Self-measured Blood Pressure Research Articles

Engagement in mHealth-Prompted Self-Measured Blood Pressure Monitoring Among Participants Recruited From a Safety-Net Emergency Department: Secondary Analysis of the Reach Out Trial.

Hypertension, a key modifiable risk factor for cardiovascular disease, is more prevalent among Black and low-income individuals. To address this health disparity, leveraging safety-net emergency departments for scalable mobile health (mHealth) interventions, specifically using text messaging for self-measured blood pressure (SMBP) monitoring, presents a promising strategy. This study investigates patterns of engagement, associated factors, and the impact of engagement on lowering blood pressure (BP) in an underserved population. We aimed to identify patterns of engagement with prompted SMBP monitoring with feedback, factors associated with engagement, and the association of engagement with lowered BP. This is a secondary analysis of data from Reach Out, an mHealth, factorial trial among 488 hypertensive patients recruited from a safety-net emergency department in Flint, Michigan. Reach Out participants were randomized to weekly or daily text message prompts to measure their BP and text in their responses. Engagement was defined as a BP response to the prompt. The k-means clustering algorithm and visualization were used to determine the pattern of SMBP engagement by SMBP prompt frequency-weekly or daily. BP was remotely measured at 12 months. For each prompt frequency group, logistic regression models were used to assess the univariate association of demographics, access to care, and comorbidities with high engagement. We then used linear mixed-effects models to explore the association between engagement and systolic BP at 12 months, estimated using average marginal effects. For both SMBP prompt groups, the optimal number of engagement clusters was 2, which we defined as high and low engagement. Of the 241 weekly participants, 189 (78.4%) were low (response rate: mean 20%, SD 23.4) engagers, and 52 (21.6%) were high (response rate: mean 86%, SD 14.7) engagers. Of the 247 daily participants, 221 (89.5%) were low engagers (response rate: mean 9%, SD 12.2), and 26 (10.5%) were high (response rate: mean 67%, SD 8.7) engagers. Among weekly participants, those who were older (>65 years of age), attended some college (vs no college), married or lived with someone, had Medicare (vs Medicaid), were under the care of a primary care doctor, and took antihypertensive medication in the last 6 months had higher odds of high engagement. Participants who lacked transportation to appointments had lower odds of high engagement. In both prompt frequency groups, participants who were high engagers had a greater decline in BP compared to low engagers. Participants randomized to weekly SMBP monitoring prompts responded more frequently overall and were more likely to be classed as high engagers compared to participants who received daily prompts. High engagement was associated with a larger decrease in BP. New strategies to encourage engagement are needed for participants with lower access to care.

The utility of home blood pressure load in predicting average self-measured blood pressure.

Average values for self-measured blood pressure (SMBP) more accurately reflect a patient's risk of cardiovascular disease than do office measurements. Oftentimes, however, patients provide lists of individual home blood pressure (BP) measurements, and average values cannot be computed within the time constraints of a clinic visit. In contrast, the home BP load - defined as the proportion of BP values greater than a partition value (e.g., 130 mmHg) - can be easily calculated. We examined the utility of the BP load in predicting the mean SMBP and confirming elevated SMBP. Four hundred twenty untreated adults at least 30 years of age acquired SMBP data twice in the morning and twice in the evening over 10 days. The 'true' SMBP was defined as the mean of these 40 determinations. Using all 10 days of BP data and a systolic BP threshold of 130 mmHg, the average SMBP associated with a home BP load of 0.50 was 130 mmHg, with a 95% prediction interval of 126-133 mmHg. True systolic SMBP was approximately 6 mmHg lower and higher at home BP loads of 0.25 and 0.75, respectively. There was a 90% probability that the true systolic SMBP was greater than 130 mmHg if the systolic home BP load was at least 0.60. Corresponding values for 3 days and 1 day of SMBP were at least 0.68 and at least 0.84, respectively. Our analysis demonstrates that the home BP load can be used to estimate the average BP acquired on home monitoring and confirm elevated SMBP.

Multidimensional phenotyping to distinguish among distinct obstructive sleep apnea, chronic obstructive pulmonary disease, and overlap syndrome phenotypes

Objective/backgroundChronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA) and their comorbid association called Overlap Syndrome (OS) are frequent chronic diseases with high individual and societal burdens. Precise descriptions of the respective symptoms, comorbidities, and medications associated with these three conditions are lacking. We used a multidimensional phenotyping approach to identify relevant phenotypes characterizing these 3 disorders. Patients/methods308 patients with OSA, COPD and OS were prospectively assessed using a combination of body shape measurements and multidimensional questionnaires evaluating sleep, fatigue, depression and respiratory symptoms. Comorbidities and medications were confirmed by physicians. Patients made home blood pressure self-measurements using a connected wearable device to identify undiagnosed or uncontrolled hypertension. ResultsThree distinct relevant phenotypes were identified. OSA patients were round in shape with a balanced waist-to-hip ratio, frequent witnessed apneas, nocturia, daytime sleepiness, depression, and high diastolic blood pressure. COPD patients had a thinner body shape with a high waist-to-hip ratio, complained mainly of fatigue, and exhibited a higher resting heart rate. OS patients were round in shape with a balanced waist-to-hip ratio, reported little sleepiness and depression, but had impaired sleep and the highest rate of cardio-metabolic comorbidities. Diminished fitness-to-drive was most apparent in patients with OSA and OS. Home blood pressure measurements identified undiagnosed hypertension in 80 % of patients and in nearly 80 % of those with hypertension it was uncontrolled by their current medications. ConclusionsOur systematic multidimensional phenotyping approach identified distinct body shapes, symptoms, and comorbidity profiles among patients with OSA, COPD, and OS.

Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study

Objective To explore in a primary care setting the associations between patients’ daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. Design and setting The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. Patients Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. Main outcome measures Association between self-reported BP and 10 self-report lifestyle-related variables. Results Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. Conclusion In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension.

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 &lt;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.

Blood Pressure Measurements Obtained by Community-Dwelling Adults Are Similar to Nurse-Obtained Measurements: The SMART-BP Validate Study.

Self-measured blood pressure (SMBP) is an effective strategy for managing and controlling hypertension. However, uncertainty regarding patients' ability to accurately measure their blood pressure (BP) contributes to treatment inertia. Therefore, we compared BP measurements with the Omron HEM-9210T device obtained by nurses and community-dwelling adults after training. This cross-sectional study was conducted in a simulated home environment at an academic institution. After a 5-min rest, a trained nurse measured a participant's BP twice at a 1-min interval. The participants then ambulated at their usual pace for 2 min. Next, they were asked to rest for 5 min, during which each individual watched a 3-min video on SMBP. Following the rest, the participants obtained two readings at a 1-min interval. We recruited 102 community-dwelling adults with a mean age of 54 (±14) years; 59% female, 88% Black race, and 63% with a hypertension diagnosis. Half (n = 51) had a home BP monitor. Overall, there were no significant differences between nurse- and participant-obtained systolic BP (mean difference [MD]: -1.1; standard deviation [SD]: 8.0; P = 0.178) or diastolic BP (MD: -0.9; SD: 5.5; P = 0.111). Participants who used an extra-large cuff had higher self-measured diastolic BP (MD: -2.9; SD: 4.5; P = 0.010). All participants demonstrated satisfactory SMBP skills after the training. Community-dwelling adults can accurately measure BP after a 3-min video training. Integrating SMBP training into patient encounters may result in reliable home BP measurements, improving hypertension management and clinical decision making.

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.

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.

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.

Validation of the ANDON KD-595 automated upper-arm blood pressure monitor according to the universal standard.

To validate the ANDON KD-595 automated upper-arm blood pressure monitor for clinical use and self-measurement blood pressure measurement according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard. Same left-arm blood pressure was sequentially measured in 90 qualified adult participants and compared with a standard mercury sphygmomanometer. A total of 270 comparison pairs were obtained and analyzed according to the universal standard. For the validation Criterion 1 of the universal standard, the mean ± SD of the differences between the test device and reference blood pressure readings was 0.96 ± 5.35 and 0.82 ± 5.08 mmHg for SBP and DBP, respectively. For Criterion 2, the SDs of the averaged blood pressure differences between the test device and reference blood pressure per subject were 4.84 and 4.64 mmHg (with maximum allowed SDs of 6.87 and 6.89 mmHg) for SBP and DBP, respectively. The ANDON KD-595 automated upper-arm blood pressure monitor passed all the validation requirements according to the AAMI/ESH/ISO Universal Standard and can be recommended for clinical use and self-measurement blood pressure measurement in the general population.

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.

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&lt;.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.

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&lt; .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.

Abstract 17939: Predictors of Time in Target Range in a Comprehensive Self-Measured Blood Pressure Program in a Socially and Economically Disadvantaged Primary Care Population

Introduction: The Community Practice Center (CPC) in North Philadelphia serves a community with significant socioeconomic barriers leading to inability to access care necessary for management of hypertension (HTN). Prior studies have shown the efficacy of SMBP programs in improving blood pressure (BP) control. Methods: All sequential patients presenting to the CPC with stage 2 HTN were screened for eligibility. Upon enrollment, patients received a Bluetooth-enabled BP cuff connected to a mobile health app and HTN education. Patients completed validated social and behavioral assessments including social determinants of health (SD)H) assessment via WellRx screen, depression screening (PHQ-9), and self-efficacy screening ( Self-Efficacy to Manage Chronic Disease Scale ). A behavior change plan was created using Brief Problem Solving Therapy based on the aforementioned assessments. Staff continuously monitored usage, BP, and provided individualized interventions. We conducted a cross-sectional quality improvement study using daily BP data from June 2022 - April 2023 to assess the correlation between baseline sociodemographic characteristics and Time in Target Range (TTR) through multivariable linear regression. We calculated TTR, defined as the percentage of time with systolic BP within 100-130 mmHg, through linear interpolation. Results: A total of 133 patients were enrolled in the program. We analyzed data from 78 patients with ≥3 days of readings (average 33; SD 49) and complete baseline characteristics (Table 1). Female sex and non-smoking status were associated with TTR, while diabetes, positive depression screening, positive SDOH screening, and self-efficacy were not (Table 2). Conclusions: In a socioeconomically disadvantaged population participating in a comprehensive SMBP program, depression, SDOH, and self-efficacy screening at time of enrollment did not predict TTR. Participation in a SMBP program may be valuable in these populations.

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.

Exploring flexible methods for national health examination surveys in Germany

Abstract Background National health examination surveys (HES) are rarely carried out due to high costs and high complexity. We piloted more flexible methods such as self-sampling, self-measurements and household visits conducted by a study-nurse replacing physician examinations in study centers. Methods Feasibility of several new methods for the German HES was tested, e.g.: large-scale implementation of unattended self-sampled dried blood spots (DBS) and oral-nasal swabs (ONS) in a countrywide general population panel including a large subsample with migration background (Study 1, n = 15,122); household visits with brief biosampling &amp; examinations (Study 2, n = 470); and unattended blood pressure (BP) self-measurements with mailed devices and video instructions (Study 3, n = 202). Results Among participants consenting to participate, Study 1 showed successful postal self-sampling of DBS for SARS-CoV-2 antibody tests in 98% of participants and 97% valid ONS for SARS-CoV-2 PCR tests. Study 2 showed successful standardized measurements of BP (97%), weight/height (99%) and DBS and venous blood sampling with onsite whole blood centrifugation (97%). Temperature requirements for centrifugation, cooled transport and ATC-coded medication assessment (Anatomical Chemical Classification) proved challenging and needed revised methods to avoid data loss. Nested validation studies confirmed use of a multiplex assay for various antibodies with DBS and of HbA1c analysis with uncooled specimen. The strict and time-consuming BP self-measurement-protocol with 12 measurements in Study 3 was followed only by 54% of participants. Conclusions Self-sampling and biosampling &amp; examinations in households are feasible options for HES but protocols with high complexity may result in low data completeness.

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.