Home Blood Pressure Management and Improved Blood Pressure Control

Bosworth, Hayden B.; Powers, Benjamin; Olsen, Maren K.; McCant, Felicia; Grubber, Janet M.; Smith, Valerie A.; Gentry, Pamela; Rose, Cynthia M.; Houtven, Courtney Harold Van; Wang, Virginia; Goldstein, Mary K.; Oddone, Eugene Z.

doi:10.1001/archinternmed.2011.276

Cited by 215 publications

(272 citation statements)

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“…This null finding was as a result of an improvement in A1c levels for both the control and intervention arms, and a lack of improvement in SBP values for either arm, and occurred despite our intervention having previously shown efficacy for BP in an academic setting 10,24 and similar interventions having shown efficacy for A1c in other academic settings. This result leads to the question of whether the intervention failed to translate to the community setting because of differences inherent in the complexities of translating interventions to community settings in general or our practices in particular, or because of some other concern.…”

Section: Discussionmentioning

confidence: 73%

“…[6][7][8][9] In these studies, changes in hemoglobin A1c (A1c) levels have reached as high as 1.1 percentage points. [6][7][8][9][10] These studies have been conducted in settings with strong academic affiliations, where intervention delivery can be tightly controlled; the potency of interventions under these ideal settings is generally referred to as "efficacy." In contrast, "effectiveness" refers to the potency of interventions under circumstances close to those that would be experienced in medical practice.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, trials in nurse management of HTN were conducted in similar settings. 10,11 There are no randomized trial data on the effectiveness of behavioral co-management of diabetes and HTN.…”

Section: Introductionmentioning

confidence: 99%

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Nurse-Led Behavioral Management of Diabetes and Hypertension in Community Practices: A Randomized Trial

et al. 2015

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BACKGROUND: Several trials have demonstrated the efficacy of nurse telephone case management for diabetes (DM) and hypertension (HTN) in academic or vertically integrated systems. Little is known about the real-world potency of these interventions. OBJECTIVE: To assess the effectiveness of nurse behavioral management of DM and HTN in community practices among patients with both diseases. DESIGN: The study was designed as a patient-level randomized controlled trial. PARTICIPANTS: Participants included adult patients with both type 2 DM and HTN who were receiving care at one of nine community fee-for-service practices. Subjects were required to have inadequately controlled DM (hemoglobin A1c [A1c]≥ 7.5 %) but could have well-controlled HTN. INTERVENTIONS: All patients received a call from a nurse experienced in DM and HTN management once every two months over a period of two years, for a total of 12 calls. Intervention patients received tailored DM-and HTN-focused behavioral content; control patients received non-tailored, non-interactive information regarding health issues unrelated to DM and HTN (e.g., skin cancer prevention). MAIN OUTCOMES AND MEASURES: Systolic blood pressure (SBP) and A1c were co-primary outcomes, measured at 6, 12, and 24 months; 24 months was the primary time point. RESULTS: Three hundred seventy-seven subjects were enrolled; 193 were randomized to intervention, 184 to control. Subjects were 55 % female and 50 % white; the mean baseline A1c was 9.1 % (SD=1 %) and mean SBP was 142 mmHg (SD=20). Eighty-two percent of scheduled interviews were conducted; 69 % of intervention patients and 70 % of control patients reached the 24-month time point. Expressing model estimated differences as (intervention -control), at 24 months, intervention patients had similar A1c [diff=0.1 %, 95 % CI (−0.3, 0.5), p=0.51] and SBP [diff=−0.9 mmH g, 95% CI (−5.4, 3.5), p=0.68] values compared to control patients. Likewise, DBP (diff=0.4 mmHg, p=0.76), weight (diff=0.3 kg, p=0.80), and physical activity levels (diff=153 MET-min/week, p=0.41) were similar between control and intervention patients. Results were also similar at the 6-and 12-month time points. CONCLUSIONS: In nine community fee-for-service practices, telephonic nurse case management did not lead to improvement in A1c or SBP. Gains seen in telephonic behavioral self-management interventions in optimal settings may not translate to the wider range of primary care settings.

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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Nurse-Led Behavioral Management of Diabetes and Hypertension in Community Practices: A Randomized Trial

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“…5,16 Briefly, this was an 18-month, single-center, randomized controlled trial that allocated 591 veterans into one of three telephone-delivered intervention arms or usual care. The three intervention arms included: (1) nurse-administered, physician-directed medication management; (2) nurse-administered behavioral management; and (3) combined medication and behavioral management.…”

Section: Methodsmentioning

confidence: 99%

Baseline Antihypertensive Drug Count and Patient Response to Hypertension Medication Management

Crowley

Olsen

Woolson

et al. 2015

J of Clinical Hypertension

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Telemedicine-based medication management improves hypertension control, but has been evaluated primarily in patients with low antihypertensive drug counts. Its impact on patients taking three or more antihypertensive agents is not well-established. To address this evidence gap, the authors conducted an exploratory analysis of an 18-month, 591-patient trial of telemedicine-based hypertension medication management. Using general linear models, the effect of medication management on blood pressure for patients taking two or fewer antihypertensive agents at study baseline vs those taking three or more was compared. While patients taking two or fewer antihypertensive agents had a significant reduction in systolic blood pressure with medication management, those taking three or more had no such response. The between-subgroup effect difference was statistically significant at 6 months (À6.4 mm Hg [95% confidence interval, À12.2 to À0.6]) and near significant at 18 months (À6.0 mm Hg [95% confidence interval, À12.2 to 0.2]). These findings suggest that baseline antihypertensive drug count may impact how patients respond to hypertension medication management and emphasize the need to study management strategies specifically in patients taking three or more antihypertensive medications. J Clin Hypertens (Greenwich). 2016;18:322-328. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.Despite widespread recognition that hypertension is a modifiable cardiovascular risk factor, up to half of hypertensive patients have inadequate blood pressure (BP) control.1 Because hypertension causes tremendous morbidity and costs, 2,3 care redesign strategies that can improve BP control are urgently needed. Trials have demonstrated that medication management, which utilizes telemedicine or other strategies to enhance treatment intensification outside the traditional clinic visit, can effectively lower BP vs usual care.4-8 Medication management approaches therefore hold substantial promise as a means of increasing rates of BP control.Many trials of telemedicine-based medication management, however, have focused on patients taking relatively few antihypertensive medications, including two particularly high-impact trials in which patients averaged fewer than two antihypertensive agents at study baseline. 4,8 A recent meta-analysis indicated that, among telemedicine trials reporting the number of prescribed antihypertensive agents, patients took an average of only 1.8 baseline BP medications.9 Therefore, while the value of telemedicine-based medication management for patients with low antihypertensive drug counts is clear, this approach's impact among highercount patients is not established. This evidence gap is problematic, because antihypertensive use continues to increase and the proportion of patients with hypertension requiring three or more BP medications is rising.10-12 This high-count group includes the particularly challenging population meeting criteria for resistant hypertension, 12 a condi...

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“…Studies of self-management support for hypertension in particular tend to show that including a healthcare professional who can adjust medications (or cause them to be adjusted) is an important driver of impact. 2 Particularly for diabetes, where both lifestyle and medication have major contributions, the need for a collaborative approach seems clear. However, it is not clear how to operationalize this partnership.…”

mentioning

confidence: 99%

Capsule Commentary on Baig et al., Picture Good Health: A Church-Based Self-Management Intervention among Latino Adults with Diabetes

Whittle

2015

J GEN INTERN MED

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Home Blood Pressure Management and Improved Blood Pressure Control

Abstract: clinicaltrials.gov Identifier: NCT00237692.

Cited by 215 publications

References 38 publications

Nurse-Led Behavioral Management of Diabetes and Hypertension in Community Practices: A Randomized Trial

Nurse-Led Behavioral Management of Diabetes and Hypertension in Community Practices: A Randomized Trial

Baseline Antihypertensive Drug Count and Patient Response to Hypertension Medication Management

Capsule Commentary on Baig et al., Picture Good Health: A Church-Based Self-Management Intervention among Latino Adults with Diabetes

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