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At-home hypertension program may control BP in 7 weeks
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Most patients who were treated for hypertension by a home-based BP control program that was run by nonphysicians achieved BP control in an average of 7 weeks, according to a study published in Clinical Cardiology.
“We are facing a problem nationally and globally of hypertension that is poorly controlled,” Naomi D.L. Fisher, MD, director of hypertension services and the hypertension specialty clinic at Brigham and Women’s Hospital, told Cardiology Today. “We recognized at the Brigham and Women’s Hospital that we have the potential to develop an innovative program that will significantly increase the control of high blood pressure and the quality of care and significantly decrease cost.”
Researchers assessed the effectiveness of a home-based BP control program in 130 patients (mean age, 59 years; 56% women) with hypertension, defined as a BP greater than 140/90 mm Hg. Patients were followed up for up to 6 months.
To create the program, a multidisciplinary group of clinical experts developed a clinical algorithm based on the National Institute for Health and Care Excellence and American College of Cardiology/American Heart Association guidelines. The algorithm incorporated strategies to improve medication adherence such as simplicity, once-daily generic medications and efficacy.
“Our algorithm has a built-in titration schedule that is much quicker than most physicians use in the office. It is not unusual for there to be a significant amount of inertia both on the part of the practitioner and also on the part of patients in the usual care of hypertension,” Fisher told Cardiology Today. “Our program applies medication titration on an every-2-week basis. We built in lifestyle modifications, and we encourage patients to lose weight, exercise and promote a healthful lifestyle. But at the same time, we don’t have a built-in indefinite lag for starting blood pressure medications, and the titration cycles and check-ins are much more frequent than usual. Patients are really engaged, so we can get there much more quickly than with traditional office-based care.”
The therapeutic algorithm was based on home BP measurements, which were automatically transmitted to the remote clinic team by a Bluetooth-enabled device. BP measurements were taken twice daily for 1 week. Normal BP was defined as those less than 135/85 mm Hg. Patients were made aware of their diagnosis. Those who had elevated home BPs had phone calls with a patient navigator to discuss medication adjustments based on the clinical algorithm. If the home BP remained elevated after the prescription of three medications, including a diuretic, patients were diagnosed with resistant hypertension and were then referred to a hypertension specialist.
“We’re aiming to develop a program that is generalizable and that can be applied at any practice,” Fisher said in an interview. “We tested it in two clinical care settings: a primary care practice and also in a cardiology practice.”
Controlled BP was achieved in 81% of patients. In patients who participated in the program and measured their BP at home, 91% achieved the goal BP in a mean of 7 weeks. The achievement of BP goals was similar across sex, race and age.
“This pilot is one part of a platform in Cardiovascular Innovation at Brigham and Women’s Hospital,” Fisher told Cardiology Today. “We have a parallel treatment program for patients with hyperlipidemia and statin intolerance and another for the remote treatment of heart failure.” – by Darlene Dobkowski
For more information:
Naomi D.L. Fisher, MD, can be reached at nfisher@bwh.harvard.edu.
Disclosures: The authors report no relevant financial disclosures.
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