Feasibility of a randomized hypertension screening initiative in the perioperative setting

Sofia I Diaz,Matthew M Burg,Luying Yan,Robert B Schonberger,Feng Dai,Bin Zhou

doi:10.1186/s13741-021-00210-7

Abstract

ObjectivesThis study sought to assess feasibility of a randomized trial of blood pressure intervention (home blood pressure monitoring vs. counseling) in the preoperative clinic and the baseline rates of primary care follow-up after such interventions.MethodsA prospective randomized feasibility study was performed at Yale New Haven Hospital Preadmission Testing Clinic. A sample of 100 adults, with elevated blood pressure, were recruited during their preadmission visit, and randomized 1:1 to receive brief BP counseling and an educational brochure versus additionally receiving a home BP monitor (HBPM) with a mailed report of their home readings. At 60-day post-surgery telephone follow-up, investigators asked whether participants had primary-care follow-up; had new/adjusted hypertension treatment; and felt satisfied with the study.ResultsThere were 51 patients in the counseling group and 49 in the HBPM group. Of 46 patients in the HBPM group who returned their monitors, 36 (78%) were hypertensive at home. At 60 days post-surgery, 31 (61%) patients in the counseling group and 30 (61%) in the HBPM group were reached by telephone with the remaining followed by EHR. Thirty-six (71%) patients in the counseling group and 36 (73%) in the HBPM group had seen their primary care provider. Seventeen of 36 (47%) in the counseling group and 18 of 31 (58%) in the HBPM group received new or adjusted hypertension medications. Sixty-one participants answered questions regarding their satisfaction with the study with 52 (85%) reporting that they felt moderately to very satisfied.ConclusionsThis feasibility study suggests that interventional blood pressure trials in the preoperative clinic are feasible, but telephone follow-up leads to significant gaps in outcome ascertainment.Trial registrationClinicaltrials.gov, NCT03634813. Registered 16 of August 2018.

Highlights

Controlled hypertension increases risk for cardiovascular disease (CVD) (Grimm Jr. et al 1985; Stamler et al 1989; Xu et al 2015) and, remains the leading modifiable cause of death and disability-adjusted life years worldwide (Lim et al 2012)
Within the field of anesthesiology, the Merit-Based Incentive Program (MIPS) included hypertension screening in its 2007 anesthesiology specific quality metrics, and subsequent literature established plausible thresholds at which preoperative blood pressures appeared reasonably predictive of longitudinal blood pressure elevation (Schonberger et al 2012; Schonberger et al 2015; Schonberger et al 2018)
In the effort to assess the feasibility of a randomized blood pressure intervention in the preoperative period and to understand baseline rates of blood pressure follow-up following such intervention, we pursued a randomized feasibility trial of blood pressure screening, education, and follow-up with vs. without longitudinal home blood pressure measurement in a cohort of 100 patients who presented to our preoperative testing center with blood pressures in the hypertensive range

Summary

Introduction

Controlled hypertension increases risk for cardiovascular disease (CVD) (Grimm Jr. et al 1985; Stamler et al 1989; Xu et al 2015) and, remains the leading modifiable cause of death and disability-adjusted life years worldwide (Lim et al 2012). While isolated teams have attempted to bring hypertension screening and treatment into perioperative workflows (Pfister et al 2020), randomized interventional studies based on these efforts have remained unexplored. In the effort to assess the feasibility of a randomized blood pressure intervention in the preoperative period and to understand baseline rates of blood pressure follow-up following such intervention, we pursued a randomized feasibility trial of blood pressure screening, education, and follow-up with vs without longitudinal home blood pressure measurement in a cohort of 100 patients who presented to our preoperative testing center with blood pressures in the hypertensive range. We measured the observed prevalence of post-operative primary care follow-up and patient perspectives on the study protocol, to better enable appropriate powering of a future trial targeting outcomes of improved blood pressure treatment

Objectives

Methods

Results

Conclusion