The Effectiveness of a Nurse-led Team-Based Hypertension Management among People with Uncontrolled Hypertension in a Community Hospital, Thailand

Introduction: Uncontrolled blood pressure of people with hypertension remains a major public health issue. The purpose of this research was to evaluate the effectiveness of a Nurse-led Team-based Hypertension Management Program (NTHMP) among people with uncontrolled hypertension.Methods: This quasi-experimental one-group pre-posttest design research was done to evaluate the effectiveness of a NTHMP in a community hospital in Thailand. The sample was thirty people with uncontrolled hypertension who received outpatient care in a community hospital in Thailand. They participated in three months NTHMP which included 1) team-approached health education, 2) medication administration support, 3) motivation interviewing on behavioral adjustment and 4) home blood pressure monitoring for three months. Outcomes of the program; systolic blood pressure, diastolic blood pressure, hospital admissions with signs of hypertensive urgency were analyzed by using frequency, percentage, mean, standard deviation, and repeated measured ANOVA.Results: The results indicated that people with uncontrolled HT had lower systolic blood pressures and diastolic blood pressure compared with baseline levels (p<0.001), and no hospital admissions.Conclusion: This program provided evidence for nurses to manage blood pressure control in people with hypertension within a collaboration with multidisciplinary team members in the community hospital.

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An Automated Blood Pressure Display for Self-Measurement in Patients With Chronic Kidney Disease (iHealth Track): Device Validation Study

JMIR mhealth and uhealth ◽

10.2196/14702 ◽

2020 ◽

Vol 8 (4) ◽

pp. e14702 ◽

Cited By ~ 1

Author(s):

Victoria Mazoteras-Pardo ◽

Ricardo Becerro-De-Bengoa-Vallejo ◽

Marta Elena Losa-Iglesias ◽

Daniel López-López ◽

César Calvo-Lobo ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Blood Pressure Monitoring ◽

Public Health Issue ◽

Global Public Health ◽

Reference Device ◽

Device Validation ◽

Mean Differences

Background Hypertension is a global public health issue and is closely related to chronic kidney disorder (CKD). In people with CKD, strict monitoring of blood pressure is an important part of therapy. Objective The aim of this research was to validate the iHealth Track blood pressure monitoring device for patients with CKD according to the European Society of Hypertension International Protocol 2010 (ESH-IP2). Methods In total, 33 patients who received hemodialysis in Plasencia participated in the study. There were 9 successive measurements made, which conformed to the ESH-IP2. We calculated the differences between the standard reference device (Omron M3 Intellisense) and the test device (iHealth Track) for blood pressure and heart rate values. For 99 total comparisons of paired measurements, we classified differences into various categories (≤5 mmHg, ≤10 mmHg, and ≤15 mmHg for blood pressure; ≤3, ≤5, and ≤8 beats per minute for heart rate). Results In 90 of 99 systolic blood pressure and 89 of 99 diastolic blood pressure comparisons between the devices, measurement differences were within 5 mmHg. In 81 of 99 heart rate comparisons between the devices, measurement differences were within 3 beats per minute. The mean differences between the test and reference standard measurements were 3.27 (SD 2.99) mmHg for systolic blood pressure, 3.59 (SD 4.55) mmHg for diastolic blood pressure, and 2.18 (SD 2.75) beats per minute for heart rate. We also observed that for both systolic and diastolic blood pressure, 31 of 33 participants had at least two of three comparisons between the devices with measurement differences less than 5 mmHg. For heart rate, 28 of 33 patients had at least two of three comparisons between the devices with measurement differences less than 3 beats per minute. Conclusions To our knowledge, this is the first study to show that iHealth Track meets the requirements of the ESH-IP2 in patients with CKD. Therefore, the iHealth Track is suitable for use in renal patients.

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Understanding the Feasibility, Acceptability, and Efficacy of a Clinical Pharmacist-led Mobile Approach (BPTrack) to Hypertension Management: Mixed Methods Pilot Study

Journal of Medical Internet Research ◽

10.2196/19882 ◽

2020 ◽

Vol 22 (8) ◽

pp. e19882

Author(s):

Lorraine R Buis ◽

Dana N Roberson ◽

Reema Kadri ◽

Nicole G Rockey ◽

Melissa A Plegue ◽

...

Keyword(s):

Blood Pressure ◽

Pilot Study ◽

Clinical Pharmacist ◽

Blood Pressure Monitoring ◽

Home Blood Pressure ◽

Uncontrolled Hypertension ◽

Hypertension Management ◽

Home Blood Pressure Monitoring ◽

Pressure Monitoring

Background Hypertension is a prevalent and costly burden in the United States. Clinical pharmacists within care teams provide effective management of hypertension, as does home blood pressure monitoring; however, concerns about data quality and latency are widespread. One approach to close the gap between clinical pharmacist intervention and home blood pressure monitoring is the use of mobile health (mHealth) technology. Objective We sought to investigate the feasibility, acceptability, and preliminary effectiveness of BPTrack, a clinical pharmacist-led intervention that incorporates patient- and clinician-facing apps to make electronically collected, patient-generated data available to providers in real time for hypertension management. The patient app also included customizable daily medication reminders and educational messages. Additionally, this study sought to understand barriers to adoption and areas for improvement identified by key stakeholders, so more widespread use of such interventions may be achieved. Methods We conducted a mixed methods pilot study of BPTrack, to improve blood pressure control in patients with uncontrolled hypertension through a 12-week pre-post intervention. All patients were recruited from a primary care setting where they worked with a clinical pharmacist for hypertension management. Participants completed a baseline visit, then spent 12 weeks utilizing BPTrack before returning to the clinic for follow-up. Collected data from patient participants included surveys pre- and postintervention, clinical measures (for establishing effectiveness, with the primary outcome being a change in blood pressure and the secondary outcome being a change in medication adherence), utilization of the BPTrack app, interviews at follow-up, and chart review. We also conducted interviews with key stakeholders. Results A total of 15 patient participants were included (13 remained through follow-up for an 86.7% retention rate) in a single group, pre-post assessment pilot study. Data supported the hypothesis that BPTrack was feasible and acceptable for use by patient and provider participants and was effective at reducing patient blood pressure. At the 12-week follow-up, patients exhibited significant reductions in both systolic blood pressure (baseline mean 137.3 mm Hg, SD 11.1 mm Hg; follow-up mean 131.0 mm Hg, SD 9.9 mm Hg; P=.02) and diastolic blood pressure (baseline mean 89.4 mm Hg, SD 7.7 mm Hg; follow-up mean 82.5 mm Hg, SD 8.2 mm Hg; P<.001). On average, patients uploaded at least one blood pressure measurement on 75% (SD 25%) of study days. No improvements in medication adherence were noted. Interview data revealed areas of improvement and refinement for the patient experience. Furthermore, stakeholders require integration into the electronic health record and a modified clinical workflow for BPTrack to be truly useful; however, both patients and stakeholders perceived benefits of BPTrack when used within the context of a clinical relationship. Conclusions Results demonstrate that a pharmacist-led mHealth intervention promoting home blood pressure monitoring and clinical pharmacist management of hypertension can be effective at reducing blood pressure in primary care patients with uncontrolled hypertension. Our data also support the feasibility and acceptability of these types of interventions for patients and providers. Trial Registration ClinicalTrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.8059

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An Automated Blood Pressure Display for Self-Measurement in Patients With Chronic Kidney Disease (iHealth Track): Device Validation Study (Preprint)

10.2196/preprints.14702 ◽

2019 ◽

Author(s):

Victoria Mazoteras-Pardo ◽

Ricardo Becerro-De-Bengoa-Vallejo ◽

Marta Elena Losa-Iglesias ◽

Daniel López-López ◽

César Calvo-Lobo ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Blood Pressure Monitoring ◽

Public Health Issue ◽

Global Public Health ◽

Reference Device ◽

Device Validation ◽

Mean Differences

BACKGROUND Hypertension is a global public health issue and is closely related to chronic kidney disorder (CKD). In people with CKD, strict monitoring of blood pressure is an important part of therapy. OBJECTIVE The aim of this research was to validate the iHealth Track blood pressure monitoring device for patients with CKD according to the European Society of Hypertension International Protocol 2010 (ESH-IP2). METHODS In total, 33 patients who received hemodialysis in Plasencia participated in the study. There were 9 successive measurements made, which conformed to the ESH-IP2. We calculated the differences between the standard reference device (Omron M3 Intellisense) and the test device (iHealth Track) for blood pressure and heart rate values. For 99 total comparisons of paired measurements, we classified differences into various categories (≤5 mmHg, ≤10 mmHg, and ≤15 mmHg for blood pressure; ≤3, ≤5, and ≤8 beats per minute for heart rate). RESULTS In 90 of 99 systolic blood pressure and 89 of 99 diastolic blood pressure comparisons between the devices, measurement differences were within 5 mmHg. In 81 of 99 heart rate comparisons between the devices, measurement differences were within 3 beats per minute. The mean differences between the test and reference standard measurements were 3.27 (SD 2.99) mmHg for systolic blood pressure, 3.59 (SD 4.55) mmHg for diastolic blood pressure, and 2.18 (SD 2.75) beats per minute for heart rate. We also observed that for both systolic and diastolic blood pressure, 31 of 33 participants had at least two of three comparisons between the devices with measurement differences less than 5 mmHg. For heart rate, 28 of 33 patients had at least two of three comparisons between the devices with measurement differences less than 3 beats per minute. CONCLUSIONS To our knowledge, this is the first study to show that iHealth Track meets the requirements of the ESH-IP2 in patients with CKD. Therefore, the iHealth Track is suitable for use in renal patients.

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Understanding the Feasibility, Acceptability, and Efficacy of a Clinical Pharmacist-led Mobile Approach (BPTrack) to Hypertension Management: Mixed Methods Pilot Study (Preprint)

10.2196/preprints.19882 ◽

2020 ◽

Author(s):

Lorraine R Buis ◽

Dana N Roberson ◽

Reema Kadri ◽

Nicole G Rockey ◽

Melissa A Plegue ◽

...

Keyword(s):

Blood Pressure ◽

Pilot Study ◽

Clinical Pharmacist ◽

Blood Pressure Monitoring ◽

Home Blood Pressure ◽

Uncontrolled Hypertension ◽

Hypertension Management ◽

Home Blood Pressure Monitoring ◽

Pressure Monitoring

BACKGROUND Hypertension is a prevalent and costly burden in the United States. Clinical pharmacists within care teams provide effective management of hypertension, as does home blood pressure monitoring; however, concerns about data quality and latency are widespread. One approach to close the gap between clinical pharmacist intervention and home blood pressure monitoring is the use of mobile health (mHealth) technology. OBJECTIVE We sought to investigate the feasibility, acceptability, and preliminary effectiveness of BPTrack, a clinical pharmacist-led intervention that incorporates patient- and clinician-facing apps to make electronically collected, patient-generated data available to providers in real time for hypertension management. The patient app also included customizable daily medication reminders and educational messages. Additionally, this study sought to understand barriers to adoption and areas for improvement identified by key stakeholders, so more widespread use of such interventions may be achieved. METHODS We conducted a mixed methods pilot study of BPTrack, to improve blood pressure control in patients with uncontrolled hypertension through a 12-week pre-post intervention. All patients were recruited from a primary care setting where they worked with a clinical pharmacist for hypertension management. Participants completed a baseline visit, then spent 12 weeks utilizing BPTrack before returning to the clinic for follow-up. Collected data from patient participants included surveys pre- and postintervention, clinical measures (for establishing effectiveness, with the primary outcome being a change in blood pressure and the secondary outcome being a change in medication adherence), utilization of the BPTrack app, interviews at follow-up, and chart review. We also conducted interviews with key stakeholders. RESULTS A total of 15 patient participants were included (13 remained through follow-up for an 86.7% retention rate) in a single group, pre-post assessment pilot study. Data supported the hypothesis that BPTrack was feasible and acceptable for use by patient and provider participants and was effective at reducing patient blood pressure. At the 12-week follow-up, patients exhibited significant reductions in both systolic blood pressure (baseline mean 137.3 mm Hg, SD 11.1 mm Hg; follow-up mean 131.0 mm Hg, SD 9.9 mm Hg; <i>P</i>=.02) and diastolic blood pressure (baseline mean 89.4 mm Hg, SD 7.7 mm Hg; follow-up mean 82.5 mm Hg, SD 8.2 mm Hg; <i>P</i><.001). On average, patients uploaded at least one blood pressure measurement on 75% (SD 25%) of study days. No improvements in medication adherence were noted. Interview data revealed areas of improvement and refinement for the patient experience. Furthermore, stakeholders require integration into the electronic health record and a modified clinical workflow for BPTrack to be truly useful; however, both patients and stakeholders perceived benefits of BPTrack when used within the context of a clinical relationship. CONCLUSIONS Results demonstrate that a pharmacist-led mHealth intervention promoting home blood pressure monitoring and clinical pharmacist management of hypertension can be effective at reducing blood pressure in primary care patients with uncontrolled hypertension. Our data also support the feasibility and acceptability of these types of interventions for patients and providers. CLINICALTRIAL ClinicalTrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584 INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.8059

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High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02074-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Prossie Merab Ingabire ◽

◽

Dike B. Ojji ◽

Brian Rayner ◽

Elijah Ogola ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Monitoring ◽

Secondary Analysis ◽

Uncontrolled Hypertension ◽

African Countries ◽

Night Time ◽

Black Africans ◽

Long Term Outcome ◽

Black African ◽

High Prevalence

Abstract Background Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of antihypertensive therapy, and intensifying salt restriction. Objectives To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of 6 months of three antihypertensive regimens on the dipping pattern among Black African hypertensive patients. Methods This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-h ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures. Results The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium > 140 mmol/l (OR = 1.72, 95% CI 1.17–2.51, p-value 0.005), a higher office systolic BP (OR = 1.03, 95% CI 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR = 0.97, 95% CI 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar’s Chi2 0.71, p-value 0.40). Conclusion There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes. Trial registration ClinicalTrials.gov (NCT02742467).

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Ambulatory blood pressure monitoring changes in hypertensive patients

Клінічна та профілактична медицина ◽

10.31612/2616-4868.2(8).2019.06 ◽

2019 ◽

Vol 2 (8) ◽

pp. 53-57

Author(s):

V.S. Pasko

Keyword(s):

Blood Pressure ◽

Arterial Pressure ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Ambulatory Blood Pressure Monitoring ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Pressure Monitoring ◽

Middle Aged ◽

Hypertensive Patients

The aim of the study was to determine the peculiarities of ABPM indices in middle-aged and elderly hypertensive patients depending on the daily BP profile. Material and methods. Indices of ambulatory blood pressure monitoring were identified in 57 middle-aged patients (45-59 years) (group I) and 43 elderly patients (60-74 years) (group II), who underwent two-week in-patient treatment. The control group consisted of 15 patients for every of the surveyed categories (group III - middle-aged and group IV – elderly respectively) matched with basic by age and gender. Results. We have shown that one of the factors that determines the change in hemodynamics in patients with essential hypertension is age, with the age patients experience the decrease in diastolic blood pressure with steadily increased systolic blood pressure, that should be considered in the prescription of antihypertensive treatment. With age, a gradual increase in systolic blood pressure is associated with the increased aortic stiffness, partially with the increase in collagen and the decrease in elastic fibrils and the formation of isolated systolic hypertension. Thus, it is proved that in the formation of isolated hypertension the growth of pulse blood pressure for more than 60 mm Hg is unfavorable in a development of cerebrovascular events. Pulse arterial blood pressure was stronger risk factor than systolic blood pressure and diastolic blood pressure or average arterial pressure in the elderly. Recently, taking into account age characteristics, all three indices were recognized as comparable predictors at the age of 50-59 years as the transitional period, and at the age of 60-79 years diastolic blood pressure adversely affecting the cardiovascular risk, increased pulse blood pressure prognostically above the level of systolic arterial pressure.

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The effect of OMEGA-3 polyunsaturated fatty acids on ambulatory blood pressure monitoring parameters in patients with type 2 diabetes mellitus and cardiovascular autonomic neuropathy

Diabetes Mellitus ◽

10.14341/dm9630 ◽

2019 ◽

Vol 22 (1) ◽

pp. 62-69

Author(s):

Victoria A. Serhiyenko ◽

Boris N. Mankovsky ◽

Ludmila М. Serhiyenko ◽

Aleksandr A. Serhiyenko

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Fatty Acids ◽

Type 2 Diabetes Mellitus ◽

Diastolic Blood Pressure ◽

Blood Pressure Monitoring ◽

Pressure Monitoring ◽

Time Index

Background: Cardiovascular autonomic neuropathy (CAN) in type 2 diabetes mellitus (T2DM), which is characterized by lesion of nerve fibers in parasympathetic and sympathetic nervous system is one of the leading causes of heart arrhythmias and an independent risk factor for cardiovascular mortality in patients with T2DM. Therefore, the problem of effective treatment of CAN is particularly relevant. Aims: To analyze the effect of long-chain polyunsaturated fatty acids (-3 PUFAs) on ambulatory blood pressure monitoring parameters in patients with T2DM and CAN. Materials and methods: 36 patients with T2DM and confirmed CAN were divided into two groups. First group received hypoglycemic therapy (n=15, control) for three months; patients in group 2 (n=21) in addition were administered 1 capsule/q.d. of -3 PUFAs for three month. Results: Treatment with -3 PUFAs led to significant decrease of the diastolic blood pressure (DBP) (p0,01), diastolic blood pressure load (p0,05), time index of DBP (p0,05) during the day; DBP (p0,05), diastolic blood pressure load (p0,05), time index of DBP (p0,05), SD DBP (p0,01) during the night (compared to the control group). Conclusions: The study showed that prescription of -3 PUFAs for three month was effective in decreasing diastolic blood pressure and its parameters among patients with T2DM and CAN.

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Two-day home blood pressure monitoring may offer an alternative to costlier methods

BMJ Innovations ◽

10.1136/bmjinnov-2017-000247 ◽

2018 ◽

Vol 4 (2) ◽

pp. 84-90

Author(s):

Gavin Devereux ◽

Daniel Gibney ◽

Fiqry Fadhlillah ◽

Paul Brown ◽

Neil Macey ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Blood Pressure Monitoring ◽

Home Blood Pressure ◽

White Coat Hypertension ◽

Home Blood Pressure Monitoring ◽

Pressure Measurements ◽

Pressure Monitoring ◽

Time Saving ◽

Home Based

BackgroundKey benefits of home-based blood pressure measurements are the potential to reduce the risk of ‘white coat hypertension’, encouraging patients to take ownership of their condition and be more actively involved in their long-term condition care, and to move work out of the doctor’s office.AimTo assess whether performing 20 resting blood pressure measurements over a 2-day period would provide a reliable, stable representation of patients’ resting systolic and diastolic blood pressure. Following clinician recommendation, each participant completed the Stowhealth home blood pressure monitoring procedure.MethodOne thousand and forty-five participants (mean age 66±13 years, 531 women and 514 men) completed the procedure, of 10 resting measurements per day, for 2 days (20 resting systolic and diastolic blood pressure readings in total). All measurements were made using automated oscillometric monitors.ResultsWithin-patient coefficient of variation for the entire participant cohort was 8% for systolic blood pressure (cohort mean 141±11 mm Hg), and 8% for diastolic blood pressure (cohort mean 79±6 mm Hg). There were no significant differences between the first and second day, for either systolic (142±1vs 141±1 mm Hg, respectively, p>0.05) or diastolic blood pressures (79±1vs 78±1 mm Hg, respectively, p>0.05 in both cases).ConclusionThe overall duration of home blood pressure monitoring may be able to be reduced to just 48 hours. This method would offer meaningful time saving for patients, and financial and time benefits for doctors and their surgery administration.

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Abstract 13197: Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Outpatient Setting

Circulation ◽

10.1161/circ.132.suppl_3.13197 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Krishna Patel ◽

Laura Young ◽

Erik H Howell ◽

Bo Hu ◽

Shannon J Morrison ◽

...

Keyword(s):

Hospital Admissions ◽

Outpatient Setting ◽

Uncontrolled Hypertension ◽

Office Visits ◽

Hypertensive Urgency ◽

Admission Rates ◽

Coronary Syndrome ◽

Asymptomatic Patients ◽

Significant Difference ◽

Hypertensive Urgencies

Background: Hypertensive urgency is a commonly encountered outpatient problem. Prevalence and short term outcomes of this condition are unknown. JNC VII recommends aggressive BP control over several days. However, a small percentage of patients are sent to the emergency department. It is unknown whether hospital management of these patients is better than outpatient BP management. Methods: Retrospective cohort study of all patients presenting to an office in a large health care system from 2008-2013 with SBP ≥180mmHg or DBP ≥ 110mmHg. We excluded pregnant women and patients referred to the hospital for symptoms or treatment of other conditions. Patients were divided into 2 groups: those sent home and those referred to hospital. We recorded baseline demographic and clinical data. Propensity matched outcomes recorded included MACE (acute coronary syndrome, stroke/TIA) uncontrolled hypertension (≥140/90 mmHg) and hospital admissions. Results: Of 2,199,019 office visits, 58,583 (5%) had hypertensive urgency. Mean age was 63±15 yrs, 58% were females, 76% Caucasian, mean BMI was 31±8 kg/m2 and mean SBP and DBP were 182±16 and 96±16 mmHg. Only 426 (0.7%) patients were referred to the ED/hospital. On propensity matched analysis between the patients referred to the hospital and sent home, there was no significant difference in MACE events at 7 days (0% vs. 0.13%, p=1), 30 days (0.25% vs. 0%, p=1) or 6 months (0.5% vs. 0.13%, p=0.26). Compared to patients sent home, patients referred to the hospital had less uncontrolled hypertension at 1 month (81% vs. 88%, p=0.001) but not at 6 months (65% vs 69%, p=0.16). They also had higher 7- and 30-day hospital admission rates (8.5% vs. 4.9%, p=0.01; 11.8% vs 7.6%, p=0.02). Conclusion: Hypertensive urgency occurs commonly, but the rate of MACE in asymptomatic patients is very low. ED visits increased hospitalizations, but did not improve outcomes. Most patients with hypertensive urgencies still had uncontrolled hypertension at 6 months.

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Abstract 091: Improved Blood Pressure Control and High Adherence to a Novel Management Model of Hypertension Care in a West African Population

Hypertension ◽

10.1161/hyp.70.suppl_1.091 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Isaac Owusu ◽

Fred Adomako-Boateng ◽

Fred Kueffer ◽

Molly Guy ◽

Chemuttaai Lang’at ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Pressure Control ◽

Management Plan ◽

West African ◽

Sub Saharan Africa ◽

Management Model ◽

Uncontrolled Hypertension ◽

Hypertension Management ◽

Software Application

Background: Logistic and socioeconomic barriers limit effective blood pressure (BP) control in many parts of Sub-Saharan Africa, including the Republic of Ghana. We tested a novel hypertension management model of care designed for resource-limited settings. Methods and Results: The “Akoma Pa” model was developed using human-centered design methodology involving patients, physicians, and nurses. The model consisted of a mobile tablet, BP machine and a novel software application in a unique platform to allow for longitudinal patient management. Patients were provided with a tailored hypertension management plan based on their enrollment comorbidities and risk factors. A cohort of 150 hypertensive patients (57±8 years; 73% female) accessed regular blood pressure assessments at a local pharmacy and received real-time automated feedback based on their individualized plan. On the mobile application, clinicians were able to view patient data, provide patients with feedback via SMS on their condition, and write electronic prescriptions which could be accessed by participating pharmacies. Average baseline BP was 135±18/84±10 mmHg in the overall cohort and 153±13/90±11 mmHg in the subgroup with uncontrolled hypertension (n=58). After 6 months of voluntary weekly monitoring, systolic blood pressure decreased significantly (p<0.01) in the overall cohort (-4.7±18.7 mmHg) and in the uncontrolled subgroup (-15.2±17.6mmHg). Systolic blood pressure remained constant in the sub group with controlled pressure at baseline. The proportion of the population with uncontrolled hypertension decreased from 39% to 27% (p=0.01). Patient compliance with weekly BP assessments was 61% and 2,855 BP assessments were conducted. During 33 of the 2,855 BP assessments (1% of pharmacy visits), the software application directly referred patients to a health facility (33 visits in 25 patients). Improvement in overall health awareness was reported in 82% of the participants and 95% of participants indicated a desire to continue using this model in the future. Conclusions: Compliance and satisfaction with this multifaceted hypertension care model were high and led to significant and sustained decreases in blood pressure in this West African hypertensive population.

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