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September 1, 2015The Journal of the American Board of Family MedicineOpen Access

Success in the Achieving CARdiovascular Excellence in Colorado (A CARE) Home Blood Pressure Monitoring Program: A Report from the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP)

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Key result

The A CARE home blood pressure monitoring program significantly reduced office systolic blood pressure by a mean difference of 5.4 mmHg compared to nonparticipants over 1 year.

Why the study?

Does a home blood pressure monitoring program with patient and provider feedback improve blood pressure control in primary care patients with hypertension?

Population

3,578 nonpregnant adults with hypertension or cardiovascular disease risk factors enrolled at 26 urban and…

Comparison

A CARE home blood pressure monitoring program… vs Nonparticipants receiving usual care at the same…

Design

Cohort

Follow-up

average of 368 days

Authors

LDLauren DeAlleaumeColorado School of Public HealthBPB. ParnesUniversity of Colorado Anschutz Medical CampusLZLinda ZittlemanUniversity of Colorado Anschutz Medical Campus

Discussion

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Implication

Supports home BP monitoring evaluation in primary care; leaves open need for randomized trials before practice change.

Key Points

  • To evaluate the impact of the A CARE home blood pressure monitoring (HBPM) program with patient and provider feedback on hypertension control in primary care settings.
  • Quasi-experimental study conducted across 26 urban and rural primary care practices enrolling 3,578 nonpregnant adults with hypertension or cardiovascular disease risk factors.
  • Participants received validated home BP monitors, submitted monthly BP averages via phone or Internet, and received provider and patient feedback.
  • Assessed changes in home and office blood pressure and the proportion of patients reaching target blood pressure using patient reports and clinic chart audits over 1 year.
  • Active participants (36% submitting ≥2 reports) achieved a mean home BP reduction of -6.5/-4.4 mmHg overall (P < .001) and -6.7/-4.7 mmHg among patients with diabetes (P < .001).
  • The proportion of active participants meeting target BP increased from 34.5% to 53.3% (P < .001), and from 24.6% to 40.0% in those with diabetes (P < .001).
  • Office BP over 1 year showed a mean difference of -5.4/-2.7 mmHg between participants and nonparticipants (P < .001 systolic, P = .01 diastolic), and -8.5/-1.5 mmHg for those with diabetes (P = .014 systolic, P = .405 diastolic).

Study Design

Type

Observational (n=3,578)

Multicenter

Yes

Structured PICO

Does a home blood pressure monitoring program with patient and provider feedback improve blood pressure control in primary care patients with hypertension?

P
Population
3,578 nonpregnant adults with hypertension or cardiovascular disease risk factors enrolled in a home blood pressure monitoring program across 26 primary care practices.
I
Intervention
A CARE home blood pressure monitoring (HBPM) program: patients were provided validated home BP monitors, asked to measure BP daily, and reported monthly average home BP readings via Internet, phone, or mail. Patients and providers received feedback.
C
Comparator
Nonparticipants receiving usual care at the same primary care practices (assessed via retrospective chart audit).
O
Outcome
Change in average home and office blood pressure and the percentage of patients achieving target blood pressure over approximately 1 year.surrogate

Main Result

Mean Difference: -5.4

Absolute Event Rate: -6.3% vs -0.9%

p-value: p=<0.001

A home blood pressure monitoring program with patient and provider feedback significantly improved blood pressure control in primary care patients compared to usual care.

Limitations

  • Not a randomized controlled trial, introducing potential selection bias by providers.
  • Did not evaluate cardiovascular disease outcomes such as myocardial infarction, stroke, or kidney disease.
  • Did not specifically address the cost-effectiveness of the program.
  • Unable to compare home blood pressure readings among participants with a control group.
  • Not a randomized controlled trial
  • Potential selection bias by providers choosing patients more likely to comply
  • Unable to compare home BP readings with control patients
  • Did not evaluate hard cardiovascular outcomes
  • Did not assess cost-effectiveness

Cite This Study

DeAlleaume et al. (2015) conducted an observational in Hypertension (n=3,578). Home blood pressure monitoring (HBPM) program vs. Nonparticipants (usual care) was evaluated on Mean difference in office systolic blood pressure over 1 year (MD -5.4 mmHg, p=<0.001). The A CARE home blood pressure monitoring program significantly reduced office systolic blood pressure by a mean difference of 5.4 mmHg compared to nonparticipants over 1 year.

synapsesocial.com/papers/6a79ac124c448619ca0dd60dhttps://doi.org/10.3122/jabfm.2015.05.150024

Topics

Hypertension management
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Also Consider

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