Self-measured Blood Pressure Monitoring Research Articles

Abstract P324: Training and Technical Assistance to Improve Hypertension Control in Community Health Centers

Introduction: About 47% of adults in the U.S. have high blood pressure (BP), a contributing factor to major adverse health conditions including heart attack, heart failure, and stroke. Hypertension has also been linked to worse outcomes from COVID-19 infection, resulting in higher rates of hospitalization and death. In 2021, the AHA launched the National Hypertension Control Initiative (NHCI) in 350 community health centers (CHCs). The 3-year initiative aimed to improve BP control and COVID-19 outcomes through training and technical assistance (T/TA) in CHCs with systematic, multi-sector, culturally sensitive and evidence-based interventions, including self-measured blood pressure (SMBP) monitoring. We hypothesize that T/TA with guideline-directed and evidence-based systematic processes can improve BP control in CHCs. Methods: The initiative included complementary components: patient and public education, community outreach and integration, health care professional and organization training, and project management and evaluation. Year one focused on laying a foundation of BP control fundamentals to strengthen knowledge and skills with webinars, office hours, tools, and resources. Years two and three reinforced key concepts, introduced new resources, and provided 1:1 support to CHCs, informed by ongoing evaluation. The adoption of systematic processes with evidence-based and guideline-directed practices were encouraged in CHCs. Recognizing potential differences across CHCs, several T/TA methods were deployed during phases of the initiative in anticipation of evolving CHC needs and readiness. The methods for T/TA include providing a core educational curriculum, developing and distributing customized CHC reports with individualized data, using new and existing resources, including a BP measurement policy and procedure and a BP treatment algorithm, and evaluating methods and practice findings. Early Results: Based on UDS data, overall, BP control rates increased in NHCI CHCs from 51.3% to 57.6% (as defined by the performance measure <140/90 mm Hg), demonstrating a 6.3% absolute increase and a 12.3% relative increase from 2020 to 2022. This is compared to all HRSA CHCs, where BP control rates increased from 58.0% to 63.4%, demonstrating a 5.4% absolute increase and a 9.3% relative increase from 2020 to 2022. While all NHCI CHCs started with BP control rates less than 58.9%, some health centers have demonstrated control rates higher than 70%. Discussion: T/TA with guideline-directed and evidence-based systematic processes may have contributed to increased BP control rates in CHCs. The degree of CHC progress may have been influenced by challenges and limitations, such as the impact of the COVID-19 pandemic on participation, clinical leadership engagement, CHC team staffing turnover, and technology interoperability.

Changes in Self-Measured Blood Pressure Monitoring Use in 14 States From 2019 to 2021: Impact of the COVID-19 Pandemic.

Self-measured blood pressure monitoring (SMBP) is an important out-of-office resource that is effective in improving hypertension control. Changes in SMBP use during the Coronavirus Disease 2019 (COVID-19) pandemic have not been described previously. Behavioral Risk Factor Surveillance System (BRFSS) data were used to quantify changes in SMBP use between 2019 (prior COVID-19 pandemic) and 2021 (during the COVID-19 pandemic). Fourteen states administered the SMBP module in both years. All data were self-reported from adults who participated in the BRFSS survey. We assessed the receipt of SMBP recommendations from healthcare professionals and actual use of SMBP among those with hypertension (n = 68,820). Among those who used SMBP, we assessed SMBP use at home and sharing BP readings electronically with healthcare professionals. Among adults with hypertension, there was no significant changes between 2019 and 2021 in those reporting SMBP use (57.0% vs. 55.7%) or receiving recommendations from healthcare professionals to use SMBP (66.4% vs. 66.8%). However, among those who used SMBP, there were significant increases in use at home (87.7% vs. 93.5%) and sharing BP readings electronically (8.6% vs. 13.1%) from 2019 to 2021. Differences were noted by demographic characteristics and residence state. Receiving a recommendation from the healthcare provider to use SMBP and actual use did not differ before and during the COVID-19 pandemic. However, among those who used SMBP, home use and sharing BP readings electronically with healthcare professional increased significantly, although overall sharing remained low (13.1%). Maximizing advances in virtual connections between clinical and community settings should be leveraged for improved hypertension management.

Determinants of Bluetooth-Enabled Self-Measured Blood Pressure Monitoring in Federally Qualified Health Centers.

In 2021, the Health Resources and Services Administration (HRSA) launched the National Hypertension Control Initiative (HTN Initiative) with the goal to enhance HTN control through Bluetooth-enabled self-measured blood pressure (BT-SMBP) monitoring and use this data to inform clinical decisions in Federally Qualified Health Centers (FQHCs) with a large proportion of their population with uncontrolled blood pressure (BP). We sought to understand the experience of Michigan-based FQHCs in implementing the HTN initiative. Staff from three Michigan-based FQHCs were invited to participate in semi-structured interviews from September to November 2022. Interviews were conducted in-person and were based on the Tailored Implementation in Chronic Diseases framework. Content analysis was performed by three coders. Ten staff participated in interviews (FQHC 1: n = 6, FQHC 2: n = 1, FQHC 3: n = 3). The FQHCs differed in their stage of implementation and their approach. FQHC 1 created a large-scale, community health worker driven program, FQHC 2 created a small-scale, short term, BP device loan program, and FQHC 3 created a primarily outsourced, large-scale program through a contracted partner. Positive staff attitudes and outcome expectations, previous experience with SMBP grants, supportive clinic leadership, social support, and free BP cuff resources were identified as facilitators to implementation. Patients' high social needs, SMBP-related Technology, and insufficient workforce and staff capacity were identified as barriers. BT-SMBP among FQHC patients is promising but challenges in integrating SMBP data into clinic workflow, workforce capacity to support the high social needs of participants, and to assist in reacting to the more frequent BP data remain to be overcome.

PENGARUH TELEHEALTH TERHADAP PENGENDALIAN TEKANAN DARAH

Hypertension is a chronic condition that attacks adults of all ages. Having an effective method or way to manage this condition is the key to successful treatment of hypertension. The design of this research is a cohort study that examines data on hypertensive patients obtained from health service databases. The research took place in October until December 2021. The inclusion criteria in this study were adults (≥45 years) with prehypertension and hypertension, residing in rural areas. An assessment was carried out on respondents who could access the telehealth application at home, and it was validated for monitoring blood pressure using mobile phone or other device with an internet connection that allows monitoring from the respondent's home and telehealth services. Respondents were asked to fill in the results of blood pressure measurements. Based on the results, 55 respondents (100%) carried out data collection. Linear regression analysis found an average reduction in systolic blood pressure of 19.2 mmHg. Respondents in the decreasing systolic blood pressure group had a higher frequency of self-measured blood pressure monitoring (OR = 0.85; 95% CI= 0.81 - 0.89; p = 0.002) than other patients. The use of telehealth at home combined with care management by health workers is considered effective in improving blood pressure control in hypertensive patients.

Self-Measured Blood Pressure Monitoring During the COVID-19 Pandemic: Perspectives From Community Health Center Clinicians.

The early period of the COVID-19 pandemic necessitated a rapid increase in out-of-office care. To capture the impact from COVID-19 on care for patients with hypertension, a questionnaire was disseminated to community health center clinicians. The extent, types, and causes of care delays and disruptions were assessed along with adaptations and innovations used to address them. Clinician attitudinal changes and perspectives on future hypertension care were also assessed. Of the 65 respondents, most (90.8%) reported their patients with hypertension experienced care delays or disruptions, including lack of follow-up, lack of blood pressure assessment, and missed medication refills or orders. To address care delays and disruptions for patients with hypertension, respondents indicated that their health center increased the use of telehealth or other technology, made home blood pressure devices available to patients, expanded outreach and care coordination, provided medication refills for longer periods of time, and used new care delivery options. The use of self-measured blood pressure monitoring (58.5%) and telehealth (43.1%) was identified as the top adaptations that should be sustained to increase access to and patient engagement with hypertension care; however, barriers to both remain. Policy and system level changes are needed to support value-based care models that include self-measured blood pressure and telehealth.

Comparison of Home and Office Blood Pressure Devices in the Clinical Setting.

Self-measured blood pressure (SMBP) monitoring is increasingly used for remote hypertension management, but the real-world performance of home blood pressure (BP) devices is unknown. We examined BP measurements from patients' home devices using the American Medical Association's (AMA) SMBP Device Accuracy Test tool. Patients at a single internal medicine clinic underwent up to five seated, same-arm BP readings using a home device and an automated BP device (Omron HEM-907XL). Following the AMA's three-step protocol, we used the patient's home device for the first, second, and fourth measurements and the office device for the third and fifth (if needed) measurements. Device agreement failure was defined as an absolute difference in systolic BP >10 mm Hg between the home and office devices in either of two confirmatory steps. Performance was examined by brand (Omron vs. non-Omron). Moreover, we examined patient factors associated with agreement failure via logistic regression models adjusted for demographic characteristics. We evaluated 152 patients (mean age 60 ± 15 years, 58% women, 31% Black) seen between October 2020 and November 2021. Device agreement failure occurred in 22.4% (95% CI: 16.4%, 29.7%) of devices tested, including 19.1% among Omron devices and 27.6% among non-Omron devices (P = 0.23). No patient characteristics were associated with agreement failure. Over one-fifth of home devices did not agree based on the AMA SMBP device accuracy protocol. These findings confirm the importance of office-based device comparisons to ensure the accuracy of home BP monitoring.

Barriers and facilitators to self-measured blood pressure monitoring among US-resettled Arab refugees with hypertension: a qualitative study

BackgroundMinoritized communities including refugees are at an increased risk of poorly controlled hypertension. Evidence indicates that self-measured blood pressure monitoring (SMBP) is an effective method to improve blood pressure control in patients with hypertension. However, it has not been studied among refugee populations. The objective of this study is to examine barriers and facilitators to SMBP among Arab refugees resettled in the United States (US) with diagnosed hypertension.MethodsA total of 109 participants were recruited through a Federally Qualified Health Center system that is a major provider of healthcare to refugees in San Diego, California. Participants completed a questionnaire and were interviewed using in-depth, semi-structured interviews. Interviews were transcribed and translated, and data were coded using inductive thematic analysis and organized based on the theory of care-seeking behavior.ResultsSeveral barriers to engaging in effective SMBP monitoring were identified. Clinical and sociodemographic barriers included reliance on public monitors and poor hypertension literacy. Psychosocial barriers of affect, norms, and habits included fear and anxiety from hypertension, cultural stigma of illness, and conditional SMBP with symptoms, respectively. Utility psychosocial barriers included lack of SMBP prioritization in treatment and perceived inaccuracy of home monitors. Family members’ support with home monitoring served as an important facilitator to SMBP.ConclusionsThere are several barriers to effective SMBP among the US-resettled Arab refugee population that may reflect unique cultural and care-seeking behaviors. Tailored public health and clinical interventions are needed to support refugee patients and providers to improve hypertension self-management behaviors for this unique population.

Engagement in Mobile Health Prompted Self-Measured Blood Pressure Monitoring among Participants Recruited from a Safety-Net ED: The Reach Out Trial (Preprint)

Engagement in Mobile Health Prompted Self-Measured Blood Pressure Monitoring among Participants Recruited from a Safety-Net ED: The Reach Out Trial (Preprint)

Abstract 18538: Results of a Self-Management Intervention to Improve Hypertension in Black Patients Using the Electronic Health Record Patient Portal

Introduction: Nearly half of American adults (47%) have hypertension (HTN), and non-Hispanic Black patients are disproportionately represented among those diagnosed (56% versus 48% for White, 46% for Asian, and 39% Hispanic adults). Models of care to reduce blood pressure for the Black patient population are not consistently implemented, in large part due to systemic and structural barriers to care. Hypothesis: The purpose of this study was to improve access to and use of digital education, skills for self-measured blood pressure (SMBP) monitoring, use of the electronic health record (EHR) patient portal, and blood pressure from baseline to 3 months in a cohort of Black Americans. Methods: A pre-post intervention design was used to evaluate the team-based, nurse-led intervention. Patients received coaching on HTN goals, screening for social determinants of health (SDOH), medication review, self-paced portal-based videos, and teach-back for BP cuff use. Post-implementation blood pressure (BP) and self-management (knowledge, cuff-use, patient portal use, and attendance at follow-up) were measured using the HELM tool, Chronic Care Model (CCM) and American Heart Association (AHA) HTN toolkit. 12-month follow-up is ongoing. Results: Black participants (n=80) averaged 59 (SD 10) years of age; most were female (n=58, 73%), employed (n=59, 75%), non-smokers (n=66, 84%), with average BMI 34.5 (SD8). From 0-3-months, views of portal-pushed videos increased to 69%, knowledge scores improved pre- (M = 67.9, SD = 16.7 to post (M = 75.2, SD = 17.4), and mean systolic BP was significantly reduced by 20.3mmHg (95%CI 16.11, 24.44). Average systolic BP pre was 152.13 (SD = 16.87) and post was 131.85 (SD = 13.13), t (79) = 9.71, p< .001. Sustainability at 12-months is ongoing. Conclusions: A team-based, nurse-led model improves patient engagement, adoption of portal-prescribed education, skills for SMBP, EHR-reported BP, and visit follow-up for Black patients with uncontrolled BP.

Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial.

Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease-related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. Reach Out was a randomized, controlled, mobile health-based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message-linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). Of the 211 Reach Out participants, 107 (50.7%) consented and 71 (33.6%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4% were female and 57.8% identified as Black. Among the 71 participants, 51 (72%) completed cognitive assessments at 3 months and 34 (48%) completed these assessments at 6 months. BP assessments were completed by 37 (52%) and 20 (28%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718.

Target:BP: A National Initiative to Improve Blood Pressure Control.

BP is a national initiative launched by the American Heart Association and the American Medical Association in 2017 in response to the high prevalence of uncontrolled blood pressure (BP) in the United States. BP provides support to health care organizations and health care teams, with no user fees, to improve the quality of care for adults with hypertension by providing education and resources and recognizing organizations committed to prioritizing and reporting their rate of BP control. Through Target:BP, the American Heart Association and the American Medical Association also collaborate to align policy with evidence through federal, state, and institutional policy advocacy and raise public awareness through media campaigns. In 2022, Target:BP recognized 1309 health care organizations serving 8.4 million patients with hypertension for prioritizing BP control, 675 of which affirmed performance of evidence-based BP measurement activities and 551 of which reported BP control rates ≥70%. With the proportion of US adults with controlled BP falling to 48.2% from 2017 to 2020, Target:BP remains focused on regaining lost ground in national BP control rates by emphasizing accurate BP measurement, rapid treatment intensification, healthful lifestyle changes, and evidence-based use of self-measured BP monitoring. BP also emphasizes adoption of team-based care models and prioritizing equitable health outcomes. More than 1.37 million unique users have visited https://targetbp.org/ and downloaded 98 341 Target:BP resources from 2017 to 2022.

Evaluation of self-measured blood pressure monitoring in a southern rural West Virginia health system.

At the time of the 2021 Behavioral Risk Factor Surveillance System survey, an estimated 32.3% of adults in the US and nearly half (43.4%, 776 000) of adults in West Virginia (WV) had hypertension. Further, the Interactive Atlas of Heart Disease and Stroke estimates an increase in the percentage of adults with hypertension in the US from 32.3% to 47.0%, with hypertension rates in WV rising as high as 58.7%, indicating a significant public health concern in the community. Hypertension increases the risk of several negative health outcomes, including heart disease and stroke, and leads to increased economic and chronic disease burden. Although certain unmodifiable factors (sex, age, race, ethnicity, and family history) increase the risk of developing hypertension, a healthy lifestyle - including a nutritious diet, maintaining a healthy weight, avoiding nicotine products, and participating in regular moderate physical activity - can decrease the risk of developing hypertension. Self-measured blood pressure (SMBP) monitoring, or home BP monitoring, when integrated with a provider's clinical management approach, is linked to improvements in BP management and control. This study represents a mid-point assessment of a remote SMBP monitoring program implemented by Cabin Creek Health Systems (CCHS), a federally qualified health center, and its impact on BP control. CCHS implemented SMBP programming in March 2020 as one element of a developing comprehensive program aimed at reducing uncontrolled hypertension, and therefore chronic disease burden, in its service area and patient population. The project, funded by the Health Resources and Services Administration, continued to February 2023. This report represents a mid-point analysis and was based on the retrospective analysis of de-identified data collected for 234 patients to June 2022, who were assessed for changes in BP between the date of enrollment and the most recently available BP measurement. Patients were enrolled in the SMBP program if they exhibited current or previous indicators of uncontrolled hypertension (systolic &ge;140 mmHg and/or diastolic &ge;90 mmHg), at the discretion of their provider, and were equipped with an iBloodPressure cellular connected home BP monitoring system, manufactured by Smart Meter. Their BP readings were documented in the integration software TimeDoc Health and electronic health record athenahealth. At the time of enrollment, 201 (86.0%) patients had uncontrolled hypertension, with 116 (49.6%) patients having both uncontrolled systolic (&ge;140 mmHg) and diastolic (&ge;90 mmHg) values. At follow-up, the number of patients with uncontrolled hypertension decreased from 201 to 98 (41.9%), with only 36 (15.4%) patients having both uncontrolled systolic and diastolic values. Additionally, 26 (11.1%) patients were in hypertensive crisis at the time of enrollment, and no patients remained in crisis at the time of follow-up. The number of patients with BP values in the controlled range (systolic <140 mmHg and diastolic <90 mmHg) increased from 33 (14.1%) at enrollment to 136 (58.1%) at follow-up. Overall, there was a 44.0% increase in the number of patients with BP values in the controlled range at follow-up, and a concomitant 44.1% decrease in the number of patients in the uncontrolled range. These observations were consistent across multiple demographic indicators, including clinic location, three-digit zip code, and patient sex. Systematic implementation of remote BP monitoring, when integrated into clinician workflows, was associated with a substantial reduction in the number of patients with uncontrolled hypertension in this rural federally qualified health center. Further, CCHS was successful in implementing a remote SMBP monitoring program in a community challenged with transportation insecurity, and poor cellular and broadband access, of which lessons learned are applicable to other health systems interested in pursuing comparable efforts.

Abstract P333: Self-measured Blood Pressure Monitoring During The Covid-19 Pandemic Among Persons Living In Rural Areas

Self-measured blood pressure monitoring (SMBP) plus clinical support can help control blood pressure among people with hypertension. The COVID-19 pandemic drove increased telehealth use, presenting an opportunity for increased SMBP use among groups with limited healthcare access. This study examined changes in the use and electronic reporting of SMBP among US adults aged ≥18 years with hypertension living in rural areas by race and ethnicity. With data from the Behavioral Risk Factor Surveillance System in 2019 and 2021, we used weighted Poisson regression to estimate the annual prevalence of adults with hypertension who reported using SMBP and who reported sharing SMBP results by phone or Internet. For each race and ethnicity and outcome, we estimated adjusted prevalence ratios (aPR) comparing 2021 to 2019, adjusted for age group, income, insurance status, sex, and education. The prevalence of SMBP use did not significantly change for any race or ethnicity from 2019 to 2021 (Figure). White, Black, and Hispanic adults reported SMBP measurements electronically more in 2021 than 2019 (aPR [95% CI]: 1.5 [1.1-1.9], 2.7 [1.2-6.0], 3.9 [1.7-9.0], respectively). Prevalence of electronic reporting among adults living in rural areas remained low in 2021, ranging from 10.5% in adults of other races to 21.7% in Hispanic adults. Despite changes that helped SMBP implementation during the COVID-19 pandemic, SMBP use did not change; electronic reporting increased but remained rare. Because SMBP can make blood pressure control more convenient and accessible, additional policies and programs can facilitate SMBP implementation, especially among populations with limited healthcare access.

Implementation Strategies to Improve Blood Pressure Control in the United States: A Scientific Statement From the American Heart Association and American Medical Association.

Hypertension is one of the most important risk factors that contribute to incident cardiovascular events. A multitude of US and international hypertension guidelines, scientific statements, and policy statements have recommended evidence-based approaches for hypertension management and improved blood pressure (BP) control. These recommendations are based largely on high-quality observational and randomized controlled trial data. However, recent published data demonstrate troubling temporal trends with declining BP control in the United States after decades of steady improvements. Therefore, there is a widening disconnect between what hypertension experts recommend and actual BP control in practice. This scientific statement provides information on the implementation strategies to optimize hypertension management and to improve BP control among adults in the United States. Key approaches include antiracism efforts, accurate BP measurement and increased use of self-measured BP monitoring, team-based care, implementation of policies and programs to facilitate lifestyle change, standardized treatment protocols using team-based care, improvement of medication acceptance and adherence, continuous quality improvement, financial strategies, and large-scale dissemination and implementation. Closing the gap between scientific evidence, expert recommendations, and achieving BP control, particularly among disproportionately affected populations, is urgently needed to improve cardiovascular health.

Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study.

According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. We aimed to determine the feasibility and acceptability of a digitally based BP self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable and that at least 50% of the patients would use the monitor at the rate required for the reimbursement of the device's cost (16 days of measurements in any 30-day period). Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (≥16 days in any rolling 30-day window) and a lenient definition (≥1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mmHg and +3.31 (SE 0.71) mmHg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5% (63/168) and 48.8% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6% (90/168) of the patients using their monitor at week 2 and only 25% (42/168) at week 11. Although only 25.6% (43/168) achieved the strict definition of compliance, 42.3% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8% (45/168) complied with the measurement rate that would result in device cost reimbursement. Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated.

Eliminating hypertension disparities in U.S. non-Hispanic black adults: current and emerging interventions.

Hypertension in non-Hispanic black (NHB) adults in the United States has an earlier onset, higher prevalence and increased severity compared with other racial/ethnic populations. Uncontrolled hypertension is responsible for the greater cardiovascular disease (CVD) morbidity and mortality and decreased longevity in NHB adults. Unfortunately, eliminating the persistent hypertension-associated disparities and the white/black mortality gap, worsened by the COVID-19 pandemic, has been challenging. Overcoming the social determinants of health (SDOH), implementing therapeutic lifestyle changes (TLC), and using intensive guideline-directed medical therapy are required. Moreover, novel approaches, including community-based interventions and self-measured blood pressure (SMBP) monitoring, may mitigate U.S. disparities in hypertension. In this review, we discuss recent data regarding the U.S. NHB adult disparate hypertension control and CVD morbidity and mortality. We note current approaches to address disparities, such as TLC, evidence-based pharmacotherapy, community-based interventions and SMBP. Finally, we explore future research and initiatives to seek hypertension-related health equity. In the final analysis, longstanding, unacceptable hypertension and CVD morbidity and mortality in U.S. NHB adults must be addressed. Appropriate TLC and evidence-based pharmacotherapy benefit all populations, especially NHB adults. Ultimately, novel community-based interventions and SMBP may help overcome the SDOH that cause hypertension disparities.

Engagement in Self-measured Blood Pressure Monitoring Among Medically Underresourced Participants (the Reach Out Trial): Digital Framework Qualitative Study.

Mobile health (mHealth) interventions serve as a scalable opportunity to engage people with hypertension in self-measured blood pressure (SMBP) monitoring, an evidence-based approach to lowering blood pressure (BP) and improving BP control. Reach Out is an SMS text messaging-based SMBP mHealth trial that aims to reduce BP among hypertensive patients recruited from the emergency department of a safety net hospital in a low-income, predominately Black city. As the benefits of Reach Out are predicated on participants' engagement with the intervention, we sought to understand participants' determinants of engagement via prompted SMBP with personalized feedback (SMBP+feedback). We conducted semistructured telephone interviews based on the digital behavior change interventions framework. Participants were purposively sampled from 3 engagement categories: high engagers (≥80% response to SMBP prompts), low engagers (≤20% response to BP prompts), and early enders (participants who withdrew from the trial). We conducted interviews with 13 participants, of whom 7 (54%) were Black, with a mean age of 53.6 (SD 13.25) years. Early enders were less likely to be diagnosed with hypertension prior to Reach Out, less likely to have a primary care provider, and less likely to be taking antihypertensive medications than their counterparts. Overall, participants liked the SMS text messaging design of the intervention, including the SMBP+feedback. Several participants across all levels of engagement expressed interest in and identified the benefit of enrolling in the intervention with a partner of their choice. High engagers expressed the greatest understanding of the intervention, the least number of health-related social needs, and the greatest social support to engage in SMBP. Low engagers and early enders shared a mixed understanding of the intervention and less social support compared to high engagers. Participation decreased as social needs increased, with early enders sharing the greatest amount of resource insecurity apart from a notable exception of a high engager with high health-related social needs. Prompted SMBP+feedback was perceived favorably by all participants. To enhance SMBP engagement, future studies could consider greater support in the initiation of SMBP, evaluating and addressing participants' unmet health-related social needs, as well as strategies to cultivate social norms.

Hypertension management before and under the COVID-19 pandemic: lessons and future directions.

Hypertension is a significant risk factor for cardiovascular diseases. The prevalence of hypertension and its complications is increasing yearly, yet it remains inadequately controlled worldwide. It has already been recognized that self-management, including self-measured blood pressure monitoring at home, is more important than office blood pressure monitoring. The practical application of telemedicine using digital technology was already underway. COVID-19 has promoted the popularization of these management systems in primary care, although the COVID-19 pandemic disrupted lifestyle and healthcare access. At the beginning of the pandemic, we were at the mercy of information on whether certain antihypertensive drugs, for example, might pose a risk of infection in the face of unknown infectious diseases. Over the past three years, however, much knowledge has been accumulated. It has been scientifically proven that there is no serious problem in managing hypertension in the same way as before the pandemic. That is to control blood pressure mainly through home blood pressure monitoring and continuing conventional drug therapy while modifying lifestyle. On the other hand, in the New Normal era, it is necessary to accelerate digital hypertension management and the establishment of new social networks and medical systems to prepare for the re-emergence of future pandemics while continuing to protect against infection. This review will summarize the lessons and future directions we learned from the impact of the COVID-19 pandemic on hypertension management. The COVID-19 pandemic has disrupted our daily life, restricted access to healthcare, and altered some of the conventional management of hypertension.

Abstract P355: Examining Sexual Identity Differences in Self-Measured Blood Pressure Monitoring Among Adults in the Behavioral Risk Factor Surveillance System

Background: Hypertension is a leading risk factor for cardiovascular disease. Self-measured blood pressure (SMBP) monitoring has been identified as an effective strategy to achieve BP control among adults with hypertension. Although there is growing evidence that sexual minority (e.g., gay/lesbian, bisexual) adults are at higher risk of hypertension than heterosexual adults, there is no data on hypertension self-management among sexual minority people with hypertension. Methods: We used data from the 2019 Behavioral Risk Factor Surveillance System to examine differences in SMBP monitoring between sexual minority and heterosexual participants with hypertension. Participants were asked questions regarding SMBP monitoring at home, including whether they were advised by a healthcare professional to check their BP at home, regularly checked their BP at home, and if they shared their home BP readings with a healthcare professional. We ran sex-stratified logistic regression models, adjusted for demographic factors and healthcare utilization, to estimate differences in SMBP monitoring between sexual minority and heterosexual participants. Results: The sample included 25,461 participants with a mean age of 54.1 ( ± 16.8) of which 95.1% were heterosexual, 1.7% were gay/lesbian, and 2.2% were bisexual. Although there were no differences in the odds of being advised by a healthcare professional to check their BP at home, lesbian women were more likely than heterosexual women to report taking their BP at home (AOR 1.23, 95% CI = 1.03-4.85) and sharing their home BP readings with a healthcare professional (AOR 2.31, 95% CI = 1.04-5.17). In contrast, bisexual women were less likely than heterosexual women to report taking their BP at home (AOR 0.59, 95% CI = 0.43-0.81) and sharing their home BP readings with a healthcare professional (AOR 0.56, 95% CI = 0.40-0.78). No differences in SMBP monitoring were found between sexual minority and heterosexual men. Conclusions: As the first examination of sexual identity differences in SMBP monitoring among adults with hypertension, this study addresses important knowledge gaps within cardiovascular and sexual minority health research. Lesbian women with hypertension exhibited more favorable self-management behaviors compared to heterosexual women. However, bisexual women with hypertension were less likely than heterosexual women to engage in SMBP monitoring. Findings suggest there is a need for clinical interventions to improve hypertension self-management among bisexual women.

Impact of COVID-19-related care disruptions on blood pressure management and control in community health centers

BackgroundUncontrolled hypertension is a leading risk factor for cardiovascular disease. To ensure continuity of care, community health centers (CHCs) nationwide implemented virtual care (telehealth) during the pandemic. CHCs use the Centers for Medicare & Medicaid Services (CMS) 165v8 Controlling High Blood Pressure measure to report blood pressure (BP) control performance. CMS 165v8 specifications state that if no BP is documented during the measurement period, the patient’s BP is assumed uncontrolled.MethodsTo examine trends in BP documentation and control rates in CHCs as telehealth use increased during the pandemic compared with pre-pandemic period, we assessed documentation of BP measurement and BP control rates from December 2019 - October 2021 among persons ages 18-85 with a diagnosis of hypertension who had an in-person or telehealth encounter in 11 CHCs. Rates were compared between CHCs that did and did not implement self-measured BP monitoring (SMBP).ResultsThe percent of patients with hypertension with no documented BP measurement was 0.5% in December 2019 and increased to 15.2% (overall), 25.6% (non-SMBP CHCs), and 11.2% (SMBP CHCs) by October 2021. BP control using CMS 165v8 was 63.5% in December 2019 and decreased to 54.9% (overall), 49.1% (non-SMBP), and 57.2% (SMBP) by October 2021. When assessing BP control only in patients with documented BP measurements, CHCs largely maintained BP control rates (63.8% in December 2019; 64.8% (overall), 66.0% (non-SMBP), and 64.4% (SMBP) by October 2021).ConclusionsThe transition away from in-person to telehealth visits during the pandemic likely increased the number of patients with hypertension lacking a documented BP measurement, subsequently negatively impacting BP control using CMS 165v8. There is an urgent need to enhance the flexibility of virtual care, improve EHR data capture capabilities for patient-generated data, and implement expanded policy and systems-level changes for SMBP, an evidence-based strategy that can build patient trust, increase healthcare engagement, and improve hypertension outcomes.