Abstract P231: Patient-Centered Care of Stage I and II Hypertension in Underserved Communities

Abstract

Background: Inadequate BP control leads to excess cardiovascular disease risk (CVD), especially in underserved communities. Patient-centered care tools including home monitoring of BP are key components in BP control and CVD risk reduction. We compared two communication methods to modify CVD risk in hypertensive patients. We also tested whether either strategy is more effective in stage I or II hypertension. Methods: 388 asymptomatic subjects (59% white, 37% AA) with Framingham risk score >10% from one urban and one rural center completed our trial. 37% had StageI HTN (SBP 140-159 mmHg), and 24% StageII HTN (SBP≥160 mmHg). Subjects were randomized to nurse management (NM) with 4 visits/year, or nurse management plus Telemedicine (T). T group reported weight, BP, steps/day at least weekly via internet (average 6.3 reports/month). Periodic summaries were sent to patients and to their care providers Results: BP decreased substantially in both groups, with a significant difference in BP reduction between NM and T in patients with stageI HTN (P=0.037-see graph). T had a lower 8 month average BP compared to NM (T: 134.6 ± 15.0, NM: 140.4±16.9 mmHg, P<0.02). StageII HTN patients had significant reduction in BP with no difference between NM and T (P=.900). Risk score was reduced by 2.6±6.8% (P< 0.001), with no difference between NM and T (P=0.750) Conclusion: Telemedicine improved BP control in patients with StageI HTN more than with StageII HTN. It appears that SBP ≥160 is more likely to be immediately treated by care providers than SBP in the (140-159) range. StageI patients, therefore, had greater benefit from Telemedicine as it stimulated a more effective intervention by their care providers.