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Self-monitoring of BP fails to improve BP control in urban population
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In a predominantly minority, urban population, self-monitoring of BP was not shown to yield improvements in BP control over the usual care, according to recent findings.
“Although control rates have improved over time, racial/ethnic disparities in hypertension control persist,” the researchers wrote. “Self-[BP] monitoring, by itself, has been shown to be an effective tool in predominantly white populations, but less studied in minority, urban communities.”
In the randomized clinical trial, the New York Public Health Department collaborated with community clinic networks to evaluate 900 participants receiving care at one of eight clinic sites. The trial included two study arms: an intervention arm (n = 450) in which participants were given automatic home BP monitors with modems able to transmit or upload home BP readings to a secure database; and a control arm (n = 450) in which patients received the usual care. Planned follow-up was 9 months. The outcomes of interest were change in systolic BP to diastolic BP from baseline to follow-up, slope of BP during follow-up period and achievement of BP control, defined as systolic BP less than 140 mm Hg and diastolic BP less than 90 mm Hg (< 130 mm Hg/80 mm Hg for those with diabetes or chronic kidney disease).
Analysis of BP changes from baseline included only those who had a follow-up visit at 7 to 10 months (intervention group, 329; control group, 332). The intervention group consisted of 35 non-Hispanic whites, 80 non-Hispanic blacks and 214 Hispanics. The control arm consisted of 34 non-Hispanic whites, 74 non-Hispanic blacks and 224 Hispanics.
No difference in BP drop
At 9 months, there was a decrease in systolic BP, but it did not differ between the groups (intervention arm, 14.7 mm Hg; control arm, 14.1 mm Hg; P = .7), according to the researchers. The results did not differ when the researchers factored in longitudinal data and calculated a mean slope over time. At the end of follow-up, 38.9% of the intervention group and 39.1% of the control group achieved BP control, with no difference between the groups in time-to-event experience of achieving BP control (log-rank P value = .91).
Additional barriers
Stella S. Yi, PhD, MPH, and colleagues wrote that these findings suggest that additional barriers to BP control may exist in this mostly Hispanic and uninsured population.
“Prior studies have demonstrated less use of a BP monitor in lower income groups, providing evidence that the cost of the monitor may be a meaningful barrier to use,” Yi, from the department of population health at New York University School of Medicine, and colleagues wrote. “Through our study design, participants had access to a BP monitor, but facilitated access to other resources related to BP management, such as behavioral counseling above and beyond what is provided by the clinic staff or reduced cost medications, was not provided. Therefore, in this patient population with a high prevalence of being uninsured, supplying the BP monitor itself may not be sufficient to produce the anticipated benefits in BP outcomes.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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