scholarly journals Reproducibility of masked uncontrolled hypertension detected through home blood pressure monitoring

2019 ◽  
Vol 21 (7) ◽  
pp. 877-883
Author(s):  
Jessica Barochiner ◽  
María Lourdes Posadas Martínez ◽  
Rocío Martínez ◽  
Diego Giunta
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
Uncontrolled Hypertension ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring

Abstract P167: Leveraging The Electronic Health Records System And Home Blood Pressure Monitoring To Optimize Blood Pressure Control

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Elizabeth H Kim ◽  
Eric Luong ◽  
Trevor Trung Nguyen ◽  
Sandy Castillo ◽  
Joseph E Ebinger ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Electronic Health Records ◽  
Blood Pressure Monitoring ◽  
Standard Of Care ◽  
Home Blood Pressure ◽  
Uncontrolled Hypertension ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Health Records ◽  
Age And Sex

Background: Home blood pressure monitoring (HBPM) devices can now be linked to electronic health records (EHR) systems in ways that could be used to facilitate blood pressure (BP) management; however, their potential feasibility and utility remain unclear. Methods: For our pilot study, we identified N=5 outpatients with uncontrolled hypertension and implemented use of a HBPM device with frequent monitoring and direct linkage to the EHR, whereby real-time data was made available to treating providers. We matched our intervention patients by age and sex with N=50 patients who also had uncontrolled hypertension and underwent standard-of-care treatment. We assessed change over time in BP measures for the intervention and standard-of-care groups. Results: In analyses accounting for differences in the timing and frequency of BP measurements, we observed that the intervention compared to the standard-of-care group had an average systolic BP at 8 weeks that was lower in percent change from baseline (β=-22 mm Hg, P=0.008). We also found a difference between baseline and 8-week systolic BP within the intervention group (mean difference -25.9 mm Hg, P=0.024). Conclusions: In our pilot, intensive remote HBPM appeared to improve BP levels over the short term. While unblinded and not controlled for factors beyond age and sex, this pilot demonstrates feasibility of an EHR-linked HBPM intervention and potential efficacy that may be related to increased patient as well as provider awareness translating to greater patient-provider engagement around hypertension management. More studies are needed to validate and expand from our findings.

scholarly journals A prospective cohort study of home blood pressure monitoring based on an intelligent cloud platform (the HBPM-iCloud study): rationale and design

2020 ◽  
Vol 11 ◽  
pp. 204062232093310
Author(s):  
Hailan Zhu ◽  
Xiaoyan Liang ◽  
Xiong-Fei Pan ◽  
Chunyi Huang ◽  
Jian Kuang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chinese Population ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
Uncontrolled Hypertension ◽  
Home Blood Pressure Monitoring ◽  
Cloud Platform ◽  
Pressure Monitoring ◽  
Telemedicine Technology

Background: Hypertension, as a predominant risk factor for cardiovascular disease, is a severe public health burden in China. Home blood pressure monitoring (HBPM) is an important tool in the detection and management of hypertension. However, there is a lack of HBPM data from prospective cohorts in China. Hence, we designed this study to investigate the impact of HBPM on major health outcomes in Chinese population participating in regular health check-ups. Methods: Leveraging telemedicine technology, the open prospective, multicenter, HBPM-iCloud (Home Blood Pressure Monitoring Based on an Intelligent Cloud Platform) cohort study will recruit participants from three participating health check-up centers in southern China to participate in cloud-based HBPM for 1 week. The prevalence of sustained hypertension, white coat hypertension (WCH), masked hypertension (MH), white coat uncontrolled hypertension (WUCH), and masked uncontrolled hypertension (MUCH) will be defined by a combination of average readings of home-based and office-based blood pressure (BP). Cardiovascular risk factors and subclinical target organ damage will be recorded. Participants will be followed-up for 5 years to examine the incidence and associated risk factors of composite major adverse cardiovascular and cerebrovascular event. Conclusion: The study will help to determine the best way to implement telemedicine technology in BP control for better prevention and treatment of hypertension. Results will provide data for a Chinese population to aid in the construction of screening, risk stratification, and intervention strategies for abnormal BP phenotypes, including WCH, MH, WUCH, and MUCH.

scholarly journals Understanding the Feasibility, Acceptability, and Efficacy of a Clinical Pharmacist-led Mobile Approach (BPTrack) to Hypertension Management: Mixed Methods Pilot Study

10.2196/19882 ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. e19882
Author(s):  
Lorraine R Buis ◽  
Dana N Roberson ◽  
Reema Kadri ◽  
Nicole G Rockey ◽  
Melissa A Plegue ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pilot Study ◽  
Clinical Pharmacist ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
Uncontrolled Hypertension ◽  
Hypertension Management ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring

Background Hypertension is a prevalent and costly burden in the United States. Clinical pharmacists within care teams provide effective management of hypertension, as does home blood pressure monitoring; however, concerns about data quality and latency are widespread. One approach to close the gap between clinical pharmacist intervention and home blood pressure monitoring is the use of mobile health (mHealth) technology. Objective We sought to investigate the feasibility, acceptability, and preliminary effectiveness of BPTrack, a clinical pharmacist-led intervention that incorporates patient- and clinician-facing apps to make electronically collected, patient-generated data available to providers in real time for hypertension management. The patient app also included customizable daily medication reminders and educational messages. Additionally, this study sought to understand barriers to adoption and areas for improvement identified by key stakeholders, so more widespread use of such interventions may be achieved. Methods We conducted a mixed methods pilot study of BPTrack, to improve blood pressure control in patients with uncontrolled hypertension through a 12-week pre-post intervention. All patients were recruited from a primary care setting where they worked with a clinical pharmacist for hypertension management. Participants completed a baseline visit, then spent 12 weeks utilizing BPTrack before returning to the clinic for follow-up. Collected data from patient participants included surveys pre- and postintervention, clinical measures (for establishing effectiveness, with the primary outcome being a change in blood pressure and the secondary outcome being a change in medication adherence), utilization of the BPTrack app, interviews at follow-up, and chart review. We also conducted interviews with key stakeholders. Results A total of 15 patient participants were included (13 remained through follow-up for an 86.7% retention rate) in a single group, pre-post assessment pilot study. Data supported the hypothesis that BPTrack was feasible and acceptable for use by patient and provider participants and was effective at reducing patient blood pressure. At the 12-week follow-up, patients exhibited significant reductions in both systolic blood pressure (baseline mean 137.3 mm Hg, SD 11.1 mm Hg; follow-up mean 131.0 mm Hg, SD 9.9 mm Hg; P=.02) and diastolic blood pressure (baseline mean 89.4 mm Hg, SD 7.7 mm Hg; follow-up mean 82.5 mm Hg, SD 8.2 mm Hg; P<.001). On average, patients uploaded at least one blood pressure measurement on 75% (SD 25%) of study days. No improvements in medication adherence were noted. Interview data revealed areas of improvement and refinement for the patient experience. Furthermore, stakeholders require integration into the electronic health record and a modified clinical workflow for BPTrack to be truly useful; however, both patients and stakeholders perceived benefits of BPTrack when used within the context of a clinical relationship. Conclusions Results demonstrate that a pharmacist-led mHealth intervention promoting home blood pressure monitoring and clinical pharmacist management of hypertension can be effective at reducing blood pressure in primary care patients with uncontrolled hypertension. Our data also support the feasibility and acceptability of these types of interventions for patients and providers. Trial Registration ClinicalTrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.8059

scholarly journals Knowledge and practice of home blood pressure monitoring 6 months after the risk and assessment management programme: does health literacy matter?

2021 ◽  
pp. postgradmedj-2020-139329
Author(s):  
Sau Nga FU ◽  
Man Chi Dao ◽  
Carlos K H Wong ◽  
Bernard M Y Cheung
Keyword(s):  
Blood Pressure ◽  
Health Literacy ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
Management Programme ◽  
Uncontrolled Hypertension ◽  
Care Practice ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Adequate Health Literacy

BackgroundLittle is known whether patients with lower health literacy could retain the practice and knowledge of home blood pressure monitoring (HBPM) after an educational programme.MethodsA cluster randomised controlled trial in five primary care clinics recruited participants with uncontrolled hypertension. Clinics were randomised either to a HBPM group education (Risk Assessment and Management Programme (RAMP-group), or individual counselling of self-management (RAMP-individual). Health literacy was assessed by the Chinese Health Literacy Scale for Chronic Care. Practice and knowledge of HBPM were surveyed by a 10-item HBPM knowledge checklist and patient record review 6 months after interventions. Predictors for regular HBPM and good HBPM knowledge were assessed by multivariate logistic regression models.Results287 participants (RAMP-group: 151; RAMP-individual: 136) were follow-up for 6 months. 272 participants completed the knowledge questionnaires (response rate 94.8%). 67.8% of the participants performed HBPM regularly, and there was no statistical difference between both interventions. Age more than 65 (adjusted odds ratios (aOR) 2.58, 95% CI 1.37 to 4.86, p=0.003), not working (aOR 2.34, 95% CI 1.10 to 4.97, p=0.027)and adequate health literacy (aOR 2.25, 95% CI 1.28 to 3.95, p=0.005) predicted regular HBPM. Participants in RAMP-group demonstrated a significant lower body weight than those in RAMP-individual (−0.3±2.0 kg vs +0.7 ±1.7 kg, p<0.001).The RAMP-group participants were eight times more likely to have full HBPM knowledge score than the RAMP-individual participants (aOR 8.46, 95% CI 4.68 to 15.28, p<0.001).ConclusionPatients could retain HBPM knowledge better after RAMP-group than RAMP-individual. Older, retired and patients with adequate health literacy were more likely to continue weekly HBPM 6 months after education.Trial registration numberNCT02551393.

scholarly journals Understanding the Feasibility, Acceptability, and Efficacy of a Clinical Pharmacist-led Mobile Approach (BPTrack) to Hypertension Management: Mixed Methods Pilot Study (Preprint)

2020 ◽  
Author(s):  
Lorraine R Buis ◽  
Dana N Roberson ◽  
Reema Kadri ◽  
Nicole G Rockey ◽  
Melissa A Plegue ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pilot Study ◽  
Clinical Pharmacist ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
Uncontrolled Hypertension ◽  
Hypertension Management ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring

BACKGROUND Hypertension is a prevalent and costly burden in the United States. Clinical pharmacists within care teams provide effective management of hypertension, as does home blood pressure monitoring; however, concerns about data quality and latency are widespread. One approach to close the gap between clinical pharmacist intervention and home blood pressure monitoring is the use of mobile health (mHealth) technology. OBJECTIVE We sought to investigate the feasibility, acceptability, and preliminary effectiveness of BPTrack, a clinical pharmacist-led intervention that incorporates patient- and clinician-facing apps to make electronically collected, patient-generated data available to providers in real time for hypertension management. The patient app also included customizable daily medication reminders and educational messages. Additionally, this study sought to understand barriers to adoption and areas for improvement identified by key stakeholders, so more widespread use of such interventions may be achieved. METHODS We conducted a mixed methods pilot study of BPTrack, to improve blood pressure control in patients with uncontrolled hypertension through a 12-week pre-post intervention. All patients were recruited from a primary care setting where they worked with a clinical pharmacist for hypertension management. Participants completed a baseline visit, then spent 12 weeks utilizing BPTrack before returning to the clinic for follow-up. Collected data from patient participants included surveys pre- and postintervention, clinical measures (for establishing effectiveness, with the primary outcome being a change in blood pressure and the secondary outcome being a change in medication adherence), utilization of the BPTrack app, interviews at follow-up, and chart review. We also conducted interviews with key stakeholders. RESULTS A total of 15 patient participants were included (13 remained through follow-up for an 86.7% retention rate) in a single group, pre-post assessment pilot study. Data supported the hypothesis that BPTrack was feasible and acceptable for use by patient and provider participants and was effective at reducing patient blood pressure. At the 12-week follow-up, patients exhibited significant reductions in both systolic blood pressure (baseline mean 137.3 mm Hg, SD 11.1 mm Hg; follow-up mean 131.0 mm Hg, SD 9.9 mm Hg; <i>P</i>=.02) and diastolic blood pressure (baseline mean 89.4 mm Hg, SD 7.7 mm Hg; follow-up mean 82.5 mm Hg, SD 8.2 mm Hg; <i>P</i>&lt;.001). On average, patients uploaded at least one blood pressure measurement on 75% (SD 25%) of study days. No improvements in medication adherence were noted. Interview data revealed areas of improvement and refinement for the patient experience. Furthermore, stakeholders require integration into the electronic health record and a modified clinical workflow for BPTrack to be truly useful; however, both patients and stakeholders perceived benefits of BPTrack when used within the context of a clinical relationship. CONCLUSIONS Results demonstrate that a pharmacist-led mHealth intervention promoting home blood pressure monitoring and clinical pharmacist management of hypertension can be effective at reducing blood pressure in primary care patients with uncontrolled hypertension. Our data also support the feasibility and acceptability of these types of interventions for patients and providers. CLINICALTRIAL ClinicalTrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584 INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.8059

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