Web-Based BP-Lowering Initiative Works in Diverse Population

Marlene Busko

October 31, 2014

DURHAM, NC — The "Check It, Change It " internet-based blood-pressure–control program conducted here in 2010–2011 was successful in improving blood-pressure levels in a diverse outpatient population, ranging from the well-insured and tech-savvy to homeless, computer-illiterate individuals[1].

With 6 months of program participation, the percentage of patients with controlled blood pressure rose from 51% to 63%, and average systolic blood pressure dropped by 14.5 mm Hg in the patients with hypertension.

"This community-based program successfully integrated healthcare providers, [the American Heart Association's] Heart360 [web-based tracking tool], and remote monitoring to engage, empower, and assist a distinct group of community residents to achieve better hypertension control, with the biggest impact on those with the most poorly controlled hypertension," Dr Kevin L Thomas (Duke University, Durham, NC) and colleagues report in a study published online October 28, 2014 in Circulation: Cardiovascular Quality and Outcomes.

"We think multidisciplinary collaborations such as Check It, Change It can serve as a potential model for community-based chronic disease management moving forward," they note, adding that the model could be improved by incorporating other options for patients without a computer.

Testing a BP-Lowering Program in a "Real-World" Community

Previous successful pharmacist- or nurse-led programs involving home blood-pressure monitoring and web-based tools were generally studied in tech-savvy patients with full insurance coverage, according to the researchers.

The current study enrolled 1756 diverse patients from five primary-care and cardiology "traditional" clinics, a private nephrology clinic, a safety-net clinic, and a free clinic in a homeless shelter.

The patients had a median age of 60 and a mean blood pressure of 138/81 mm Hg; 66% were female, and 76% were black.

Many had no health insurance (16%) or high school certificate (22%) and had never accessed the internet (37%). About half had previously checked their own blood pressure, and four in 10 owned a BP-monitoring device.

Participants had access to kiosks located in convenient places, such as churches, beauty salons, libraries, and community centers, where they could measure their blood pressure and then upload the readings to Heart360.

Based on their initial blood-pressure readings, they were divided into three groups: normal blood pressure (<140/90 mm Hg), low-risk (140–159/90–99 mm Hg; 30% of patients), and high-risk (>159/99 mm Hg; 19% of patients).

All patients were asked to enter their blood-pressure readings in Heart360 every 2 weeks for 6 months, and they received email reminders.

Low-risk patients obtained behavioral and lifestyle tips from a physician assistant who could also adjust antihypertensive medications. High-risk patients also received at least one home visit from a community health coach to identify any barriers to treatment.

Over the 6 months, the percentage of black patients with normal blood pressure increased from 49% to 62%, and the percentage of Medicaid and uninsured patients with normal blood pressure rose from about 35% to 51%.

However, patients only entered an average 6.5 blood-pressure readings in Heart360, and only 11% entered more than 12 readings. Poor compliance was largely due to difficulties accessing a computer or the internet.

"By the end of the study, it was apparent that a digital divide existed among many of the elderly patients and those individuals with financial hardship that inhibited their ability to master the processes necessary for web-based monitoring," Thomas and colleagues write. Many participants preferred providing blood-pressure readings over the phone.

Future interventions should consider providing a blood-pressure cuff to high-risk participants and adding an automated telephone system that participants could use to log their BP readings, they suggest.

Check It, Change It was developed in collaboration with the American Heart Association and Durham Health Innovations and was completed with a sponsorship from Novartis. Thomas reports he has no relevant financial relationships. Disclosures for the coauthors are listed in the article.

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