Clinical decision support system may improve hypertension management in adults with CKD
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Key takeaways:
- Patients on the clinical decision support system had greater systolic blood pressure change.
- Mean systolic blood pressure change in the intervention group was 14.6 mm Hg.
A computerized clinical decision support system could improve the management of uncontrolled hypertension in adults with chronic kidney disease, according to published data.
“Primary care practitioners play a critical role in reducing the burden of CKD by identifying patients with CKD and addressing risk factors, like hypertension and diabetes,” Lipika Samal, MD, MPH, and colleagues wrote in the study. “Referral of patients to nephrology care is associated with cost and morbidity and mortality benefits, but access to ambulatory nephrology care does not match the need at a population level.”
In the multicenter trial, researchers randomly selected 174 primary care practitioners and 2,026 patients for the intervention. The study involved 15 hospital-based, ambulatory and community health center clinics that were chosen between 2021 and 2022. Patients with CKD and hypertension who visited a primary care practitioner in the last 2 years were included.
Overall, 87 primary care practitioners and 1,029 patients were included in the intervention group, and 87 primary care practitioners and 997 patients were in the usual care group.
The intervention incorporated behavioral economic principles and human-centered design methods and provided tailored recommendations for managing hypertension, including use of renin-angiotensin-aldosterone system inhibitors. Patients in the control group received standard care, while the clinical decision support system operated silently.
Overall, 1,714 patients were treated for hypertension at baseline. Researchers measured the change in mean systolic blood pressure between baseline and 180 days in each group. A total of 1,623 patients had systolic blood pressure measurement at 180 days.
Patients of clinicians who used the clinical decision support system showed significantly greater systolic blood pressure change at 180 days vs. the usual care group, according to the findings. Mean systolic blood pressure change in the intervention group vs. the usual care group was 14.6 mm Hg compared with 11.7 mm Hg, respectively.
There was no difference in the percentage of patients who had BP control in the intervention group vs. control group. More patients received an action aligned with the clinical decision support in the intervention group (49.9%) than in the usual care group (34.6%).
“Further research is needed to understand the persistence of these findings and impact on CKD outcomes,” the researchers wrote, “such as cardiovascular disease and progression of kidney disease at the population level.”
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