BP Self-monitoring Research Articles

Abstract 18935: A Prospective Evaluation of a Community-Based Outreach Initiative for Black Women With Severe, Uncontrolled Hypertension

Introduction: Despite American Heart Association evidence-based guidelines for care, inequities in prevalence and management of HTN disproportionately impact minority populations. Though studies have evaluated strategies to improve management of HTN and self-measurement of blood pressure (SMBP), existing strategies have not included a patient-partner who is a peer in literacy level, socio-economic status, and the lived experience of hypertension. Hypothesis: This pilot study was designed to evaluate a community-based intervention using patient-selected partners to improve blood pressure at 12 months. Secondary aims were to improve engagement in care, BP cuff distribution and use, and patient-centered goal setting for Life’s Essential Eight. Methods: We used a prospective, pre-post cohort design to evaluate the peer-partnership intervention. The team-based intervention included:1)Distribution of blood pressure cuffs and provision of skill-based training for BP self-monitoring to women at a federally qualified health center (FQHC).2) Implementation of coaching and feedback with patients on SMART goal setting for Life’s Essential Eight, to improve goal concordance and goal achievement. Results: Participants included Black women (n=335), average age 56 (SD 9.6). Preliminary results on key process measures indicate early signs of adoption: patient engagement in calls completed (n=426), cuffs distributed (n=186), SMART goals set (187, 56%), and partnerships established with family or community sites (n=91, 27%). Blood pressure was significantly reduced overall from baseline to 12 months (pre-systolic mean 172.05 (SD 13.3) mmHg versus post-systolic mean 140.3 (SD 20.9) mmHg; p<.0001) Focus groups evaluating patient perceptions of the added value of peer-partnership are ongoing. Conclusions: Community-based partnerships may improve SMBP skills, goal setting, and communication among patients in minority and low socioeconomic groups.

Hypertension clinical care in the era of coronavirus disease 2019

Objective: The objective of this study was to seek the opinion of Indian health-care professionals (HCPs) about hypertension (HTN) care during coronavirus disease 2019 (COVID-19) era. Methods: HCPs' opinions (n = 2832) were recorded based on survey and round table meetings. Standard questionnaire consisting of nine questions pertaining to HTN care in COVID-19 was prepared, discussed, and evaluated by experts who treat patients with HTN during COVID-19 era. Results: Smoking/tobacco use, obesity, and comorbidities (diabetes/dyslipidemia) were ranked as the top three modifiable risk factors. A total of 37% and 33% of HCPs reported an increase in blood pressure (BP) during the lockdown period in 10%–20% and 20%–40% of hypertensive patients, respectively, who were on monotherapy. Around 35% of HCPs reported that 20%–30% of their patients with HTN showed uncontrolled BP (>150/100 mmHg). Dual-drug therapy in patients with uncontrolled BP was preferred by 56% of HCPs. Nearly 71% preferred dual combination for HTN management. In dual combination, 27% preferred angiotensin receptor blockers (ARBs) + diuretic, 26% preferred ARB + calcium channel blockers, and 18% preferred ARB + beta-blockers. The majority of HCPs (44%) consider that <30% of their patients with HTN check BP at home. A total of 47% of HCPs reported acute coronary syndrome as the most common HTN-related complication. The majority of HCPs (57%) considered that avoiding contamination during BP measurement is the challenging parameter. Around 32% considered self-BP monitoring (SBPM) as the best method to improve medication adherence. Conclusion: SBPM, combination therapies, and digital connect with patients are critical aspects of HTN management during COVID-19 pandemic.

What Should Patients Know About Self Blood Pressure Measurement? A Review Article

Many people measure their blood pressure (BP) outside doctors’ offices with a common goal of concerning their health status. Self-BP monitoring devices are widely accessible as health care products or available in different community institutes. Patients often seek their doctors’ advice on their BP readings in our daily practice. Current international guidelines recommend that correct self-BP measurement with validated devices can enhance patients’ self-management and drug compliance, improving overall BP control. While most of the clinicians were supportive of their patients’ efforts, they were also concerned about the validity and reliability of the out-of-office BP readings. How can we effectively educate patients to get meaningful BP readings, which may improve their overall BP control? This article will review the current best evidence on patient self-BP monitoring.

FEASIBILITY, ACCEPTABILITY, AND APPROPRIATENESS OF THE PHONE BASED INTERVENTIONS UNDER NURSE GUIDANCE AFTER STROKE (PINGS) IN GHANA

Background PINGS is a clinical trial to evaluate a nurse-led mHealth technology - centered approach to maintaining BP control among recent stroke survivors with hypertension in Ghana. PINGS involves domiciliary BP self-monitoring, mobile phone consultations, phone alerts as reminders, and patient education via text messages. We assessed the feasibility, acceptability, and appropriateness of PINGS from the perspective of health workers in general - not necessarily working in stroke rehabilitation. Methods Using an adaptation of psychometrically validated Likert-scale measures for feasibility, acceptability, and appropriateness of interventions, we deployed an online survey among health workers. Summed composite scores were obtained, dichotomized, and binary logistic regression performed using R programming software. Results There were 665 respondents; males (57%), females (43%); clinical staff (75%) and non-clinical staff (25%); and median age was 33 years (IQR 29, 37). PINGS was feasible, acceptable, and appropriate to 93%, 93% and 94% of respondents respectively. Clinical staff found PINGS feasible (OR 9.28; C.I. 4.86, 18.7; p<0.001), acceptable (OR 7.41, C.I. 3.95, 14.5; p<0.001), or appropriate (OR 7.59, C.I. 3.9, 15.5; p<0.001) compared to non-clinical staff. The measures were not significantly affected by type (including public or private), level (including tertiary or district), or regional location of the facility. Conclusion PINGS was overwhelmingly perceived as feasible, acceptable, and appropriate, with these perspectives not being significantly different across different types of facilities, levels of health care, or geographic locations in Ghana. Clinical staff however found PINGS much more feasible, acceptable, and appropriate than their non-clinical counterparts. PINGS is a clinical trial to evaluate a nurse-led mHealth technology - centered approach to maintaining BP control among recent stroke survivors with hypertension in Ghana. PINGS involves domiciliary BP self-monitoring, mobile phone consultations, phone alerts as reminders, and patient education via text messages. We assessed the feasibility, acceptability, and appropriateness of PINGS from the perspective of health workers in general - not necessarily working in stroke rehabilitation. Using an adaptation of psychometrically validated Likert-scale measures for feasibility, acceptability, and appropriateness of interventions, we deployed an online survey among health workers. Summed composite scores were obtained, dichotomized, and binary logistic regression performed using R programming software. There were 665 respondents; males (57%), females (43%); clinical staff (75%) and non-clinical staff (25%); and median age was 33 years (IQR 29, 37). PINGS was feasible, acceptable, and appropriate to 93%, 93% and 94% of respondents respectively. Clinical staff found PINGS feasible (OR 9.28; C.I. 4.86, 18.7; p<0.001), acceptable (OR 7.41, C.I. 3.95, 14.5; p<0.001), or appropriate (OR 7.59, C.I. 3.9, 15.5; p<0.001) compared to non-clinical staff. The measures were not significantly affected by type (including public or private), level (including tertiary or district), or regional location of the facility. PINGS was overwhelmingly perceived as feasible, acceptable, and appropriate, with these perspectives not being significantly different across different types of facilities, levels of health care, or geographic locations in Ghana. Clinical staff however found PINGS much more feasible, acceptable, and appropriate than their non-clinical counterparts.

Randomized feasibility trial of a digital intervention for hypertension self-management.

Home blood pressure monitoring (HBPM) can improve hypertension management. Digital tools to facilitate routinized HBPM and patient self-care are underutilized and lack evidence of effectiveness. MyBP provides video-based education and automated text messaging to support continuous BP self-monitoring with recurring feedback. In this pragmatic trial, we sought to generate preliminary evidence of feasibility and efficacy in community-dwelling adults ≥55 y/o with hypertension recruited from primary care offices. Enrollees were provided a standard automatic BP cuff and randomized 2:1 to MyBP vs treatment-as-usual (control). Engagement with MyBP was defined as the proportion of BP reading prompts for which a reading was submitted, tracked over successive 2-week monitoring periods. Preliminary measures of efficacy included BP readings from phone-supervised home measurements and a self-efficacy questionnaire. Sixty-two participants (40 women, 33 Blacks, mean age 66, mean office BP 164/91) were randomized to MyBP (n = 41) or a control group (n = 21). Median follow-up was 22.9 (SD = 6.7) weeks. In the MyBP group, median engagement with HBPM was 82.7% (Q1 = 52.5, Q3 = 89.6) and sustained over time. The decline in systolic [12 mm Hg (SD = 17)] and diastolic BP [5 mm Hg (SD = 7)] did not differ between the two treatment groups. However, participants with higher baseline systolic BP assigned to MyBP had a greater decline compared to controls [interaction effect estimate -0.56 (-0.96, -0.17)]. Overall hypertension self-efficacy improved in the MyBP group. In conclusion, trial results show that older hypertensive adults with substantial minority representation had sustained engagement with this digital self-monitoring program and may benefit clinically.

Targeting of uncontrolled hypertension in the emergency department (TOUCHED): Design of a randomized controlled trial

BackgroundUncontrolled or undiagnosed hypertension (HTN) is estimated to be as high as 46% in emergency departments (EDs). Uncontrolled HTN contributes significantly to cardiovascular morbidity and disproportionately affects communities of color. EDs serve high risk populations with uncontrolled conditions that are often missed by other clinical settings and effective interventions for uncontrolled HTN in the ED are critically needed. The ED is well situated to decrease the disparities in HTN control by providing a streamlined intervention to high risk populations that may use the ED as their primary care. MethodsTargeting of UnControlled Hypertension in the Emergency Department (TOUCHED), is a two-arm single site randomized controlled trial of 770 adults aged 18–75 presenting to the ED with uncontrolled HTN comparing (1) usual care, versus (2) an Educational and Empowerment (E2) intervention that integrates a Post-Acute Care Hypertension Consultation (PACHT-c) with a mobile health BP self-monitoring kit. The primary outcome is differences in mean systolic blood pressure (SBP) at 6-months post enrollment. Secondary outcomes include differences in mean SBP and mean diastolic BP (DBP) at 3-months and mean DBP at 6-months. Additionally, improvement in cardiovascular risk score, medication adherence, primary care engagement, and HTN knowledge will also be assessed as part of this study. ConclusionsThe TOUCHED trial will be instrumental in determining the effectiveness of a brief ED-based intervention that is portable to other urban EDs with high-risk populations. Trial registrationclinicaltrials.gov Identifier: NCT03749499.

Abstract 13768: Adoption and Effectiveness of an Mhealth Intervention for Hypertension in Older Adults: A Pilot Clinical Trial

Introduction: Hypertension is uncontrolled in 50% of diagnosed adults in the US, and especially in older adults. Home blood pressure monitoring (HBPM) can improve hypertension management by providing clinicians with up-to-date information on BP control and by improving patients’ adherence to prescribed medications and other healthy behaviors. MyBP is a patient-facing HBPM aide that provides video-based education and supports BP self-monitoring with recurring feedback using proactive, bidirectional, automated text messages. Summary reports are routed to primary care providers. Hypothesis: In this proof-of-concept, pragmatic clinical trial, we tested the hypothesis that MyBP will improve hypertension self-efficacy and lower BP in older adults. Methods: Community-dwelling adults ≥55 y/o with uncontrolled hypertension were recruited from primary care offices. Enrollees were provided a standard automatic BP cuff and randomized 2:1 to MyBP vs treatment-as-usual (control). Engagement with MyBP was defined as the proportion of BP reading prompts for which a reading was submitted, tracked over successive 2-week monitoring periods. Study BP data were acquired independently of MyBP from all participants by single-blind, phone-supervised home BP measurements. Results: Participants (N=62; 40 women, 33 Blacks, 38 without a college degree, mean age 66, mean office BP 164/91, mean # BP medications 2.6) were randomized to MyBP (41) vs. control (n=21). In the MyBP group, engagement with HBPM averaged over 80%, without notable attrition over the 5-month study period. Regression analyses revealed an interaction between baseline systolic BP and group assignment on change in systolic BP [interaction effect estimate -0.59 (-1.00, -0.19)], such that patients who had a higher baseline systolic BP and were assigned to MyBP showed a greater decline in systolic BP when compared to control patients. Hypertension self-efficacy also improved in the intervention group compared to controls [estimate 0.556 (0.104,1.008)]. Conclusions: In this pragmatic, pilot clinical trial, older adults with hypertension used a novel mHealth technology at high levels, reported improved hypertension self-efficacy, and experienced a decline in BP if home BP was elevated at baseline.

Therapeutic approaches to the Rational Use of trip-le combination therapy with a fixed combination of amlodipine, indapamide and perindopril arginine (TRIPLE COMBINATION) in patients with hypertension who do not control blood pressure on conventional treatment. (Description and main results of the TRIO program)

Aim To study tactics of outpatient physicians in choosing the treatment when the previous double antihypertensive therapy (AHT) fails and to analyze the effectivity of an amlodipine/indapamide/perindopril arginine triple combination (TC).Material and methods The program included 1252 patients with arterial hypertension (AH); the TC group consisted of 992 (79.23 %) patients (38.3 % males; age, 61.6 [55.0; 67.9]); the control group included 260 (20.77 %) patients (37.7 % males; age, 60.6 [53.3; 67.4]). The main inclusion criteria were essential AH, age 18-79 years, insufficient response to previous AHT (clinical systolic blood pressure (SBP) &gt;140-179 mm Hg). The study duration was three months. The following parameters were evaluated: dynamics of clinical and ambulatory BP (BP self-monitoring (BPSM); frequency of achieving the first goal of &lt;140 / 90 mm Hg and the goal of &lt;130 / 80 mm Hg); and changes in glomerular filtration rate (GFR) and quality of life (QoL). Responses to TC were analyzed in groups with different ranges of increased baseline SBP in patients with AH and diabetes mellitus (DM)/impaired glucose tolerance (IGT), overweight or obesity, and chronic kidney disease (CKD, reduced estimated GFR (eGFR &lt;60 ml/min/1.73 m2). Safety was evaluated based on records of adverse events (AEs).Results The TC group had a more severe condition at baseline by clinical parameters and history and had higher baseline BP, which made difficult the intergroup comparison. Nevertheless at three months, the decrease in clinical SBP was more pronounced in the TC group (from 162.1 to 126.8 mm Hg, Δ=35.7 mm Hg) than in the control group (from 157.8 to 128.4 mm Hg, Δ=29.4 mm Hg). 87.8% of patients in the TC group and 81.9 % (р=0.012) in the control group achieved the first BP goal of &lt;140 / 90 mm Hg; 34.3% and 28.2% of patients, respectively, achieved the BP goal of &lt;130 / 80 mm Hg (р=0.055). The more effective SBP control in the TC group was associated with a pronounced BP decrease with higher BP values at baseline, which was also confirmed by an analysis in subgroups with SBP 140-160, 160-180, and &gt;180 mm Hg. The TC treatment was associated with a pronounced antihypertensive effect with respect of BPSM values, improved QoL, and renal function. Significant decreases in BP and achievement of BP goals by a vast majority of patients receiving TC were also observed in subgroups with DM or IGT, overweight and/or obesity, and CKD. AEs were observed during the treatment only in 8 patients (0.64 %), which confirmed good tolerability and high safety of the therapy.Conclusion The study results demonstrated a therapeutic effect of the amlodipine/indapamide/perindopril arginine fixed-dose combination (Triplixam®). This effect was evident as control of clinical BP with any baseline BP level, including different ranges of increased SBP, in AH combined with DM, IGT, obesity, and CKD, which offers advantages over a subjective choice of AHT. TC improved BPSM values, QoL indexes, provided nephroprotection, and was well tolerated.

Reach Out: Recruitment in a multicomponent, mobile health, behavioral intervention to reduce blood pressure in the Emergency Department patient population.

Background Hypertension is the most important modifiable risk factor for cardiovascular disease and an important contributor to the racial disparities of stroke. The Emergency Department (ED) may represent an opportunity to identify difficult-to-reach hypertensive populations. Methods Reach Out is a health system focused, multicomponent, health theory based, mobile health behavioral intervention to reduce Blood Pressure among ED patients. It is operational at a safety net hospital in the under-resourced, primarily minority community of Flint, Michigan. Patients are eligible for Reach Out if they are receiving care in the ED who have an elevated blood pressure and are expected to be discharged home. Following a three-week screening phase, participants who respond to text messages with persistently elevated blood pressures are randomized into the main trial. Reach Out consists of three components, each with two intensity levels: 1) healthy behavior text messaging (daily vs. none), 2) prompted home BP self-monitoring (daily vs. weekly), 3) facilitated primary care provider appointment scheduling and transportation (provided vs. not). Participants without outpatient providers are scheduled with a local Federally Qualified Health Center. Randomized participants are distributed across eight experimental arms and followed for twelve months. The primary outcome is change in systolic blood pressure at one-year. Results Recruitment began March 25, 2019. As of October 28, 2019, 872 ED patients have been approached, 508 participants have been enrolled, and 244 participants have been randomized. Among patients presenting to the ED who were found to have persistent hypertension, more than 50% were African American. Within our study, 60% of approached patients and 62% of randomized participants are African American. Approximately 95% of participants are under the age of 65. The most common reason for non-enrollment is absence of mobile phone. Conclusion The Emergency Department is a promising setting to reach working age African Americans for enrollment in behavioral interventions to reduce blood pressure. Reach Out may serve as a model for initiation of primary stroke prevention in safety net hospitals.

Assessment of the clinical efficacy of telemonitoring and distant counseling in patients with uncontrolled hypertension

The aim of the study was to investigate the mathematical correlation of the clinical efficacy of blood pressure telemonitoring and distant counseling (BPTM) in patients in uncontrolled hypertension (HTN). Telehealth tools are widely used in HTN management. However clinical efficacy of such interventions assessed mainly in groups investigated without its populational and attributable impact. Materials and methods. The total of 240 patients were included, then randomized in 2:1 manner to BPTM group (n=160, median age 47 y.o.) and control group (n=80, median age 49 y.o). The user - friendly and secure telehealth software was provided with mobile application (patients) and desktop (doctors) platforms which allowed storage and analysis of self-BP monitoring data and remote consultations. A three - month surveillance was designed with mandatory baseline and final face - to - face visits with the assessment of office systolic BP (oSBP). Mathematical evaluation was based on target SBP rates achieved in comparator groups and included the absolute efficacies (AE), the attributable efficacy (AtE), the relative efficacy (RE) and the population attributable efficacy (PAtE). Results. BPTM group characterized by larger decrease in SBP level compared with controls (-16.8±2.9 mm Hg versus -7.9±3.9 mm Hg; p.

Contraception and CKD.

In general, nephrologists give little thought to contraception, leaving this task to other practitioners, but the significant risks associated with drugs routinely prescribed to treat kidney disease; the potential for pregnancy-associated adverse outcomes in women with CKD; and the effect that

Self-blood pressure monitoring as a tool to increase hypertension awareness, adherence to antihypertensive therapy, and blood pressure control.

Self-blood pressure monitoring as a tool to increase hypertension awareness, adherence to antihypertensive therapy, and blood pressure control.

Telemedicine and out-of-office blood pressure monitoring: up-to-date view of ESC/ESH

The 2018 Joint Guidelines of the European Society of Cardiology and the European Society of Hypertension Specialists present a successful attempt to revise the approach to one of the most prevalent health problems worldwide. For more than two years, a Task Force of experts from the two Societies have assessed and have investigated the most recent scientific advances in the field of hypertension (HTN) in order to provide doctors with the adequate diagnostic tools, evaluation of cardiovascular risk and the optimal drug treatment. Undoubtedly, among a number of crucial changes of target blood pressure (BP) range along with the new sections dedicated to HTN in different circumstances, one can notice equally valuable, albeit subtle remarks about out-of-office BP and closely related telehealth. Extensive use of ambulatory and self-BP monitoring forced to match it to office BP. Booming information and communication technologies applied successfully in various therapeutic areas and have taken place in the Guidelines. From now digital health becomes a piece of the follow-up and adherence control. This brief report highlights the current position of European experts on telemedicine and outpatient methods of monitoring blood pressure.

Improving Blood Pressure Among African Americans With Hypertension Using a Mobile Health Approach (the MI-BP App): Protocol for a Randomized Controlled Trial.

BackgroundAfrican Americans shoulder significant disparities related to hypertension (HTN), which is a serious public health problem in the city of Detroit, Michigan, where more than 80% of the population is African American. Connectivity through smartphones, use of home blood pressure (BP) monitoring, and newly developed mobile health (mHealth) interventions can facilitate behavioral changes and may improve long-term self-care for chronic conditions, but implementation of a combined approach utilizing these methods has not been tested among African American patients with uncontrolled HTN. Since African Americans are more likely than other racial or ethnic subgroups to utilize the emergency department (ED) for ambulatory care, this presents an opportunity to intervene on a population that is otherwise difficult to reach.ObjectiveThe MI-BP app aims to reduce health disparities related to HTN in the community by employing a user-centered intervention focused on self-BP monitoring, physical activity, reduced sodium intake, and medication adherence. We seek to test the efficacy of MI-BP, an mHealth app for HTN self-management, on BP control (primary aim), physical activity, sodium intake, and medication adherence (secondary aim) in African Americans with HTN. This study also seeks to evaluate the cost-effectiveness of MI-BP when compared with usual care methods.MethodsThis is a 1-year randomized controlled trial that will recruit individuals who have uncontrolled HTN from 2 EDs in the city of Detroit, with a planned sample size of 396 randomized participants. To be eligible for inclusion, potential participants must be African American, 25 to 70 years old, previously diagnosed with HTN, have a smartphone compatible with MI-BP, and have uncontrolled BP at triage and on repeat measurement at least 1-hour post triage vitals. Once a participant is deemed eligible, all study procedures and subsequent follow-up visits (8 in total) are conducted at the Wayne State University Clinical Research Service Center. We seek to determine the effect of MI-BP on BP for 1 year (using BP control and mean systolic BP as coprimary outcomes and physical activity, sodium intake, and medication adherence as secondary outcomes) compared with usual care controls.ResultsRecruitment for this study began in January 2018. The study will continue through 2021.ConclusionsAs the first of its kind conducted in an ED setting, MI-BP was designed to document the efficacy and acceptability of a multicomponent mHealth approach to help African Americans with uncontrolled BP modify their lifestyle to better manage their HTN. We expect to lay the foundation to sustainably reduce HTN-related health disparities through better integration of multiple behavior self-monitoring and improve outcomes for those who traditionally rely on the ED for chronic disease care.Trial RegistrationClinicalTrials.gov NCT02360293; http://clinicaltrials.gov/ct2/show/NCT02360293International Registered Report Identifier (IRRID)RR1-10.2196/12601

Improving Hypertension Control in Primary Care With the Measure Accurately, Act Rapidly, and Partner With Patients Protocol.

Better blood pressure (BP; mm Hg) control is a pivotal national strategy for preventing cardiovascular events. Measure accurately, Act rapidly, and Partner with patients (MAP) with practice facilitation improved BP control (<140/<90 mm Hg) from 61.2% to 89.8% during a 6-month pilot study in one primary care clinic. Current study objectives included evaluating the 6-month MAP framework in 16 Family Medicine Clinics and then withdrawing practice facilitation and determining whether better hypertension control persisted at 12 months since short-term improvements often decline by 1 year. Measure accurately included staff training in attended (intake) BP measurement and unattended automated office BP when intake BP was ≥140/≥90 mm Hg. Act rapidly (therapeutic inertia) included protocol-guided escalation of antihypertensive medications when office BP was ≥140/≥90 mm Hg. Partner with patients (systolic BP decline/therapeutic intensification) included shared decision making, BP self-monitoring, and affordable medications. Study data were obtained from electronic records. In 16 787 hypertensive adults (mean, 61.2 years; 54.1% women; 46.0% Medicare) with visits at baseline and first 6 months, BP control improved from 64.4% at baseline to 74.3% ( P<0.001) at 6 and 73.6% ( P<0.001) at 12 months. At the first MAP visit, among adults with uncontrolled baseline BP and no medication changes (n=3654), measure accurately resulted in 11.1/5.1 mm Hg lower BP. During the first 6 months of MAP, therapeutic inertia fell (52.0% versus 49.5%; P=0.01), and systolic BP decreased more per therapeutic intensification (-5.4 to -12.7; P<0.001). MAP supports a key national strategy for cardiovascular disease prevention through rapid and sustained improvement in hypertension control, largely reflecting measuring accurately and partnering with patients.

Abstract P228: Text-Facilitated Home Blood Pressure Monitoring: A Qualitative Analysis of Health Behavior Change

Uncontrolled hypertension constitutes a major challenge for healthcare systems. Home blood pressure monitoring (HBPM) is widely recommended and may lower BP when combined with other supports. However, scalable and systematic HBPM interventions are lacking and the behavioral mechanism(s) through which BP is lowered remain poorly understood. Our team designed the MyBP program with video-based education and a fully automated, bi-directional texting to facilitate longitudinal HBPM. Exit interviews conducted after six-weeks of MyBP revealed that most participants made at least one healthy behavior change. The current study examines why participants made healthy behavior changes, and what specific components of the MyBP program facilitated those changes. Adults with hypertension were recruited from either an urban emergency department, a primary care office, or a hypertension referral center. The 40 enrolled participants were widely representative: age range 34-70, 23 women, 24 minority, 14 completed only high school, BP range 110-250/70-130 mm Hg, and prescribed BP medications range 0-5. A thematic analysis of transcribed exit interview audio-recordings identified three themes contributing to patients’ decision to initiate a behavior change: 1) improved hypertension literacy from viewing educational videos; 2) increased day-to-day salience of one’s BP as a result of consistent HBPM; and 3) use of BP readings as feedback on participants’ health behaviors, with high readings often triggering intrinsic motivations to make behavior changes. These themes and associated sub-themes were found to have analogous constructs in the Health Belief Model and Social Cognitive Theory. The presentation of educational materials at baseline, followed by regular BP self-monitoring, increased confidence and motivation to initiate changes in health behaviors. The receipt of bi-weekly reports then acted as feedback fueling participants’ motivation to maintain or add healthy behaviors. Facilitation of HBPM with automated texting, in conjunction with educational videos and regular feedback, appears to stimulate improvements in hypertension self-management via mechanisms consistent with recognized models of behavior change.

Hypertension: Benefit of BP self-monitoring for hypertension.

Hypertension: Benefit of BP self-monitoring for hypertension.

Review: In hypertension, BP self-monitoring interventions improve BP levels and BP control at 12 months.

Source Citation Tucker KL, Sheppard JP, Stevens R, et al. Self-monitoring of blood pressure in hypertension: a systematic review and individual patient data meta-analysis. PLoS Med. 2017;14:e100238...

Abstract 093: Can Hypertension Control be Improved Within a Short Time Frame? - Results From Implementing the Measure Accurately, Act Rapidly and Partner With Patients (MAP) Program

Objective: Evaluate a multifaceted quality improvement program with evidenced-based interventions for Measuring blood pressure (BP, mm Hg) accurately, Acting rapidly to manage uncontrolled BP, and Partnering with patients to promote BP self-management (MAP) in primary care. Methods: Study design : Quasi-experimental, pre-post intervention, design. BP control and BPs of uncontrolled patients were compared at baseline, February 2015[A1] to May 2016, at the last visit of the next 6 months.. Measure accurately included training staff in BP measurement. If attended BP was ≥140/90, unattended, automated office (AO) BP was obtained. Act rapidly included intensification of BP meds when unattended AOBP was ≥140/90 assessed by percent of visits with uncontrolled BP and no treatment change (therapeutic inertia). Partner with patients including BP self-monitoring and using low-priced generic BP meds assessed indirectly by the fall in systolic BP (SBP) per therapeutic intensification. Population Studied: Hypertensive patients (21,035) from 16 practices who had a visit during the baseline period and either no visit (4,691) or at least one visit (16,344) during the program. Results: BP control rose from 65.6% (13,790 of 21,035) to 74.8% (12,234 of 16,344) (p&lt;.001); 12 of 16 practices had significant increases in BP control. In uncontrolled patients at baseline, mean SBP/DBP fell from 149/85 to 139/80 (p&lt;.001/p&lt;.001). Measure accurately lowered SBP 12.8 mm Hg (p&lt;.001) in uncontrolled patients with better technique in attended BP reducing SBP ≥6.5 mm Hg per practice; while unattended AOBP lowered SBP 8.6 mm Hg (p&lt;.001). Therapeutic inertia was unchanged (50.2% vs. 48.4%; p=.10); the mean fall in SBP per therapeutic change increased from 5.4 to 14.0 mm Hg (p&lt;.001). Conclusions: MAP was associated with significant improvement in hypertension control in primary care during a six-month period. The decrease in SBP and improved control were largely explained by Measure accurately and Partner with patients as therapeutic inertia (Act rapidly) did not change. Evidence-based strategies in MAP provide opportunities for primary care practices to quickly improve hypertension control toward the national goals of 80%, and importantly to reduce cardiovascular risk.

PP.15.03] MEASURE ACCURATELY, ACT RAPIDLY AND PARTNER WITH PATIENTS (MAP) IMPROVES HYPERTENSION CONTROL

Objective: A quality improvement program to improve hypertension control with evidenced-based interventions for Measuring blood pressure (BP, mmHg) accurately, Acting rapidly to manage uncontrolled BP, and Partnering with patients to promote self-management of BP (MAP) was implemented in 2016 in a Family Medicine residency in South Carolina, United States. Design and method: Hypertensive patients were included in the study if they had a visit in the year before intervention (baseline period) and at least one visit during the six-month intervention period. Omron HEM-907 devices were used to measure BP with a checklist for positioning; if initial BP was > = 140/90, the automated office BP (AOBP) device was used to measure three additional BPs one minute apart with the patient alone in the examination room (measure accurately) and display the AOBP mean. When AOBP mean was > = 140/90, intensification of antihypertensive medications (act rapidly) took place and was assessed by the percent of visits with uncontrolled BP and no treatment change (therapeutic inertia). Facilitating BP self-monitoring and using affordable generic medications (partner with patients) was assessed indirectly by a reduction in systolic BP (SBP) per therapeutic change. Results: 714 hypertensive adults met inclusion criteria (mean age 54.4 years, 53.8% black, 66.0% female, 50.3% Medicaid). From baseline to the last intervention visit, BP control increased from 61.2% to 88.0% (p < 0.01). Among 277 uncontrolled hypertensive patients at baseline, mean systolic/diastolic BP fell from147/88 to 131/79 (p < 0.01/p < 0.01) and 80.5% (223/277) were controlled to < 140/90. For measuring accurately, SBP was 12.7 mmHg (p < 0.001) lower among the uncontrolled group with improved technique; while AOBP measurement showed a 2.5 mmHg (p < 0.05) lower SBP. Therapeutic inertia was unchanged (44.4% vs. 38.3%; p = 0.57); the reduction in SBP per therapeutic change increased from 8.3 mmHG to 21.6 mmHG (p < 0.01). Conclusions: MAP was associated with better hypertension control in a medically underserved population. Data indicate that measuring accurately and better patient engagement, i.e., greater decrease in SBP with each therapeutic change, accounted for improved hypertension control. Plans are in place to spread the program to 40 additional practices.