profile in hypertensive patients followed by general practitioners (GPs) in Morocco. Methods: This national, observational, multicentre, prospective, longitudinal study of patients with newly diagnosed hypertension was carried out between September 2011 and December 2011. The use of antihypertensive drugs was evaluated at inclusion and after 3 months of follow up. Uncontrolled hypertension was defined as systolic blood pressure (SBP) ⩾ 140 mmHg or diastolic blood pressure (DBP) ⩾ 90 mmHg at 3 months of follow up. The SCORE scale issued by the European Society of Cardiology (ESC) was used to assess overall cardiovascular risk and probability of experiencing a cardiovascular event within 10 years. Results: A total of 909 hypertensive patients were recruited (62.4% female). Mean age was 56.8 ± 10.6 years. More than half of the patients (53.0%) were between 40–60 years and more than one-third (34.1%) were obese [body mass index (BMI) ⩾ 30 kg/m2]. There were significantly more obese females than males ( p < 0.001). Over half of the patients (52.5%) had a high or extremely high cardiovascular risk. Abdominal obesity (measured as waist circumference) was the most common cardiovascular risk factor (61.7%) followed by age (40.5%), dyslipidaemia (36.3%) and diabetes (34.3%). Mean SBP decreased from 168.1 ± 14.8 to 138.3 ± 13.2 mmHg ( p < 0.001) and mean DBP decreased from 93.0 ± 10.5 to 81.0 ± 8.6 mmHg ( p < 0.001) after 3 months of treatment. Control of blood pressure was achieved in only 46.8% of patients. Poor compliance (17.1%) and a lack of treatment efficacy (16.9%) were the two main reasons for not achieving the blood pressure target. Conclusions: More than half (53.2%) of the hypertensive patients in our study did not achieve adequate blood pressure control during the 3-month follow-up period and had a high cardiovascular risk. More effective management of hypertension is required in primary care.

Effects of an Antihypertensive Combination in Japanese Hypertensive Outpatients Based on the Long-Acting Calcium Channel Blocker Benidipine on Vascular and Renal Events: A Sub-Analysis of the COPE Trial

2020 ◽  
Vol 16 ◽  
Author(s):  
Seiji Umemoto ◽  
Toshio Ogihara ◽  
Masunori Matsuzaki ◽  
Hiromi Rakugi ◽  
Kazuyuki Shimada ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Calcium Channel ◽  
Calcium Channel Blocker ◽  
Channel Blocker ◽  
Rank Test ◽  
Vascular Events ◽  
Treatment Groups ◽  
Β Blocker ◽  
The Difference ◽  
Long Acting

Background: In the trial known as COPE (Combination Therapy of Hypertension to Prevent Cardiovascular Events) three benidipine (a calcium channel blocker; CCB) regimens were compared. Hypertensive Japanese outpatients aged 40–85 years (n=3,293) who did not achieve the target blood pressure of <140/90 mmHg with benidipine 4 mg/day were treated with the diuretic thiazide (n=1,094) or a β-blocker (n=1,089) or an additional angiotensin receptor blocker (ARB; n=1,110). A significantly higher incidence of hard cardiovascular composite endpoints and of fatal or non-fatal strokes was observed in the benidipine-β-blocker group compared to the benidipine-thiazide group. Objective and Methods: We further evaluated the treatment effects of the three benidipine-based regimens on vascular and renal events in a sub-analysis of the COPE patients. Results: A total of 10 vascular events (0.8 per 1,000 person-years) including one aortic dissection (0.1 per 1,000 person-years) and nine cases of peripheral artery disease (0.8 per 1,000 person-years) were documented, as was a total of seven renal events (0.6 per 1,000 person-years). No significant differences in vascular and renal events were revealed among the three treatment groups: vascular events p=0.92 renal events p=0.16 log-rank test. Conclusions: Blood pressure-lowering therapy with benidipine combined with an ARB, β-blocker, or thiazide was similarly effective in the prevention of vascular and renal events in hypertensive outpatients, although there is no enough these events to compare the difference in the three treatment groups.

scholarly journals Improving the Blood Pressure Control With the ProActive Attitude of Hypertensive Patients Seeking Follow-up Services

Medicine ◽  
2016 ◽  
Vol 95 (14) ◽  
pp. e3233 ◽  
Author(s):  
Shangfeng Tang ◽  
Ghose Bishwajit ◽  
Lu Ji ◽  
Da Feng ◽  
Haiqing Fang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Hypertensive Patients

The Relationship Between Blood Pressure Variability And Renal Progression In Hypertensive Patients With Chronic Kidney Disease

2021 ◽  
Vol 6 (14) ◽  
pp. 80-88
Author(s):  
Huseyin Duru ◽  
Ekrem KARA
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Blood Pressure Measurement ◽  
Rapid Progression ◽  
Night Time ◽  
Hypertensive Patients ◽  
Significant Difference ◽  
Renal Progression

Objective: To evaluate the effect of 24 hour systolic blood pressure (SBP) and diastolic blood pressure (DBP) variability (BPV) on renal progression in hypertensive patients with chronic kidney disease (CKD) Methods: A total 59 hypertensive patients (mean age: 54.2±14.6 years, 50.8% male) with CKD who underwent 24 hours ambulatory blood pressure measurement (ABPM) were included. Data on SBP, DBP, BPV coefficients (VC) for SBP (SBP-CV) and DBP (DBP-CV) were recorded. A decrease in e-GFR of <5 ml/min/year was considered as normal renal progression and a decrease in ≥5 ml/min/year was considered as rapid renal progression. Results: Overall, 40.6% of the patients had uncontrolled HT, while 45.8% had non-dipper pattern. Mean±SD daytime and night-time SBP and SBP-VC values were 135.3±17.9 mmHg, 128.6±23.0 mmHg, 11.7±2.8 and 9.5±3.6, respectively. Mean±SD daytime and nigh-time DBP and DBP-VC values were 84.5±13.4 mmHg, 77.2±16.1 mmHg, 13.8±3.8 and 12.0±3.7, respectively. Rapid renal progression was detected in 25.4% of patients with no significant difference in daytime, night-time and total SBP, SBP-VC, DBP and DBP-VC values between patients with rapid vs. natural renal progression. The regression analysis adjusted for age, gender, presence of DM, baseline e-GFR and dipping status revealed no significant impact of SBP-VC and DBP-VC in predicting rapid progression (p> 0.05). Conclusion: In conclusion, our finding revealed no significant association between BPV and renal progression in hypertensive patients with CKD. Larger scale prospective, randomized controlled trials with longer follow-up are needed to clarify this issue.

Abstract 356: Hypertension Management at the University of Michigan Student Run Free Clinic: Does it Meet National Guidelines?

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Lindsey Gakenheimer ◽  
Hari S Conjeevaram
Keyword(s):  
Blood Pressure ◽  
Salt Intake ◽  
Lifestyle Changes ◽  
Uncontrolled Hypertension ◽  
Diabetic Patients ◽  
University Of Michigan ◽  
Initial Visit ◽  
Free Clinic ◽  
The University

Purpose: The University of Michigan Student Run Free Clinic (UMSRFC) provides primary care to uninsured adults in Southeast Michigan. Optimal management of chronic conditions, such as hypertension, is one of the clinic’s primary goals. Our aim was to evaluate UMSRFC’s success in meeting the Centers of Medicare and Medicaid Service’s (CMS’s) goal of blood pressure (BP) within the recommended values for ≥63% of clinic patients diagnosed with hypertension. Methods: A retrospective chart review identified hypertensive patients with at least two UMSRFC visits between April 2012 and July 2013. Age, sex, ethnicity, body mass index, medications, blood pressure (BP), and comorbidities were extracted and stored in an online database. Patients were separated into two groups: those with controlled hypertension (≤140/90 mmHg for systolic/diastolic BP) at their most recent clinic date and those with uncontrolled hypertension (>140/90 mmHg for systolic/diastolic BP) at the most recent clinic visit. Results: Of 43 patients presenting with hypertension, 26 (60.5%) met inclusion criteria. The average age was 52.3 +/- 2.0 years, and 12 (46.2%) were male. The majority (17, 65.4%) of patients self-identified as Caucasian, and 24 (92.4%) were from Southeast Michigan. Follow-up BP was controlled for 17 (65.4%) patients. All 6 (23.1%) patients controlled at initial visit remained controlled at follow-up, and 15 (75%) of those uncontrolled at initial visit were controlled at follow-up. BP control among diabetic patients improved the most: from 1 (16.7%) to 5 (83.3%) (p=0.833) achieving control; statistical insignificance is likely due to sample size. Most patients reduced their BP with the addition of medications, but 2 (7.8%) achieved control with lifestyle changes (eg. reduced salt intake, increased exercise or improved home BP recording adherence) alone. Conclusions: UMSRFC has marginally exceeded CMS’s benchmark with 17 (65.4%) of patients with hypertension having a controlled blood pressure at follow-up. While this result demonstrates that a free clinic working with an uninsured population can provide quality care, UMSRFC will continue to work diligently toward the goal of controlled BP for 100% of patients with hypertension.

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