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Collaborative, community-based hypertension program improved BP control
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A tiered, multifaceted community-based hypertension intervention improved BP control across a diverse population, according to study data published in Circulation: Cardiovascular Quality and Outcomes.
Researchers enrolled 1,756 patients (median age, 59 years; 65.6% female; 76.1% black) from eight diverse ambulatory clinics in Durham County, N.C. All clinics were participants in Check It, Change It, a community-based quality improvement BP program. Patients older than 18 years with a previous hypertension diagnosis were eligible for participation. For 6 weeks, participants were asked to input their BP measurements into Heart360, a Web-based portal, at least once every 2 weeks. Participants were assigned to one of the following three tiers based on BP: tier 0 (mean BP <140 mm Hg/90 mm Hg), tier 1 (mean BP, 140 mm Hg-159 mm Hg/90 mm Hg-99 mm Hg), and tier 2 (mean BP >159 mm Hg/99 mm Hg). Patients continued to enter BP information into the Heart360 portal every 2 weeks after categorization and remained enrolled in the program for up to 26 weeks.
The intervention strategies were tailored to each tier: Tier 0 patients received automated, bimonthly reminders to provide BP information for Heart360; tier 1 patients also received ongoing lifestyle/behavioral counseling, detailed medication assessment and dosage adjustments as needed; tier 2 patients received all aforementioned interventions, along with at least one home visit to evaluate barriers to BP control.
The primary outcomes were as follows: change to systolic and diastolic BP from enrollment to the final recorded measurement; the percentage of participants to achieve BP <140 mm Hg/90 mm Hg by the last clinic visit within 6 months of enrollment; and the percentage of participants to achieve BP <140 mm Hg/90 mm Hg or experience at least a 10-mm Hg decrease in systolic BP between enrollment and their final visit.
The mean systolic and diastolic BP for the cohort at enrollment was 138.1 mm Hg and 81.7 mm Hg, respectively. After 6 months, the mean overall systolic BP for the cohort decreased by 4.7 mm Hg, whereas mean diastolic BP decreased by 2.8 mm Hg. There was an overall increase in the percentage of patients who had achieved their target BP, from 51% at baseline to 63% at 6 months. Participants either achieved target BP or a systolic BP decrease by 10 mm Hg or more in 69% of cases.
Among patients in tier 1 specifically, researchers observed a mean decrease of 8.8 mm Hg to systolic BP and of 5 mm Hg to diastolic BP; a greater decrease was observed for patients in tier 2 (23.7 mm Hg for systolic and 10.1 mm Hg for diastolic BP).
“This community-based program successfully integrated health care providers, Heart360 and remote monitoring to engage, empower and assist a distinct group of community residents to achieve better hypertension control, with the biggest impact on those with the most poorly controlled hypertension,” the researchers wrote. “We think multidisciplinary collaborations such as [Check It, Change It] can serve as a potential model for community-based chronic disease management moving forward.”
Disclosure: See the full study for a list of relevant financial disclosures.
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