New platform aims to improve quality of, research on BP control
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A new BP control laboratory utilizing the national Patient-Centered Outcomes Research Network, or PCORnet, has the potential to improve surveillance of patients with hypertension and enhance comparative effectiveness research on the topic, according to a presentation at the American Heart Association Epidemiology, Prevention, Lifestyle and Cardiometabolic Health Scientific Sessions.
Researchers noted the PCORnet Blood Pressure Control Laboratory has three demonstration projects underway: BP Track, which is conducting national surveillance of BP control and aims to elucidate disparities; BP MAP, a cluster-randomized trial comparing two versions of a BP control quality improvement intervention; and BP Home, a patient-level randomized trial comparing standard home BP monitoring with a smartphone-linked BP monitoring system. The presentation was simultaneously published in Circulation: Cardiovascular Quality and Outcomes.
BP Track has so far collected data from 1.48 million patients who completed 5.8 million visits. In interim results, 61% of patients with hypertension have it under control, defined as BP less than 140/90 mm Hg, and only 12% of patients with a high BP measurement at an ambulatory visit received a prescription for a new medication.
“We are hoping to learn the status of BP treatment and control across the country; our sites are not a random sample, but represent most areas of the country,” Mark J. Pletcher, MD, MPH, professor of epidemiology and biostatistics at the University of California, San Francisco, and Cardiology Today Editorial Board Member Rhonda M. Cooper-DeHoff, PharmD, MS, FAHA, FACC, FCCP, associate professor and Research Foundation Professor in the College of Pharmacy at the University of Florida, told Healio. “Where are the opportunities for improvement? We can help pinpoint the health care processes that need improvement and that should lead to better control. We can see what high-performing health systems are doing, how we can learn from best practices, etc. We think BP Track can provide actionable information to health systems as they make changes to how they deliver care over time.”
The initial data show that hypertension control can be better, especially if the new definition recommended by the American College of Cardiology and the AHA, BP less than 130/80 mm Hg, is used, and so can medication management, Pletcher and Cooper-DeHoff said in an interview.
“Guidelines recommend adding a new class of medication when a patient is not in control, rather than simply increasing the dose,” they said. “Our data show that this is done only rarely; and that, when new medications are added, there is an average reduction in systolic BP that is quite substantial. Also, prescribing combination drug products is not part of routine practice, despite evidence and guidelines that show it is effective for improving adherence and BP control.”
BP MAP is designed to test whether the AMA’s M.A.P. (Measure accurately, Act rapidly, and Partner with patients) BP control quality intervention program is effective, and whether it can be delivered effectively as a self-guided program or requires additional support, such as with a practice change facilitator, they said.
“The AMA is planning to scale up this intervention once results are available,” Pletcher and Cooper-DeHoff said.
For BP Home, “smartphone integration enables use of smartphone apps that can help remind patients to take their blood pressure at home, take their medications, and can support communication with their physicians about how well they are doing,” Pletcher and Cooper-DeHoff told Healio. “But it’s not clear if this will actually help patients control their blood pressure.”
Overall, they said, “We are hoping that the BP control laboratory will be able to support future research projects, including enhanced surveillance and additional randomized controlled trials. We are open to collaboration, and encourage interested investigators to reach out to study leadership.” – by Erik Swain
References:
Pletcher MJ, et al. Abstract 56. Presented at: American Heart Association Epidemiology, Prevention, Lifestyle and Cardiometabolic Health Scientific Sessions; March 3-6, 2020; Phoenix.
Pletcher MJ, et al. Circ Cardiovasc Qual Outcomes. 2020;doi: 10.1161/CIRCOUTCOMES.119.006115.
Disclosures: The lab is funded by a partnership including the Patient-Centered Outcomes Research Institute, the AMA and the AHA. Cooper-DeHoff and Pletcher report they received salary support from the sponsors to help complete the demonstration projects.