Project Details
Description
PROJECT ABSTRACT
Over 100 million US adults have hypertension, the number one chronic disease risk factor in the world. The
United States Preventive Services Task Force and the 2017 American College of Cardiology/American Heart
Association blood pressure (BP) guidelines recommends measuring BP outside of the clinic for the diagnosis
and management of hypertension. Home blood pressure monitoring (HBPM) involves self-measurement of BP
by the patient and is the most common method for assessing out-of-office BP in the US. The guideline
recommendations are based on high-quality observational studies in which out-of-office BP was typically
obtained at a single point and individuals with high out-of-office BP were observed to have higher rates of
cardiovascular outcomes and increased rates of all-cause mortality, regardless of office BP levels. Additionally,
clinical trials have demonstrated that HBPM reduces clinic BP over short 6-12 month time frames, especially
when combined with disease management programs. There are no studies evaluating the effectiveness of
HBPM in routine clinical practice in a diverse population from across the country. Additionally, there are a lack
of data on: a) whether use of HBPM reduces risk for clinical outcomes; b) the impact of HBPM on both short-
and long-term clinic BP, clinical inertia, and medication adherence in routine clinical practice; and c) how
clinicians and patients utilize HBPM. Over the last ~10 years, approximately 400,000 Veterans have measured
home BPs as part of the VA’s telehealth program. We propose to identify Veterans age 18-90 years with
uncontrolled clinic BP enrolled in HBPM programs and a cohort of Veterans not enrolled in HBPM programs.
We will link telehealth data to clinical and outcome data. The proposal will make use of the large number of
patients enrolled in the VA’s HBPM program and the variation in how the HBPM program is implemented
across VA sites. In Aim 1, we will evaluate the effect of HBPM on major adverse cardiovascular events, non-
cancer mortality, and adverse events. In Aim 2, we will assess the impact of HBPM on clinic BP, BP
medication intensification, and medication adherence. In Aim 3, we will determine facility-, provider-, and
patient-level factors associated with use of HBPM in routine practice. Results will establish a) the long-term
benefits of HBPM, b) the association between HBPM and clinical events, and c) the effects in important
subgroups. These findings will inform selection of patients for and the design of a much-needed randomized
controlled trial evaluating the effect of HBPM on clinical outcomes compared to office-based hypertension
management. Additionally, identifying factors associated with greater reductions in BP and greater number of
home BP values transmitted, such as case management programs, may identify barriers to adherence that can
be addressed and inform implementation strategies and the use of HBPM in clinical practice. The proposed
study will answer questions critically important to implementation of HBPM in routine clinical practice with the
ultimate goal of reducing the morbidity and mortality associated with hypertension.
Status | Active |
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Effective start/end date | 6/1/22 → 5/31/24 |
Funding
- National Heart, Lung, and Blood Institute: $494,258.00
- National Heart, Lung, and Blood Institute: $471,886.00
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