Self-monitoring Of Blood Pressure Research Articles

Women's Acceptability of and Satisfaction With Self-Monitoring Blood Pressure During Pregnancy.

The aim of this study was to evaluate the acceptability and satisfaction of pregnant women at risk of hypertensive disorders with self-monitoring their blood pressure. A prospective cross-sectional study. Women at risk of hypertensive disorders during pregnancy were recommended to self-monitor their blood pressure at the study site to reduce hospital visits. Women who purchased a subsidised blood pressure monitor through the hospital were invited to participate in a survey about acceptability of and satisfaction with self-monitoring their blood pressure between hospital visits. Data were analysed with descriptive statistics and content analysis. Thirty women completed the survey. Most women were highly satisfied with self-monitoring their blood pressure and the support provided from hospital staff for responding to high readings experienced at home. The reassurance of monitoring their health and the convenience of reduced hospital visits were reported benefits of self-monitoring blood pressure. Inaccuracy of readings, anxiety associated with high readings, and cost of purchasing the machine were described as concerns by a small number of women. The findings suggest that self-monitoring blood pressure may be a useful addition to antenatal care for women at risk of hypertensive disorders. Ensuring that antenatal care providers adequately test machines for accuracy and educate women about proper use is essential. Promoting equitable access to self-monitoring by providing free or very low-cost machines to women experiencing financial disadvantage is warranted. Self-monitoring blood pressure during pregnancy has the potential to improve the detection of hypertensive disorders and reduce hospital visits and associated healthcare system costs. The authors have nothing to report.

Intervention development and optimisation of a multi-component digital intervention for the monitoring and management of hypertensive pregnancy: the My Pregnancy Care Intervention.

Hypertensive disorders of pregnancy affect around 10% of pregnancies and remain a major cause of maternal and foetal morbidity and mortality. Trials have shown that self-monitoring blood pressure during pregnancy is safe, but self-monitoring alone does not improve blood pressure control or pregnancy outcomes. This study aimed to develop and optimise a multicomponent intervention to support blood pressure monitoring, hypertension management and urine testing within current care pathways. Relevant literature, input from patient and public contributors (PPI) and stakeholder groups, and the researcher's previous experience were used to develop an initial intervention. Think-aloud interviews and focus groups with women from diverse backgrounds with lived experience of hypertension in pregnancy and healthcare professionals provided feedback on the intervention prototype (n = 29). The MRC Framework for Developing Complex Interventions guided the processes to optimise the intervention's acceptability and maximise engagement. A detailed tabulation of participants' views and logic models was produced using the COM-B model of Behaviour Change. The prototype intervention was acceptable and viable to both pregnant women with experience of hypertensive pregnancy and healthcare professionals. Emerging themes centred on how the intervention could be optimised within current National Health Service care pathways and the lives of pregnant women to support behaviour change. Key target behaviours to support the intervention included increasing understanding of blood pressure management, engagement with the intervention, monitoring blood pressure and urine and taking appropriate actions based on those readings. This informed the development of recommendations involving clear action timelines for women and evidence-based guidance to support decision-making by healthcare professionals. The findings were used to produce the multi-component My Pregnancy Care intervention, consisting of a smartphone application and an information leaflet to support blood pressure self-monitoring and proteinuria self-testing, self-management of antihypertensive medication and smartphone application use. This research provided comprehensive insight into the needs of pregnant women with hypertension and their healthcare teams regarding self-monitoring and management of blood pressure. This supported the development of a tailored multi-component digital intervention that addresses barriers to blood pressure self-management by being user-friendly, persuasive and acceptable. It is hoped that the intervention will support the monitoring and management process, collaboration between healthcare professionals and women, clinical action and improved clinical outcomes.

Effectiveness of Home-Based Self-monitoring of Blood Pressure in a Primary Care set-up of India (EASE-BP): Protocol for an Open-Label Randomized Controlled Trial.

Rising hypertension from inadequate detection, noncompliance with treatment, and poor control presents a major public health challenge. Previously, adopting the strategy of self-monitoring of blood pressure (SMBP) showed better hypertension detection, control, and medication adherence. However, evidence from India is scarce. Here, we present the trial protocol for the effectiveness of SMBP intervention in hypertension detection, blood pressure (BP) control, and medication adherence in a primary care set-up. EASE-BP is an open-label randomized trial in two distinct adult populations - part-A self-reported non-hypertensive population (total sample size: 400) and part-B known hypertensive population (total sample size: 332). The two populations will be sampled from two separate villages under the Ballabgarh Health and Demographic Surveillance System. In both the populations, participants randomized in the intervention arm will receive a validated electronic BP device and will be advised to self-monitor BP for at least twice a month (or more). Those in the control arm will be advised to monitor BP for at least twice a month (or more) at the nearby health center. Participants in both arms will receive education on hypertension and atherosclerotic disease. In addition, adult family members in the households of randomized participants will be encouraged to monitor their BP. All participants and family members will be instructed to maintain a log of BP recordings in a diary that will be provided to them. Data will be collected at baseline and then every month for three-months. The primary outcome in part-A will be the incidence of new cases of hypertension during 3 months follow-up and in part-B will be the difference in SBP and rate of medication adherence at 3 months follow-up. Secondary outcomes will include (1) uptake of the intervention, (2) any stroke, myocardial infarction, or death, (3) additional yield of new cases of hypertension among the family members, and (4) integrating the intervention into the national programs for long-term noncommunicable disease goals. EASE-BP will help understand if SMBP improves hypertension detection, BP control, and medication adherence. Consequently, this will appraise policymakers on whether provision of BP instruments may be added to the national program for hypertension prevention and control. This trial was registered under Clinical Trial Registry - India with reference number CTRI/2023/02/049949.

Participatory Surveillance and Candidacy: A Discourse Analysis of Views on Self-Testing for Proteinuria in Pregnancy.

Actively involving people in self-monitoring and management during their pregnancy is an emerging clinical and social practice. Self-monitoring of blood pressure and self-testing for proteinuria, key diagnostic tests for pre-eclampsia, are becoming commonplace in hypertensive pregnancies. While evidence exists on the acceptability and feasibility of self-monitoring blood pressure, evidence for self-testing for proteinuria in pregnancy is thin, with little knowledge of how it might affect the traditional structures of maternity care. As part of a diagnostic accuracy study on self-testing for proteinuria, pregnant people and healthcare professionals were recruited to a qualitative study to understand their experiences of, and attitudes to, self-testing. Multiple qualitative methods were used, including interviews, focus groups, and free text postcards. A discourse analysis was conducted to understand how self-testing might inform and reshape routine antenatal care. Analysis revealed a tension between the empowering concept of participatory surveillance, which pregnant people and healthcare professionals were broadly positive about, and the adjudications made by healthcare professionals about the candidacy, or suitability, of certain pregnant people to self-test. Candidacy is a framework for understanding what influences access to healthcare for socially disadvantaged groups, including professional judgments that impact access to interventions. While participatory surveillance was felt to have the potential to empower pregnant people in antenatal care, the loss of the traditional clinical gaze was disquieting for some, and pregnant people and healthcare professionals were reluctant to cede professional responsibility.

Designing A Web Application for Self-Blood Pressure Monitoring and Control at Home

Designing A Web Application for Self-Blood Pressure Monitoring and Control at Home

Developing a Tool for Self-Blood Pressure Monitoring and Control at Home

Developing a Tool for Self-Blood Pressure Monitoring and Control at Home

A Quality Improvement Project On The Introduction Of A Nurse-Led, Patient Self-Monitored Blood Pressure Telehealth Platform

Abstract Background Telehealth is a strategy for health and wellbeing promotion. Hypertension is a modifiable risk factor in vascular health. Timely, reliable and accessible identification of this risk is important. Working within an interdisciplinary ambulatory neurovascular hub, a nurse-led model of service provided the opportunity to effectively identify and modify this risk through the secondary prevention measure of hypertension management. Methods An interdisciplinary neurovascular service quality improvement group, the “Stroke Big Room”, evaluated service models and telehealth platforms for patient-self monitoring of hypertension. The telehealth “Florence” platform was introduced. An accompanying Patient Information Leaflet was developed with the Communications Team within the Trust. Patients with a blood pressure of 130/80mmHg and a confirmed diagnosis of minor stroke or transient ischaemic attack were offered the “Flo” platform. Results A 20-patient sample found: 50% required no treatment change, 30% were commenced on antihypertensive treatment and 20% required antihypertensive dose increase. In the 2023/24 financial year, 285 patients participated in the Flo platform. Conclusion Timely identification and modification of hypertension is a reversible risk factor for neurovascular disease. A nurse-led service for the provision of, education on and support in use of a telehealth monitoring platform is an effective approach. This service model allows for effective secondary prevention treatment in a rapid and accessible way. The telehealth platform “Flo” was accessible to patients on the basis of patient reported outcome measures. As a result of the use of the platform, pharmacotherapeutic interventions occurred in 50% of participants in this telehealth programme.

Implementation of Healthy Heart Ambassador to improve blood pressure control at community health centers in Texas

BackgroundHypertension is one of the most prevalent chronic diseases in the United States and can increase a person’s risk of stroke and other cardiovascular complications. Yet only 1 in 4 people with high blood pressure in the United States have their blood pressure managed. To improve hypertension control, we supported 9 health centers in Texas with the implementation of the Healthy Heart Ambassador Blood Pressure Self-Monitoring (HHA) Program.MethodsWe provided health center training using the HHA Program Facilitation Training Guide, recorded barriers to implementing the HHA program, and employed strategies to overcome those barriers.ResultsThere were 68 staff members from the health centers trained to deliver the HHA program. Three health centers successfully implemented all three major components of HHA, three were able to implement two components, two adopted two components, and one withdrew due to insufficient capacity. Capability, technology infrastructure, and motivation were among the barriers most referenced.ConclusionClinic non-physician team members delivering the HHA program will need training and ongoing technical assistance to overcome implementation barriers.

Practice of blood pressure self-monitoring and associated factors among hypertensive patients on follow-up visits at hospitals, West Shoa Zone, Oromia, Ethiopia, 2022…An institution-based cross-sectional study

IntroductionBlood pressure self-monitoring is patients' regular use of personal blood pressure measurement equipment to measure their blood pressure outside of a clinical environment. Inadequate blood pressure self-monitoring remains a significant problem faced by healthcare providers and populations in the prevention of Hypertension. This study is to assess the practice of blood pressure self-monitoring and associated factors among hypertensive patients on follow-up visits at Hospitals, West Shoa zone, Oromia, Ethiopia, 2022. MethodsAn institution-based cross-sectional quantitative study supported by a qualitative study was carried out on 412 hypertensive patients from September 01–30/09/2022. An interviewer-administered questionnaire was used to collect data, and a simple random sampling technique was employed to select the study participants. Data were entered into a computer using the Kobo toolbox and exported to Statical package of social science Version 26 for analysis. Binary logistic regression analysis was run to assess the association between the dependent and independent variables and Variables with P- value < 0.25 were entered into a multivariate logistic regression to control the effects of potential confounding factors. P-value of <0.05 was taken as a cutoff point to declare a statistically significant association between independent and dependent variables. ResultThe proportion of blood pressure self-monitoring practice among hypertensive patients on follow-up visits at hospitals in the West Shoa zone was 19.6 %. Educational level [AOR=7.49, 95 %CI (3.00, 8.67)], income [AOR=3.14, 95 %CI (1.21, 8.13)], co-morbidities [AOR=5.55, 95 %CI (2.74, 11.24)], recommendation toward self-monitoring [AOR=2.40, 95 %CI (1.15, 5.03)] and awareness of self-monitoring [AOR=8.54, 95 %CI (3.54, 10.60)] were factors significantly associated with blood pressure self-monitoring practice. Conclusion and RecommendationThe proportion of blood pressure self-monitoring among hypertensive patients on follow-up visits at hospitals in the West Shoa zone was low. The practice of blood pressure self-monitoring needs to be deliberated by health education programs and recommended to minimize hypertension complications.

Evaluation of self-monitoring of blood pressure in the PERHIT study and the impact on glomerular function

Background Although intensive blood pressure (BP) control has not been shown to slow the progression of chronic kidney disease (CKD), intensive BP control has been shown to reduce the risk for adverse cardiovascular outcomes in the CKD population. The aim of this post-hoc study was to study the interplay between a self-monitoring BP system and glomerular function. Methods In all, 949 participants with hypertension underwent visits at baseline, after eight weeks and 12 months. Half of the participants received a BP monitor and installed a program on their mobile phone. During eight weeks, they measured daily and reported their BP values. Results Within the intervention group, BP and systolic BP (SBP) decreased from baseline to eight weeks and 12 months (p < .001). Pulse pressure (PP) and mean arterial blood pressure (MAP) decreased from baseline to eight weeks (p = .021 and p = .004) vs 12 months (p = .035 and p = .008). Within the control group, a decrease was observed from baseline to 12 months for SBP, diastolic BP (DBP) and PP (p = .025, p = .023 and p = .036). In the intervention group, we observed an association between a decrease in SBP, DBP, PP and MAP and a decrease in eGFR (estimated glomerular filtration rate), (p < .001, p < .001, p = .013 and p < .001). In the control group, similar results were observed for PP only (p = .027). Within the intervention group, eGFR decreased (p < .001) but within the control group, the decrease was non-significant (p = .051). Conclusion We observed an association between a decrease in all BP components and eGFR decline within the normal range in the intervention group but not in the controls. Trial registration The study was registered with ClinicalTrials.gov [NCT03554382].

O29 LACK OF VALIDATED BLOOD PRESSURE DEVICES FOR USE IN PREGNANCY AVAILABLE FROM AUSTRALIAN PHARMACIES

Background and objective. Self-monitoring of blood pressure (BP) at home can aid in the management of hypertension, including during pregnancy. Only 20% of home BP devices have been validated for the general population. However, specific accuracy validation in pregnant women is required for use among this population. The availability of home BP devices that have been validated for use in pregnant women is unknown, which was the aim of this study. Secondary aims were to assess device cost and claims regarding use in pregnancy. Methods. A search of pharmacies with physical and online stores in Australia that sell upper-arm cuff home BP devices was conducted. Validation status in pregnant women was determined by checking model numbers on the STRIDE-BP website. Cost of device and claims about the devices’ use in pregnancy were extracted from instruction manuals and information on the pharmacy webpage. Results. Eighteen pharmacies and 40 unique home BP devices were identified. Four (10%) devices were validated for use in pregnancy, and these were more expensive than other devices (Table). Fifteen devices listed a caution warning to seek healthcare provider advice before use if pregnant, including all four that had been validated for pregnancy. Concerningly, information about four devices stated they were recommended for pregnancy, although evidence of validation was not found on STRIDE-BP. Information about one device stated it had not been tested on pregnant women and was not suitable for use, although this information was only available in the device manual and not point-of-sale. Nineteen devices had no mention of pregnancy at all. Conclusion. Very few home BP devices available from Australian pharmacies are specifically validated for use in pregnancy, are priced higher than non-validated devices and do not effectively target their intended users. To guarantee that only validated home BP devices are used in pregnancy increased awareness is urgently needed and could be assisted by clear labelling on devices provided at the point-of-sale instore or online. Table. Home BP devices sold in 18 Australian pharmacies. BP: blood pressure. Cost displayed in Australian dollars (AUD). The percentages add to more than 100% because some devices validated in the general population were also validated for pregnancy and pre-eclampsia.

Abstract P316: Beyond the Cuff: Revolutionizing Hypertension Care through Human-Centered Design and Tech-Driven Solutions in an Urban Community Health Center

Community Health Centers serve populations burdened with cardiovascular disease due to social determinants of health, necessitating innovative solutions in resource-limited environments. Wi-Fi/Bluetooth-enabled home blood pressure monitors have emerged as clinical tools for diagnosing, monitoring, and managing hypertension. The real time data enables timely interventions by care teams of patients being monitored. A multifaceted approach beyond clinic settings, supported by digital tools, can help reduce healthcare costs by preventing avoidable emergency room visits. We posited that implementing a self-monitored blood pressure (SMBP) program, supplemented by holistic, human-centered patient coaching and feedback, in a community health center setting would enhance patient engagement, medication adherence, and hypertension control. We designed and piloted a small SMBP program using Bluetooth-enabled blood pressure devices, targeting adult patients with documented uncontrolled blood pressure seen in our health centers in a 6- month window. This was further augmented by a holistic, human-centered individual and group-level coaching session. Patients enrolled in the SMBP program received comprehensive education on hypertension, including medication management and lifestyle changes, as well as data-driven feedback on their blood pressure profiles during virtual group and individual outreach sessions. The program's goals were to increase patient engagement in their care, adherence to interventions, leading to better blood pressure control. Results were significant: 22 of 32 participants graduated, achieving improved blood pressure control with medication and lifestyle changes. Average reductions of 17 mmHg in systolic and 6 mmHg in diastolic blood pressure were noted after being in the program for an average of three months. Among the graduates, 50% required medication intensification, and 60% adopted lifestyle changes, indicating the program's effectiveness. Our pilot affirmed the efficacy of utilizing digital solutions and integrated strategies to improve hypertension control and empower patients to make timely changes with data feedback. The key findings from our pilot led to the expansion of the SMBP program to serve a larger cohort of patients in our clinic. This underscores the critical role of patient engagement, technology integration, and an integrated approach to care in improving hypertension management, particularly in underserved communities.

Abstract P190: Blood pressure monitoring and knowledge in the first year after a hypertensive disorder of pregnancy

Introduction: In the first year postpartum, hypertension (HTN) is a leading cause of morbidity and mortality, particularly for those with hypertensive disorders of pregnancy (HDP). Timely recognition of HTN is key to reducing short- and long-term cardiovascular risk among birthing people. Therefore, we assessed knowledge of when to seek medical attention for blood pressure (BP) elevations and rates of BP measurement in the first year postpartum among those with and without HDP. Methods: This was a secondary analysis of primiparas who participated in a randomized trial of prenatal counseling to improve postpartum health. We included 405 participants who self-reported information on postpartum BP assessment. We calculated (1) the proportion of participants who stated they would contact a clinician for a systolic BP above 140 and a diastolic BP above 90 at 3-months postpartum and (2) the frequency and location of BP checks reported from 3-12 months postpartum among those with and without HDP. Subgroup analyses compared BP knowledge by sociodemographic and health-related factors. Results: Participants were 32 +/-5 years, 16% reported a HDP, 60% identified as White, 75% had private insurance, and 84% had ≥ college education. For systolic BP, 44.6% with HDP and 23.5% without HDP identified a BP of 140 as the threshold above which they would contact a clinician (p&lt;0.01); for diastolic BP, 52.4% with HDP and 28.5% without identified a BP threshold of 90 (p&lt;0.01).From 3-12 months postpartum, 83.1% with HDP and 59.4% without HDP had a BP check (p &lt; 0.01); 41.6% with HDP and 9.7 % without HDP checked their BP at home (p&lt;0.01). Home monitoring was not associated with awareness of when to contact a physician for hypertension among those with HDP (TABLE). BP awareness was higher among people who had private health insurance, ≥ college education and were non-smokers. Conclusions: Efforts are needed to improve postpartum BP assessment, self-monitoring, and awareness of when to seek medical attention for HTN, among birthing people with and without HDP.

Evaluating the Effectiveness of a Patient-Centered, Nonphysician Led Self-Monitoring Blood Pressure Program in a Rural Federally Qualified Health Center.

Uncontrolled hypertension can lead to an increased risk of cardiovascular disease, myocardial infarction, stroke, or death. Self-monitoring blood pressure (SMBP) programs have been associated with blood pressure (BP) reduction, particularly among rural, minority, and low-income individuals. There is limited literature about nonphysician SMBP programs. To evaluate the effectiveness of an SMBP program designed to engage nonphysician team members in hypertension management within a federally qualified health center (FQHC). Self-monitoring blood pressure program activities were implemented using a Plan, Do, Study, Act model. The University of Washington Health Promotion Research Center evaluated processes and patient-level outcomes in a mixed-methods design. Quantitative analysis examined clinical outcomes related to hypertension, and qualitative analysis relied on interviews with clinical staff examining program implementation, adoption, and sustainability. Family Health Centers (FHCs), a FQHC located in rural Washington, serving medically underserved populations. Two hundred five active SMBP patients out of 2600 adult patients (over 18years old) who had a diagnosis of hypertension within the last 12months. Patients with uncontrolled hypertension were given a BP cuff to log their daily BP. Patients met with community health workers (CHWs) and medical staff to review logs and set self-management goals over 3 to 4months. Controlled BP measurements and factors to implementation and sustainment. Facilitators to implementation included expanded telehealth reimbursement during the COVID-19 pandemic, integration of CHWs, and linguistically adapted resources. Barriers included a lack of reimbursement for nonphysician time and BP monitors. Quantitative results demonstrated an effort to reach minoritized populations but did not show an improvement in BP outcomes. Family Health Center implemented an SMBP program adapted to meet the linguistic and social needs of their patients. The successful integration of CHWs and the need for reimbursement policies to support SMBP programs were key factors for implementation and sustainability.

Effect of a Mobile Health Intervention on Self-Monitoring and Management of Glucose and Blood Pressure Among Women With Gestational Diabetes

Effect of a Mobile Health Intervention on Self-Monitoring and Management of Glucose and Blood Pressure Among Women With Gestational Diabetes

Conquering hypertension in Vietnam: 12- month follow up results from a cluster-randomised controlled trial

BackgroundApproximately 20% of adults in Vietnam have hypertension, and management of this chronic condition remains challenging. This study aimed to assess the effectiveness of a multicomponent intervention in reducing blood pressure (BP) in adults with uncontrolled hypertension. MethodsThis cluster randomised controlled trial was conducted in sixteen communities (8 intervention and 8 comparison) in a rural setting in Vietnam (2017-2022). Consenting adults (aged≥18 years) with uncontrolled hypertension were enrolled. Sixteen communities were equally randomised to an intervention or comparison group stratified by district. Consenting adults were assigned to study groups by community. The comparison arm received training sessions about hypertension prevention and management for health workers, and patient education materials. The intervention arm received training sessions about hypertension prevention and management for health workers, and patient education materials and three enhancement components including a storytelling intervention, home BP self-monitoring, and expanded community health worker services. The primary outcome was the difference in changes in patient’s levels of systolic BP between the study groups over a 12-month follow-up period. Patients and outcome assessors were masked. FindingsA total of 671 patients (340: intervention, 331: comparison) were enrolled in the trial. The mean age was 66 years and 45% were men. At the 12-month follow-up, the mean systolic BP declined by 18.4 mmHg in the intervention group and 3.7 mmHg in the control group (differential decline of 14.7 mmHg [95% CI: 11.8 – 17.6]). The intervention group also achieved better BP control and medication adherence than the control group. There were no serious adverse events related to study participation. InterpretationThe results of this trial demonstrate that a multicomponent intervention can effectively reduce elevated BP in individuals with uncontrolled hypertension in Vietnam. Trial registrationThis trial was registered at ClinicalTrials.gov, NCT03590691. FundingNational Heart, Lung, and Blood Institute

The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial.

Hypertension is one of the most important cardiovascular disease risk factors and affects >100 million American adults. Hypertension-related health inequities are abundant in Black communities as Black individuals are more likely to use the emergency department (ED) for chronic disease-related ambulatory care, which is strongly linked to lower blood pressure (BP) control, diminished awareness of hypertension, and adverse cardiovascular events. To reduce hypertension-related health disparities, we developed MI-BP, a culturally tailored multibehavior mobile health intervention that targeted behaviors of BP self-monitoring, physical activity, sodium intake, and medication adherence in Black individuals with uncontrolled hypertension recruited from ED and community-based settings. We sought to determine the effect of MI-BP on BP as well as secondary outcomes of physical activity, sodium intake, medication adherence, and BP control compared to enhanced usual care control at 1-year follow-up. We conducted a 1-year, 2-group randomized controlled trial of the MI-BP intervention compared to an enhanced usual care control group where participants aged 25 to 70 years received a BP cuff and hypertension-related educational materials. Participants were recruited from EDs and other community-based settings in Detroit, Michigan, where they were screened for initial eligibility and enrolled. Baseline data collection and randomization occurred approximately 2 and 4 weeks after enrollment to ensure that participants had uncontrolled hypertension and were willing to take part. Data collection visits occurred at 13, 26, 39, and 52 weeks. Outcomes of interest included BP (primary outcome) and physical activity, sodium intake, medication adherence, and BP control (secondary outcomes). We obtained consent from and enrolled 869 participants in this study yet ultimately randomized 162 (18.6%) participants. At 1 year, compared to the baseline, both groups showed significant decreases in systolic BP (MI-BP group: 22.5 mmHg decrease in average systolic BP and P<.001; control group: 24.1 mmHg decrease and P<.001) adjusted for age and sex, with no significant differences between the groups (time-by-arm interaction: P=.99). Similar patterns where improvements were noted in both groups yet no differences were found between the groups were observed for diastolic BP, physical activity, sodium intake, medication adherence, and BP control. Large dropout rates were observed in both groups (approximately 60%). Overall, participants randomized to both the enhanced usual care control and MI-BP conditions experienced significant improvements in BP and other outcomes; however, differences between groups were not detected, speaking to the general benefit of proactive outreach and engagement focused on cardiometabolic risk reduction in urban-dwelling, low-socioeconomic-status Black populations. High dropout rates were found and are likely to be expected when working with similar populations. Future work is needed to better understand engagement with mobile health interventions, particularly in this population. ClinicalTrials.gov NCT02955537; https://clinicaltrials.gov/study/NCT02955537. RR2-10.2196/12601.

Home blood pressure measurement days and changes in urinary sodium-to-potassium ratio, estimated salt and potassium intakes and blood pressure: 1-year prospective study.

Current international guidelines recommend home blood pressure (BP) measurement and low sodium and high potassium intakes for the management of hypertension. We hypothesized that increased home BP measurement may result in more effective management of sodium and potassium intakes and BP. We examined associations of home BP measurement days with changes in the urinary sodium-to-potassium (Na/K) ratio, estimated salt and potassium intakes and BP. We included 209 healthy participants (mean age, 55.9 years; 56.5% women) from a prospective cohort study. We examined 1-year data on self-measured home BP and spot urine samples. Median (interquartile range) days of home BP measurement was 324 (225-358) over 1-year. Baseline mean (SD) Na/K ratio, salt and potassium intakes, morning and evening SBP, and morning and evening DBP were 3.8 (2.3), 8.5 (1.9) g/day, 1833.5 (416.5) mg/day, 120.4 (14.0) mmHg, 118.2 (14.2) mmHg, 79.2 (10.1) mmHg, and 76.2 (10.1) mmHg, respectively. In multivariable-adjusted linear regression , β (standard error) per 10 days increase in number of home BP measurement were -0.031 (0.017) for Na/K ratio, -0.036 (0.015) for salt intake, -1.357 (2.797) for potassium intake, -0.178 (0.064) for morning SBP, -0.079 (0.041) for morning DBP, -0.109 (0.067) for evening SBP and -0.099 (0.045) for evening DBP. Additionally, relationships persisted for men and women, but changes in salt intake were more pronounced among participants taking antihypertensive medication (interaction P = 0.002). Continuous measurement of home BP may lead not only to self-monitoring of BP, but also to declines in salt intakes and some BP indices.

A Case Series Study Assessing an Equity-Focused Implementation of Self-Monitoring Blood Pressure Programs Using Telehealth.

Self-monitoring blood pressure (SMBP) programs are an evidence-based hypertension management intervention facilitated through telehealth. SMBP programs can provide a continuum of care beyond a clinical setting by facilitating hypertension management at home; however, equitable access to SMBP is a concern. To evaluate the implementation of telehealth SMBP programs using an equity lens in 5 federally qualified health centers (FQHCs) in Massachusetts (MA). A prospective case series study. Five FQHCs. The MA Department of Public Health (MDPH) selected 5 FQHCs to implement SMBP programs using telehealth. FQHCs were selected if their patient population experiences inequities due to social determinants of health and has higher rates of cardiovascular disease. Each of the 5 FQHCs reported data on patients enrolled in their SMBP programs totaling 241 patients examined in this study. SMBP programs implemented through telehealth. Systolic blood pressure and diastolic blood pressure. Approximately 53.5% of SMBP participants experienced a decrease in blood pressure. The average blood pressure decreased from 146/87 to 136/81 mm Hg. Among all patients across the 5 FQHCs, the average blood pressure decreased by 10.06/5.34 mm Hg (P < .001). Blood pressure improved in all racial, ethnic, and language subgroups. Five MA FQHCs successfully implemented equitable telehealth SMBP programs. SMBP participants enrolled in the programs demonstrated notable improvements in their blood pressure at the conclusion of the program. A flexible, pragmatic study design that was adjusted to meet unique patient needs; engaging nonphysician team members, particularly community health workers; adapting health information technology; and partnerships with community-based organizations were critical facilitators to program success.

Virtual Expansion of the YMCA's Blood Pressure Self-Monitoring (BPSM) Program: Using Telehealth to Adapt an Evidence-Based Program to Reach Rural Communities in South Carolina.

Disparities in cardiovascular disease prevalence and death exist among South Carolina's rural residents. Blood pressure self-monitoring (BPSM), where individuals measure their own blood pressure outside of the clinical environment, coupled with additional support, is an evidence-based, cost-effective strategy that is underutilized at large. The YMCA's BPSM program is an evidence-based, 4-month program that includes 2 individualized office hours with a Healthy Heart Ambassador and 4 nutrition education sessions per month. Participants are provided with a blood pressure cuff and notebook to track their blood pressure at home in between sessions. The SC Department of Health and Environmental Control partnered with the SC Alliance of YMCAs to expand the YMCA's BPSM program virtually. The traditional program was adapted to allow for virtual participant encounters. To target rural communities, partnerships were leveraged or established with rural health centers, federally qualified health centers, free medical clinics, and other state health department regions for participant referrals into the program. A developmental evaluation design was utilized to monitor the virtual adaptation of the YMCA's BPSM program from April 2021 to May 2023. At the end of the project, 10 referral sources were identified to refer participants to the program. In total, 253 participants were referred to the program, 126 participants enrolled into the program, and 52 participants completed the program. Completers of the virtual program were successful in improving their blood pressure. Successes of the virtual program were not without challenges. Lessons learned from the virtual expansion of this program included ensuring participants' readiness to engage in a 4-month program, assessing participants' digital literacy, and considering broadband access in rural areas. Improvements in blood pressure and the program's reach demonstrate merit in continuing to scale the virtual adaptation of this program; however, contextual and structural factors should be considered.