Physician non-intensification of treatment for elevated home blood pressure due to 'acceptable' levels was associated with a lower incidence of repeat alerts (HR 0.69; 95% CI 0.58-0.83).
Cohort (n=296)
Does an intervention alert for elevated home blood pressure lead to treatment intensification in patients undergoing hypertension telemanagement?
Failure to intensify treatment in response to elevated home blood pressure alerts may represent good clinical judgment rather than clinical inertia when blood pressure is close to acceptable thresholds.
Effect estimate: HR 0.69 (95% CI 0.58 to 0.83)
Clinical inertia represents a barrier to hypertension management. As part of a hypertension telemanagement trial designed to overcome clinical inertia, we evaluated study physician reactions to elevated home blood pressures. We studied 296 patients from the Hypertension Intervention Nurse Telemedicine Study who received telemonitoring and study physician medication management. When a patient's 2-week mean home blood pressure was elevated, an "intervention alert" prompted study physicians to consider treatment intensification. We examined treatment intensification rates and subsequent blood pressure control. Patients generated 1216 intervention alerts during the 18-month intervention. Of 922 eligible intervention alerts, study physicians intensified treatment in 374 (40.6%). Study physician perception that home blood pressure was acceptable was the most common rationale for nonintensification (53.7%). When "blood pressure acceptable" was the reason for not intensifying treatment, the mean blood pressure was lower than for intervention alerts where treatment intensification occurred (135.3/76.7 versus 143.2/80.6 mm Hg; P<0.0001). Blood pressure acceptable intervention alerts were associated with the lowest incidence of repeat alerts (hazard ratio: 0.69 95% CI: 0.58 to 0.83), meaning that the patient home blood pressure was less likely to subsequently rise above goal, despite apparent clinical inertia. This telemedicine intervention targeting clinical inertia did not guarantee treatment intensification in response to elevated home blood pressures. However, when physicians did not intensify treatment, it was because blood pressure was closer to an acceptable threshold, and repeat blood pressure elevations occurred less frequently. Failure to intensify treatment when home blood pressure is elevated may, at times, represent good clinical judgment, not clinical inertia.
Crowley et al. (Tue,) conducted a cohort in Hypertension (n=296). Telemedicine intervention alerts for elevated home blood pressure was evaluated on Incidence of repeat alerts when blood pressure was deemed acceptable (HR 0.69, 95% CI 0.58 to 0.83). Physician non-intensification of treatment for elevated home blood pressure due to 'acceptable' levels was associated with a lower incidence of repeat alerts (HR 0.69; 95% CI 0.58-0.83).