Key result
Providing a home blood pressure monitor in the preoperative setting resulted in a 73% rate of 60-day primary care follow-up, compared to 71% with brief counseling alone.
Why the study?
This pilot study sought to assess the feasibility of a randomized blood pressure intervention trial in the preoperative clinic and determine baseline rates of primary care follow-up.
Does home blood pressure monitoring added to brief counseling improve primary care follow-up and hypertension treatment modification in preoperative patients with elevated blood pressure?
RCT (n=100)
Open-label
1:1 stratified by gender
No
Does home blood pressure monitoring added to brief counseling improve primary care follow-up and hypertension treatment modification in preoperative patients with elevated blood pressure?
Absolute Event Rate: 73% vs 71%
A preoperative hypertension screening and counseling initiative is feasible and well-accepted, but adding home blood pressure monitoring did not clearly demonstrate a large incremental benefit in 60-day primary care follow-up rates.
Adding home BP monitoring yields no meaningful increase in primary care follow-up; challenges its routine addition to preoperative counseling.
Objectives: This pilot study sought to assess feasibility of a randomized trial of blood pressure intervention (home blood pressure monitoring vs counseling) in the preoperative clinic and the baseline rates of primary care follow-up after such interventions. Methods: A prospective randomized pilot study was performed at Yale New Haven Hospital Preadmission Testing Clinic. A sample of 100 adults with elevated blood pressure, were recruited during their preadmission visit, and randomized 1:1 to receive brief BP counseling and an educational brochure versus additionally receiving a home BP monitor (HBPM) with a mailed report of their home readings. At 60-day post-surgery telephone follow-up, investigators asked whether participants had primary-care follow-up; had new/adjusted hypertension treatment and felt satisfied with the study. Results: There were 51 patients in the counseling group and 49 in the HBPM group. Of 46 patients in the HBPM group who returned their monitors, 36 (78%) were hypertensive at home. At 60 days post-surgery, 31 (61%) patients in the counseling group and 30 (61%) in the HBPM group were reached by telephone with the remaining followed by EMR. 36 (71%) patients in the counseling group and 36 (73%) in the HBPM group had seen their Primary Care provider. 17 of 36 (47%) in the counseling group and 18 of 31 (58%) in the HBPM group received new or adjusted hypertension medications. 61 participants answered questions regarding their satisfaction with the study with 52 (85%) reporting that they felt moderately to very satisfied. Conclusions: This pilot study suggests that interventional blood pressure trials in the preoperative clinic are feasible, but telephone follow-up leads to significant gaps in outcome ascertainment. Trial Registration: Clinicaltrials.gov, NCT03634813. Registered 16 of August 2018, https://clinicaltrials.gov/ct2/show/NCT03634813
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Diaz et al. (2021) conducted an RCT in Hypertension (n=100). Home blood pressure monitor (HBPM) and educational brochure vs. Brief counseling and educational brochure was evaluated on Primary care follow-up 60 days after surgery. Providing a home blood pressure monitor in the preoperative setting resulted in a 73% rate of 60-day primary care follow-up, compared to 71% with brief counseling alone.
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