Targeted support program to improve blood pressure

RESTON, Virginia, May 14, 2022 — A nurse-led blood pressure program that included patient education and patient management support. high blood pressure helped participants take their blood pressure medications regularly and have fewer episodes of uncontrolled high blood pressure, according to preliminary research to be presented to the American Heart Association Scientific Research Sessions on Quality of Care and Outcomes 2022. The meeting will be held Friday and Saturday, May 13-14, 2022 in Reston, Va., and will feature the latest research focused on the quality of cardiovascular medical care and patient outcomes in the treatment and prevention of heart disease and stroke. cerebrovascular.

“Our local population in the Bronx is predominantly black and Hispanic, and high blood pressure, type 2 diabetes, and cardiovascular risk factors are prevalent throughout our community. Controlling high blood pressure is especially important in reducing the prevalence of these health problems,” said study co-author Masood A. Shariff, MD, a researcher at Lincoln Hospital, New York City Health and Hospitals in the Bronx, a borough of New York. York. “Two years ago we launched a targeted treatment program for people with uncontrolled high blood pressure to receive care at a specialist clinic within our outpatient care center, and we have found that this approach was successful in helping participants. better manage your blood pressure.”

The goal of the program was to get more people to reach a target blood pressure of 120/80 mm Hg, as recommended by the American Heart Association/American College of Cardiology Guidelines. To measure the program’s success, researchers identified more than 2,700 people in an outpatient clinic who had uncontrolled high blood pressure above 130/80 mm Hg or who had been started on a new blood pressure medication at the start of the study period. Each participant’s medical records for the two years before (August 2017 to October 2018) the targeted intervention and two years after (January 2019 to March 2020) the start of the special program were reviewed. The participants were on average 61 years old; 57% were women; 70% identified as Hispanic; and 25% of participants identified as black.

The support program consisted of nurses who worked closely with study participants to track their blood pressure history from a diary kept by each person and to assess whether they were taking their medications as prescribed and whether the medications were working to manage their blood pressure. Other healthcare professionals provided study participants with information and support to cope with lifestyle changes, such as salt intake and weight loss, to improve nutrition and health. increase physical activity.

Nurses were able to communicate with participants in a more personalized and frequent way than doctors are able to provide in a regular outpatient setting such as a doctor’s office or clinic. At the start of the program, participants returned in three weeks for a visit to the clinic with a blood pressure nurse, compared to the usual three months for a visit to a doctor. Visits once every three weeks continued as medications were adjusted, and although this was more frequent early in the program, researchers found that over the two years fewer visits were necessary because of the number of incidences of uncontrolled hypertension. decreases.

The analysis found:

  • Because people could control their high blood pressure, they didn’t need to come to the clinic as often. The average number of clinic visits decreased by 31% among study participants – from more than five visits during the two-year pre-intervention period to approximately three visits during the treatment period to the target.
  • The mean number of uncontrolled high blood pressure readings among all participants increased from three before the intervention to two incidences after the targeted program.
  • Mean systolic blood pressure (upper number) fell by 7.6 mm Hg (to 135.5 mm Hg) in the target treatment group.

“Before the Treat-to-Target program, it took a lot longer to control a person’s blood pressure. Doctors usually only see patients every three to six months, and sometimes it takes multiple visits to get the right drug dosages. And if a person doesn’t take their meds or takes them wrong, it’s not effective if we don’t see them until six months later,” Shariff said. “In the targeted treatment program, if a person’s blood pressure was not controlled, they would be seen sooner by a blood pressure nurse who could consult with the doctor and make medication adjustments quickly, which resulted in fewer visits and better blood flow control of pressure on program participants.

The researchers said the program also helped identify the reasons why some people were unable to control their blood pressure or did not take their medications as prescribed. Issues that may have affected some people included language barriers, lack of awareness of the importance of taking medication on a daily basis, or the importance of follow-up visits. Regular communication with the blood pressure nurse has solved some of these issues.

“We believe implementing this targeted program with the blood pressure nurse made a big difference,” said Mohammad Faiz, MD, study co-author and internal medicine specialist at Lincoln Medical. Center in the Bronx, New York. “The use of a multi-faceted team approach, particularly in a primary care setting, which means that nursing, nutrition and social work staff work closely with physicians to resolve medical issues and others, is key to reaching blood pressure goals.Through a team approach, we were able to provide care well before three to six months after starting medication, and the reinforcement of healthy eating, checking blood pressure every day, checking to make sure the medications are taken correctly has really made a difference.

The researchers noted that given the burden of high blood pressure, type 2 diabetes, and cardiovascular risk among black and Hispanic populations, more blood pressure counseling, screening, monitoring, and support is needed. important.

“We know that pre-existing social conditions, such as access to quality health care, employment, education and housing, influence differences in the health status of individuals and communities. The American Heart Association works with community health centers and community organizations across the country through the National Hypertension Control Initiative (NHCI), an evidence-based initiative to manage blood pressure and reduce poor health outcomes for people from disproportionately affected racial and ethnic groups,” said Eduardo Sanchez, MD, MPH, FAHA, FAAFP, Chief Medical Officer of the American Heart Association for Prevention and Chief Investigator for NHCI. “Targeted approaches to ensuring appropriate blood pressure measurement, monitoring both at home and in a health care setting, and developing a plan with each individual to reduce high blood pressure are important components. initiative and proven ways to effectively manage blood pressure.”

The researchers said a limitation of the study is that the same study participants had previously participated in high blood pressure treatment through the outpatient clinic, although these encounters were not as personalized. They also noted that individual interaction and working styles may differ from nurse to nurse and that some approaches may have been more effective than others.

Co-authors are Iqra Arshad, MD; Julio A. Ovalle Ramos, MD; Matthew R. Ding, BS; Rakeshkumar Mistry, MD; and Maria Espejo, MD Author disclosures are listed in the abstract.

The authors reported no outside funding for this study.

REMARK: The presentation time for this oral abstract is 8:42 a.m. ET, Saturday, May 14, 2022.

Statements and conclusions of studies presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect the policy or position of the Association. The Association makes no representations or warranties as to their accuracy or reliability. Abstracts presented at the Association’s Scientific Meetings are not peer-reviewed, but rather by independent review committees and are considered based on the potential to add to the diversity of scientific issues and viewpoints discussed. during a meeting. Results are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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Ryan H. Bowman