January 1, 2018Open Access

Measure Accurately, Act Rapidly, and Partner With Patients (MAP) improves hypertension control in medically underserved patients: Care Coordination Institute and American Medical Association Hypertension Control Project Pilot Study results

Q: What is the clinical evidence from this study?

Study design: Other. Population: hypertension (n=714). Intervention: Measure Accurately, Act Rapidly, and Partner With Patients (MAP) protocol vs. Baseline. Primary outcome: BP control to <140/<90 mm Hg (p=<.0001).

Key Result

The Measure Accurately, Act Rapidly, and Partner With Patients (MAP) protocol improved blood pressure control (<140/<90 mm Hg) from 61.2% at baseline to 89.9% (P<.0001).

Structured PICO

Does the MAP protocol improve hypertension control in medically underserved patients?

Population

714 medically underserved patients with hypertension evaluated before and during a 6-month intervention.

Intervention

Measure Accurately, Act Rapidly, and Partner With Patients (MAP) protocol, including unattended automated office BP measurement, intensification of antihypertensive medications, BP self-monitoring, reducing pill burden, and minimizing medication costs over a 6-month period.

Comparator

Baseline (pre-intervention) care.

Outcome

Blood pressure control to <140/<90 mm Hg at the last study visit.surrogate

Implementation of the MAP protocol significantly improved hypertension control from 61.2% to 89.9% in a medically underserved clinic population over 6 months.

Main Result

Absolute Event Rate: 89.9% vs 61.2%

p-value: p=<.0001

Abstract

Measure Accurately, Act Rapidly, and Partner With Patients (MAP) is an evidence-based protocol implemented to improve hypertension control in a clinic for underserved patients (49.9% Medicaid and 50.2% black). Patients with hypertension seen during the year before intervention and with at least one visit during the 6-month intervention (N = 714) were included. If initial attended blood pressure (BP; standard aneroid manometer) was ≥140/≥90 mm Hg, unattended automated office BP was measured in triplicate and averaged (Measure Accurately) using an Omron HEM-907XL. When automated office BP was ≥140/≥90 mm Hg, Act Rapidly included intensification of antihypertensive medications, assessed by therapeutic inertia. Partner With Patients included BP self-monitoring, reducing pill burden, and minimizing medication costs, which was assessed by systolic BP change per therapeutic intensification. Between baseline and the last study visit, BP control to <140/<90 mm Hg increased from 61.2% to 89.9% (P < .0001). MAP rapidly and significantly improved hypertension control in medically underserved patients, largely as a result of measuring BP accurately and partnering with patients.