Blood Pressure Self-management Research Articles

Blood Pressure Self-Management After Hypertensive Pregnancy-Reply.

Blood Pressure Self-Management After Hypertensive Pregnancy-Reply.

Improving mental health in black men through a 24-week community-based lifestyle change intervention: the black impact program

BackgroundPoor mental health is a leading cause of morbidity and mortality among Black men in the United States. Efforts to improve mental health among Black men have been hampered by a lack of access and utilization of mental health services. Physical activity and social networks have been shown to improve mental health. Thus, we examined the effect of a community team-based physical activity, health education and social needs intervention among Black men on mental health over 24 weeks.MethodsBlack adult males (n = 74) from a large Midwestern city participated in Black Impact, a 24-week community-based lifestyle change program adapted from the Diabetes Prevention Program and American Heart Association’s (AHA) Check, Change, Control Blood Pressure Self-Management Program, which incorporates AHA’s Life’s Simple 7 (LS7) framework. Measures of mental health including the Center for Epidemiological Studies Depression Scale (CES-D), Patient Health Questionnaire 2-question depression screener (PHQ-2), and Perceived Stress Scale-10 (PSS-10) were completed at baseline, 12 and 24 weeks. The change in mental health scores from baseline to 12 and 24 weeks were evaluated using linear mixed-effects models adjusting for age, education, and income. The change in cardiovascular health scores, defined as objective metrics of LS7 (LS5 [blood pressure, total cholesterol, fasting glucose, body mass index and smoking]), by baseline mental health were evaluated using linear mixed-effects models with an interaction term (time*baseline mental health variable) and a random intercept for each participant.ResultsAmong 71 Black men (mean age 51, 85% employed) at 24 weeks, CES-D scores decreased from 10.54 to 7.90 (-2.64, 95%CI:-4.74, -0.55), PHQ-2 decreased from 1.04 to 0.63 (-0.41, 95%CI: -0.75, -0.07), and PSS-10 decreased from 14.62 to 12.91 (-1.71, 95%CI: -3.53, 0.12). A 1-unit higher CES-D at baseline was associated with less improvement in LS5 scores by -0.04 (95%CI: -0.076, -0.005) and − 0.032 (95%CI:-0.067, 0.003) units at week 12 and 24, respectively, with similar findings for PSS.ConclusionsThe Black Impact community-based lifestyle program has the potential to reduce depressive symptoms and stress in Black men. There is a dire need for larger, randomized studies to test the impact of Black Impact on mental health in Black men to advance health equity.Trial RegistrationRetrospectively Registered, ClinicalTrials.gov Identifier: NCT04787978.

Abstract 15804: Intervention to Improve Self-management of Blood Pressure for Low-Income Black Patients With Severe Hypertension

Background Hypertension is a leading cause of preventable mortality and morbidity and is disproportionately represented among minority populations. Despite proven interventions outlined in practice guidelines, only 48% of patients who are diagnosed with hypertension have their condition controlled. In a southeastern US county, the prevalence of hypertension is 42%, with a strong association with race, suggesting opportunities to intervene at a neighborhood level to reduce hypertension disparities and improve overall population health. Aims To improve access to care through targeted opportunities for self-management of blood pressure (BP). Methods: This quality initiative used a pre-post evaluation design. We identified Black low-income patients with uncontrolled hypertension (SBP > 160 mmHg and/or DBP > 100 mmHg) from a local federally qualified health center (FQHC). Trained student ambassadors provided telephone outreach, BP cuffs, and goal setting on AHA Essential 8 for 4 months. Follow-up occurred at 7 months. Results: Among Black participants (n=345), average age was 55.4 years (SD 8.7), and a majority were male (n=173, 50.1%) and uninsured (n=159, 46.1%). Engagement in calls occurred for 67.8% (n=234) of the cohort; cuff distribution was 22.9% (n=79); and AHA Essential 8 goal setting occurred for 64 patients. BP improved for 40% of the cohort (mean pre: 168/98 mmHg, mean post: 150/89 mmHg; p <0.0001). Of the cohort reached, 33% expressed social needs such as food insecurity, housing, and medication costs. Conclusion Findings suggest that telephone outreach with student ambassadors successfully improves patient engagement and reduces blood pressure, on average.

Abstract 17353: Health Literacy and Hypertension: A Systematic Review

Introduction: Low health literacy (HL) is highly prevalent in the United States. Despite the potential for low HL to be a major barrier to effective self-management of blood pressure (BP), data on HL among adults with hypertension (HTN) is scarce. Goals: We conducted a systematic review to examine the prevalence and factors associated with low HL among adults with HTN. Additionally, we examined intervention trials which sought to modify the impact of low HL among participants with HTN. Methods: A comprehensive search of 6 databases was performed to identify studies which measured HL using a validated survey and included adults with HTN. After removing duplicate citations, two authors independently reviewed the references for eligibility, data extraction, and risk of bias assessment. Results: A total of 1,046 studies were identified of which 44 met eligibility criteria. The prevalence of low HL was 33% among the 31,507 participants included across the 44 studies. In the studies that reported associations between social determinants of health factors and HL, lower education levels, non-white race, and lower HTN knowledge were found to be significantly associated with lower HL among adults with HTN. Among the 15 observational studies which examined BP, lower HL was associated with higher BP in 8 studies. Six randomized control trials included an intervention to modify HL and measure its effect on BP control. Two of these trials demonstrated significant reductions in BP among the intervention group compared to control. Conclusion: Among studies which measured HL in adults with HTN, education, HTN knowledge and race were associated with HL; however, interventions to address HL were not consistently associated with improvements in BP control. A more detailed examination of methods to address HL among adults with HTN is warranted.

Addressing non-medical health-related social needs through a community-based lifestyle intervention during the COVID-19 pandemic: The Black Impact program.

Non-medical health-related social needs (social needs) are major contributors to worse health outcomes and may have an adverse impact on cardiovascular risk factors and cardiovascular disease. The present study evaluated the effect of a closed-loop community-based pathway in reducing social needs among Black men in a lifestyle change program. Black men (n = 70) from a large Midwestern city participated in Black Impact, a 24-week community-based team lifestyle change single-arm pilot trial adapted from the Diabetes Prevention Program and American Heart Association's (AHA) Check, Change, Control Blood Pressure Self-Management Program, which incorporates AHA's Life's Simple 7 (LS7) framework. Participants were screened using the Centers for Medicare and Medicaid Services (CMS) Accountable Health Communities Health-Related Social Needs Screening Tool. Participants with affirmative responses were referred to a community hub pathway to address social needs. The primary outcome for this analysis is change in social needs based on the CMS social needs survey at 12 and 24 weeks using mixed effect logistic regressions with random intercepts for each participant. Change in a LS7 score (range 0-14) from baseline to 12 and 24 weeks was evaluated using a linear mixed-effects model stratified by baseline social needs. Among 70 participants, the mean age of participants was 52 ±10.5 years. The men were sociodemographically diverse, with annual income ranging from <$20,000 (6%) to ≥$75,000 (23%). Forty-three percent had a college degree or higher level of education, 73% had private insurance, and 84% were employed. At baseline 57% of participants had at least one social need. Over 12 and 24 weeks, this was reduced to 37% (OR 0.33, 95%CI: 0.13, 0.85) and 44% (OR 0.50, 95%CI: 0.21, 1.16), respectively. There was no association of baseline social needs status with baseline LS7 score, and LS7 score improved over 12 and 24 weeks among men with and without social needs, with no evidence of a differential effect. The Black Impact lifestyle change single-arm pilot program showed that a referral to a closed-loop community-based hub reduced social needs in Black men. We found no association of social needs with baseline or change in LS7 scores. Further evaluation of community-based strategies to advance the attainment of LS7 and address social needs among Black men in larger trials is warranted.

Effectiveness of an mHealth application on remote monitoring and self-management of persons with hypertension in a coastal taluk of Udupi district: A study protocol

Background: Hypertension is the most important risk factor for cardiovascular disease, a major cause of death and disability globally. There is increasing evidence that demonstrates clinically relevant benefits from self-monitoring and self-management of blood pressure. Evidence suggests a reduction of systolic BP by 3.2 mm/hg through self-monitoring. The use of mHealth applications in health care monitoring and self-management can help in the timely delivery of health information. Around 33% of Indians use mHealth applications in their daily life. However, well-designed, user complied mHealth applications are essential to reach the masses and to be effective. A previously conducted study in India demonstrated that applications are not customized according to users' needs and expectations and lacked usability assessment by patients. Therefore, we aimed to develop and test a novel mHealth application on remote monitoring and self-management in hypertension. Methods: The study will be carried out in three phases. The first phase will be an in-depth interview to identify the required parameters to develop a customized mHealth android-based application to monitor hypertension. The second phase is to develop the customized application through the Agile development design using the android studio platform. In the third phase, a community-based cluster randomized trial will be carried out to assess the effectiveness of the mHealth intervention on the remote monitoring and self-management of people with hypertension. A sample of 236 people from 12 villages will be randomized and the mHealth application will be delivered to the intervention group and the standard regimen will be continued in the control group. Results: In the proposed study if the intervention is found to be helpful, then hypertension patients in the community can be encouraged to install the mHealth application. This application, if found effective can improve the health status, knowledge, and self-care approach among hypertensive patients. Registration: CTR India (CTRI/2022/03/041544).

708-P: Hypertension Control among People with Diabetes Using a Self-Management Multicondition Digital Platform

Introduction: Digital multicondition platforms seek to assist persons with diabetes in management of their diabetes and comorbidities. Hypertension is reported in over two-thirds of patients with type 2 diabetes. Both are major risk factors for cardiac, stroke, and kidney disorders. Dario’s digital therapeutics platform for chronic conditions supports self-management of diabetes and high blood pressure. The platform enables digital evaluation of blood glucose and blood pressure levels in real time and supports interventions based on clinical indicators. Method: A retrospective data evaluation was performed on the Dario data base since 2019. A population of active users who started with hypertension stage 1 as baseline was identified. Blood glucose and blood pressure readings were assessed at first month and 6th month of use. A subgroup of users who started at hypertension stage 2 was evaluated as well. Systolic, diastolic pressures and average blood glucose were evaluated along of the study. Results: For the 2554 users identified with diabetes and hypertension, more than two thirds improved their systolic blood pressure by 13 mmHg (P&amp;lt;0.001; 144±14 to 131±13) . A group of 38.7% (N=990) moved to a lower hypertensive stage (P&amp;lt;0.001) . The subset of 1367 users with stage 2 hypertension improved their systolic blood pressure from 150±12.4 to 141±15.2 mmHg on average and 43.9% (N=600) improved their blood pressure by more than mmHg over six months (P&amp;lt;0.001) . A subgroup of 3users who started at high-risk blood glucose levels significantly reduced their blood glucose average by 15% over 6 months (232.4±46 to 198±65 mg/dL) (P&amp;lt;0.001) . Conclusion: A multicondition digital therapeutic platform may promote behavioral modifications and result in sustainable improvements in both glycemic control and blood pressure levels. The study demonstrates an improvement in multiple chronic conditions (diabetes and Hypertension) for people using one digital platform. Disclosure Y.Hershcovitz: None. M.Tamir: None. O.Manejwala: Employee; DarioHealth Corp., Stock/Shareholder; DarioHealth Corp.

Establishing a screening programme for diabetic retinopathy in Kilimanjaro Region, Tanzania using intervention mapping.

BackgroundThe Kilimanjaro Diabetic Programme used the Intervention Mapping framework to develop a theory- and evidence-based diabetic retinopathy screening programme. A Working Committee of health care workers and stakeholders ensured community engagement and empowerment of the target audience.ObjectivesTo deliver a culturally appropriate, sustainable, community supported health intervention, promoting eye health behaviour change, to prevent avoidable blindness.MethodsThe six steps of the Intervention Mapping protocol incorporated eight components: (1) a needs assessment of people with diabetes and health care workers (2) a clinical trial of diabetic retinopathy screening modes, (3) comic strips as a motivational strategy for diabetic retinopathy screening uptake, (4) health care worker education (5) an electronic database of people with diabetes (6) a self-carry diary (7) implementation of mobile diabetic retinopathy retinal screening (8) process and outcome programme evaluation.ResultsThe programme eliminated barriers to diabetic retinopathy screening in Kilimanjaro Christian Medical Centre eye and diabetic clinics, placing a digital retinal screening camera in the diabetic clinic and a fast-track screening system in the eye clinic. Two comic strips and a diary provided information about self-management and record of medications, treatment, blood sugar and blood pressure at clinic visits. An annual rural health care worker education programme met requests for knowledge on treatment and care of diabetes, targeting prevention of diabetic retinopathy. Rural digital retinal screening was implemented. Rural diabetes clinics were initiated.ConclusionsIntervention Mapping provided a systematic, iterative model to formulate and deliver an urban and rural diabetic retinopathy screening programme.Trial registration numberISRCTN31439939. Details available at https://www.isrctn.com/

Postpartum blood pressure self-management following hypertensive pregnancy: protocol of the Physician Optimised Post-partum Hypertension Treatment (POP-HT) trial

IntroductionNew-onset hypertension affects approximately 10% of pregnancies and is associated with a significant increase in risk of cardiovascular disease in later life, with blood pressure measured 6 weeks postpartum predictive...

Improving cardiovascular health in black men through a 24-week community-based team lifestyle change intervention: The black impact pilot study

BackgroundHigher cardiovascular health scores, using American Heart Association's (AHA) Life's Simple 7 (LS7), have been associated with lower risk of cardiovascular disease, type 2 diabetes, cancer, and mortality among all racial/ethnic groups. Nationally, Black men have the lowest levels of LS7. Thus, a study was conducted to evaluate the impact of a community-based team lifestyle change program on LS7 among Black men. MethodsBlack adult males (n = 74) from a large Midwestern city participated in Black Impact, a 24-week community-based team lifestyle change program adapted from the Diabetes Prevention Program and AHA's Check, Change, Control Blood Pressure Self-Management Program, which incorporates AHA's LS7 framework. The change in a LS7 score (range 0–14) from baseline to 12 and 24 weeks was evaluated using a linear mixed-effects model adjusted for age, education, and income. ResultsThe mean age of participants was 52 ± 10 years. The men were sociodemographically diverse, with annual income ranging from <$20,000 (7%) to ≥$75,000 (25%). Twenty-five percent were college graduates, 73% had private insurance, and 84% were employed. In fully adjusted models, LS7 score at baseline was 7.12 and increased 0.67 (95%CI: 0.14, 1.20, p = 0.013) and 0.93 (95%CI: 0.40, 1.46, p<0.001) points at 12 and 24 weeks, respectively, compared to baseline. Sensitivity analysis evaluating 5 components (excluding diet and physical activity) and 6 components (excluding diet) also showed significant increases at 12 and 24 weeks (all p<0.01). ConclusionsThe Black Impact lifestyle change single-arm pilot program showed that a community-based lifestyle intervention has the potential to improve LS7 in Black men. Further randomized studies are urgently needed to improve cardiovascular health and advance cardiovascular health equity in Black men.

Abstract 12916: Improving Cardiovascular Health in Black Men Through a 24-week Community-Based Lifestyle Change Intervention: The Black Impact Program

Introduction: Higher cardiovascular health scores, using American Heart Association’s (AHA) Life’s Simple 7 (LS7), have been associated with lower risk of cardiovascular disease, type 2 diabetes, cancer and mortality among all racial/ethnic groups. Nationally, Black men have the lowest levels of LS7. Thus, a study was conducted to evaluate the impact of a community-based lifestyle change program on LS7 among Black men. Hypothesis: A community-based lifestyle change program will increase levels of LS7 among Black men. Methods: Black adult males (n=74) from a large Midwestern city participated in Black Impact, a 24-week community-based lifestyle change program adapted from the Diabetes Prevention Program and AHA’s Check, Change, Control Blood Pressure Self-Management Program which incorporates AHA’s LS7 framework. The change in a LS7 score (range 0-14) from baseline to 12 and 24 weeks was evaluated using a linear mixed effects model adjusted for age, education and income. Results: The mean age of participants was 52 ±10 years. The men were sociodemographically diverse with annual income ranging from &lt;$20,000 (7%) to ≥$75,000 (25%). Twenty-five percent were college graduates, 73% had private insurance and 84% were employed. In fully adjusted models, LS7 score at baseline was 7.12 and increased 0.67 (95%CI: 0.14, 1.20, p=0.013) and 0.93 (95%CI: 0.40, 1.46, p=&lt;0.001) points at 12 and 24 weeks, respectively, compared to baseline. Sensitivity analysis evaluating 5 components (excluding diet and physical activity) and 6 components (excluding diet) also showed significant increases at 12 and 24 weeks (all p&lt;0.01). Conclusions: The Black Impact lifestyle change single-arm pilot program showed that a community-based lifestyle intervention has the potential to improve LS7 in Black men. Further randomized studies are urgently needed to improve cardiovascular health and advance cardiovascular health equity in Black men.

Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program

It is unclear whether mobile technology hypertension self-management programs are associated with blood pressure (BP) control. To examine whether engagement with a hypertension self-management program with a BP monitor and connected smartphone application with clinically based digital coaching was associated with BP control during a follow-up period of as long as 3 years. This cohort study enrolled US adults with elevated BP or hypertension between January 1, 2015, and July 1, 2020. The hypertension self-management program was provided through the participant's (or their spouse's) employer health plan. Program engagement, defined by average number of application sessions. Systolic and diastolic BP measured by a US Food and Drug Administration-cleared BP monitor, with categories defined as normal (systolic BP, <120 mm Hg), elevated (systolic BP, 120-129 mm Hg), stage 1 hypertension (systolic BP, 130-139 mm Hg), and stage 2 hypertension (systolic BP ≥140 mm Hg). Other measures included age, gender, depression, anxiety, diabetes, high cholesterol, smoking, geographic region, area deprivation index, self-reported weight, and device-measured physical activity (steps per day). Among 28 189 participants (median [IQR] age, 51 [43-58] years; 9424 women [40.4%]; 13 902 men [59.6%]), median (IQR) baseline systolic BP was 129.5 mm Hg (120.5-139.6 mm Hg) and diastolic BP was 81.7 mm Hg (75.7-88.4 mm Hg). Median systolic BP at 1 year improved at least 1 category for 495 of 934 participants (53.0%) with baseline elevated BP, 673 of 966 (69.7%) with baseline stage 1 hypertension, and 920 of 1075 (85.7%) with baseline stage 2 hypertension. Participants in the program for 3 years had a mean (SEM) systolic BP reduction of 7.2 (0.4), 12.2 (0.7), and 20.9 (1.7) mm Hg compared with baseline for those starting with elevated, stage 1 hypertension, and stage 2 hypertension, respectively. Greater engagement was associated with lower systolic BP over time (high-engagement group: 131.2 mm Hg; 95% CI, 115.5-155.8 mm Hg; medium-engagement group: 133.4 mm Hg; 95% CI 116.3-159.5 mm Hg; low-engagement group: 135.5 mm Hg; 95% CI, 117.3-164.8 mm Hg; P < .001); these results persisted after adjusting for age, gender, depression, anxiety, diabetes, high cholesterol, smoking, area deprivation index rank, and US region, which was partially mediated by greater physical activity. A very high BP (systolic BP >180 mm Hg) was observed 11 637 times from 3778 participants. Greater engagement was associated with lower risk of very high BP; the estimated probability of a very high BP was greater in the low-engagement group (1.42%; 95% CI, 1.26%-1.59%) compared with the medium-engagement group (0.79%; 95% CI, 0.71%-0.87%; P < .001) and the high-engagement group (0.53%; 95% CI, 0.45%-0.60%; P < .001 for comparison with both groups). The findings of this study suggest that a mobile technology hypertension self-management program can support long-term BP control and very high BP detection. Such programs may improve real-world BP monitoring and control.

Abstract P121: Automated Messaging Program To Facilitate Systematic Home Blood Pressure Monitoring: A Qualitative Analysis Of Provider Interviews

Introduction: Hypertension is a leading cause of morbidity worldwide. Home blood pressure monitoring (HBPM) has been shown to lower blood pressure (BP) if paired with co-interventions but such programs are not routinely used in clinical care. MyBP is an automated bi-directional text messaging HBPM program that assists lowering of BP, but how to best implement within clinical care remains unknown. Therefore, in this study, we sought stakeholder input from care providers. Methods: We conducted semi-structured interviews (average recorded duration 28 minutes) with physicians, nurses, and medical assistants from primary care settings, most of whom had participated in a feasibility trial of MyBP. The interview was designed around constructs from the Consolidated Framework for Implementation Research. Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes. Results: Subjects were physicians (n = 11) and nurses/medical assistants (n = 6). Care providers felt that patients benefitted from MyBP’s positive influence on BP measurement adherence, psychological factors (such as health literacy and patient empowerment), and perceived patient usability of the program. They reported that the program data aided in clinical diagnosis and management of HTN with a practical user interface for providers. Barriers to implementation included lack of integration into the electronic medical record and difficulty in training office staff in its use. Conclusion: In this qualitative analysis of care provider stakeholders, MyBP was seen as a pragmatic and effective way to empower patients in BP self-management and tangibly aid providers. Future research will need to focus on strategies to overcome implementation barriers to facilitate integration in to the clinical and digital environment.

Short-Term Postpartum Blood Pressure Self-Management and Long-Term Blood Pressure Control: A Randomized Controlled Trial.

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Abstract P195: The Association Of Psychological Stress Measures With Allostatic Load Among African Americans With Hypertension

African Americans experience disproportionate stress over the life course, which has been posited as an explanatory mechanism underlying racial disparities in CVD risk. We studied associations between measures of self-reported psychosocial stress and allostatic load (AL) (elevated or fluctuating endocrine or neural responses resulting from chronic stress) among 74 participants of the Achieving Blood Pressure (BP) Control Together (ACT) study—a randomized control trial to improve BP self-management and control among African Americans. We examined ancillary AL biomarkers (i.e., DHEA-S, cortisol, CRP, IL-6) in addition to ACT study measures (i.e., HbA1c, diabetes status, total cholesterol, HDL-C, triglycerides, hyperlipidemia, urinary microalbumin) collected at 12-months follow-up. We used linear univariable and multivariable regression to estimate correlations between ratings of the Perceived Stress Scale (PSS-10), the Everyday Discrimination Scale, and the Patient Health Questionnaire (PHQ-8) with total AL score (1 point per aforementioned component measure threshold achieved) and its components. Ninety-three percent of the sample reported moderate to severe stress; the mean discrimination score was 14.9 (SD: 7.4) (of a possible 39 points); 22% had moderate to severe depressive symptoms. The mean AL score was 3 of a possible total of 11. Perceived stress was negatively associated with CRP adjusting for other components and patient characteristics. Discrimination was associated with increases in inflammatory factors; however, this association diminished after adjusting for other AL components and patient characteristics. Depressive symptoms were positively associated with inflammatory factors and triglycerides adjusting for other AL components and patient characteristics. In conclusion, the findings from this study of African Americans with hypertension suggest correlations between self-reported psychological stressors and AL components, but not total AL score.

Abstract 15858: Efficacy of Hypertension Self-management Classes Among Low-Income Patients of a Federally Qualified Health Center

Introduction: Racial and socioeconomic disparities in hypertension prevalence and treatment have been observed over numerous decades. There is opportunity to close racial disparities by focusing resources on patient education, skill-building, and self-management. Methods: A hypertension-reduction program was established between an academic-affiliated FQHC in the southeast, the American Heart Association, the Centers for Disease Control, and the American College of Preventive Medicine using a multidisciplinary outreach model in the community setting. Participants included 265 high-risk patients from the FQHC with severe hypertension (&gt;160/90 mm HG). Program activities included a weekly class where participants learned about hypertension, were trained to take their blood pressure (BP), and received cuffs to use at home. A prospective pre-post cohort design was used to evaluate this portion of the program. Participants’ attendance at the self-management classes was tracked along with BP measurements at every class attended. Results: Over the program’s first 6 months, 93 of the 265 recruited participants attended at least one of 28 BP management classes. The 29 participants who attended multiple classes achieved an average 19 mm HG reduction in systolic BP ( p =0.004) and an average 14 mm HG reduction in diastolic BP ( p =0.002). Patients who were Black were significantly more likely to attend multiple classes than patients who were Hispanic ( p =0.004). Also, patients who were self-monitoring their BP prior to class attendance were significantly more likely to attend multiple classes than those who were not previously self-monitoring ( p =0.014). Multiple class attendance was also associated with higher baseline BP ( p =0.038 for systolic and p =0.018 for diastolic). Conclusions: Implementation of blood pressure self-management classes showed success in reducing hypertension among many of the high-risk participants. Hispanic patients were much less likely to attend multiple classes, underscoring the need for culturally and linguistically appropriate class content. The low proportion of Hispanic patients previously monitoring their BP points to an opportunity to improve patient awareness about hypertension among Hispanic populations generally.

Hypertension-Focused Medication Therapy Management: A Collaborative Pilot Program Uniting Pharmacists, Public Health, and Health Insurers in Wisconsin.

Heart disease and stroke are leading causes of death and disability in the United States, and high blood pressure is a major risk factor for both. Community pharmacists are readily positioned to improve cardiovascular health through services such as medication therapy management and self-management education. In 2018, the Pharmacy Society of Wisconsin, the Wisconsin Division of Public Health, and NeuGen, a not-for-profit health insurer, piloted a pharmacist-led medication therapy management program for people with hypertension in partnership with 8 community pharmacies. We evaluated changes in use of blood pressure self-management tools and barriers to antihypertensive medication adherence before and after medication therapy management services. Participant satisfaction was also assessed for the 59 participants at the end of the program. We observed improvements in self-reported use of self-management tools, reductions in medication adherence barriers, and high satisfaction with pharmacist care. This collaborative pilot resulted in sustainable reimbursement for participating pharmacies delivering medication therapy management services to eligible NeuGen members.

Primary care doctors' views on self-monitoring of blood pressure and self-titration among patients with uncontrolled hypertension in Spain. The ADAMPA trial focus group study.

BackgroundDespite the increased use of blood pressure (BP) monitoring devices at home, the hypertension of more than 50% of European patients remains uncontrolled. Nevertheless, the self-management of BP, through the combination of home monitoring of BP with self-titration, could be anaccessible and effective tool for improving hypertension control in the primary care setting. The ADAMPA study is a trial with participants randomised to BP self-management (BPSM) with self-titration of antihypertensive medication or to usual care, in a population of patients with poorly controlled hypertension.AimTo explore the views and attitudes of primary care doctors participating in the ADAMPA trial regarding BPSM with self-titration.Design & settingA focus group study took place with primary care doctors participating in the ADAMPA trial, which was carried out in one health district of the Valencia Health System in Spain.MethodNine primary care doctors participating in the ADAMPA trial were included in the focus group. Three researchers (two using manual methods and one using NVivo software) independently conducted a content analysis, reading the transcripts, identifying, classifying, and coding the contents, and developing a conceptual scheme based on these topics.ResultsParticipating doctors clearly support home BP monitoring (HBPM), the setting of individual BP targets, and incorporating patient readings into decision-making. They consider it an investment to educate patients for medication self-adjustment and estimate that an important proportion of their patients are potential candidates for hypertension self-management with medication self-titration. However, they show important divergences regarding the role of nursing in BP control.ConclusionPrimary care doctors participating in the ADAMPA trial feel comfortable with BPSM with self-titration, and would consider extending its use (or the use of some components, such as BP target setting) to other patients with hypertension outside the trial.

Implementing self-management: a mixed methods study of women\u2019s experiences of a postpartum hypertension intervention (SNAP-HT)

BackgroundSelf-management strategies are effective in a number of medical conditions; however, implementation studies have demonstrated adoption into clinical practice can be problematic. The process of implementation was explored during a pilot randomised controlled trial evaluating postpartum blood pressure self-management in women with medicated hypertensive disorders of pregnancy.MethodsA mixed methods study using semi-structured interviews with a qualitative and a scored (quantitative) component were undertaken as part of a pilot randomised controlled trial (SNAP-HT) in postnatal women with medicated gestational hypertension or pre-eclampsia. Women were randomised to usual care or blood pressure self-management. Self-management entailed daily home blood pressure monitoring and automated medication reduction via telemonitoring. Women from both groups optionally consented to participate in audio-recorded interviews at 4 weeks and 6 months postpartum. Interview questions were developed to explore the proposed benefits of self-management and the constructs of normalisation process theory. Participants provided a score (Likert scale 1–5) for each question and were encouraged to expand upon these answers through further discussion. The interviews were transcribed and analysed using the framework approach.ResultsSixty-eight women, 34 from each randomised group, completed at least one audio-recorded interview. Several overarching themes emerged from analysis of 126 interview transcripts: control; convenience; confidence, communication and knowledge; concern; constraints; and components of the intervention. In the scored component of the analysis, both groups reported feeling more in control of their condition postpartum compared to during pregnancy, more so in those self-managing at both 4 weeks and 6 months: adjusted differences 0.6 (95% confidence interval [CI] 0.2 to 1.1) and 0.7 (95% CI 0.3 to 1.2) respectively.ConclusionsInterviews and quantitative data showed that self-management enhanced women’s sense of control and improved their blood pressure-related anxiety. Prior to taking part, a few women anticipated that home monitoring might increase anxiety, but stated that it had the opposite effect. Self-management was perceived as more flexible and reactive and as enabling more targeted down-titration of medication. These data provide considerable support for blood pressure self-management postpartum and reinforce the effectiveness of the intervention used in this study.Trial registrationClinicalTrials.gov: NCT02333240. Prospectively registered on 7 January 2015.

Effectiveness of a multifactorial intervention, consisting of self-management of antihypertensive medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and physical exercise, in patients with uncontrolled hypertension taking 2 or more antihypertensive drugs: The MEDICHY study.

Introduction:High blood pressure is the leading modifiable risk factor for cardiovascular disease, and is associated with high morbidity and mortality and with significant health care costs for individuals and society. However, fewer than half of the patients with hypertension receiving pharmacological treatment have adequate blood pressure control. The main reasons for this are therapeutic inertia, lack of adherence to treatment, and unhealthy lifestyle (i.e., excess dietary fat and salt, sedentary lifestyle, and overweight). Cardiovascular risk and mortality are greater in hypertensive patients who are receiving treatment but have suboptimal control of blood pressure.Methods/Design:This is a multicentre, parallel, 2-arm, single-blind (outcome assessor), controled, cluster-randomized clinical trial. General practitioners and nurses will be randomly allocated to the intervention group (self-management of antihypertensive medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and physical exercise) or the control group (regular clinical practice). A total of 424 patients in primary care centers who use 2 or more antihypertensive drugs and blood pressure of at least 130/80 during 24-hambulatory blood pressure monitoring will be recruited. The primary outcome is systolic blood pressure at 12 months. The secondary outcomes are blood pressure control (<140/90 mm Hg); quality of life (EuroQol 5D); direct health care costs; adherence to use of antihypertensive medication; and cardiovascular risk (REGICOR and SCORE scales).Discussion:This trial will be conducted in the primary care setting and will evaluate the impact of a multifactorial intervention consisting of self-management of blood pressure, antihypertensive medications, and lifestyle modifications (hypocaloric and low sodium diet and physical exercise).