Blood pressure 2 years after a chronic disease management intervention study

Abstract

Objectives. To follow blood pressure change over time in participants who had participated in ayear chronic disease management program focused on blood pressure reduction. The expectation was that blood pressure would return back to the baseline once the study was completed. Study design. Prospective, single-arm observational study. Methods. Study participants were Status Indians living on-reserve with type diabetes and persistent hypertension who had participated in the DREAM3 study. Blood pressure was measured with the BpTRU automated device every 6 months for years. The primary endpoint was the change in systolic blood pressure over the follow-up period. Results. Sixty of the original 96 participants agreed to participate in the follow-up. Mean blood pressure at the beginning of the follow-up was 130/76 (SD 18/12) mmHg. Mean blood pressure at the end of the follow-up period was 132/76 (17/9 SD) mmHg. Target blood pressure (<130/80 mmHg) was present in 53%. The 99% confidence limit around change of blood pressure over the months of follow-up was ±.7mmHg. Conclusions. Contrary to expectations, the participants maintained their blood pressure control and did not revert to baseline levels. Community awareness and engagement resulting from the chronic disease management program led to a sustainable improvement in the health parameters of the participants and the community that lasted beyond the duration of the -year DREAM3 project.

Best Practices for the Prevention and Management of Diabetes and Obesity-Related Chronic Disease among Indigenous Peoples in Canada: A Review

“…A number of studies had control arms that received the intervention at staggered times, but the search identified only 1 randomized controlled trial (DREAM3) (53). Ronsley et al (42) state that an RCT would not have been acceptable to the community because of the longstanding relationship that had been established between the researchers and the community.…”

“…Ronsely et al (42) recorded a modest 3% drop in blood pressure postintervention, alongside a 15% increase in high blood pressure in their control group. Tobe et al (53) and Oster et al (46) reported improvements in blood pressure. Toth (45) reported no improvement in blood pressure.…”

“…Only 4 studies included a control group (37,38,42,53). Most of the interventions lasted less than 1 year, and in 1 case, evaluation of the intervention began only 1 week after implementation (40).…”

Improvement of diabetes care in a small but geographically widely spread population in Greenland. Effects of a national diabetes care programme

“…The reduction was demonstrated both in a group where the anti‐hypertensive treatment was adjusted by the home care nurse using a treatment algorithm and in a group with only home care blood pressure monitoring by nurses including follow‐up treatment by a family physician [21]. The positive effect on the blood pressure was sustained 2 years after the end of the intervention [23].…”

The Effectiveness of Text Messaging for Detection and Management of Hypertension in Indigenous People in Canada: Protocol for a Randomized Controlled Trial

“…Our research showed that the implementation of the new model led to significantly better BP control [ 20 ]. Two years after the completion of the DREAM3 study, BP in the treatment arm remained controlled, and BP in the control arm had fallen equal to that of the treatment arm [ 21 ].…”