Evaluation of Integrating Self Blood Pressure Monitoring Into Urban Primary Care Practices

NCT ID: NCT01123577

Last Updated: 2012-08-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

899 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-05-31

Study Completion Date

2012-08-31

Brief Summary

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Background:

Hypertension (HTN) is a major risk factor for cardiovascular disease (CVD), the leading cause of death in the United States and New York City (NYC). One in 4 NYC adults has hypertension, with higher prevalence in both Blacks and Latinos compared to Whites (Angell 2008). In NYC, only 65% of all adults with HTN and on treatment are controlled (Angell 2008).

Self-blood pressure monitoring (SBPM) is associated with reduced blood pressure in patients with hypertension (Cappuccio 2004). Studies suggest that SBPM may increase control either by inducing clinicians to titrate medication more actively, (Agency for Healthcare Research and Quality 2002) by engaging patients to participate in their own health care, (Taylor 2007) or a combination of the two.

However, minimal research has been done to evaluate the effectiveness of SBPM in different racial and/or ethnic groups or in low income populations or to discern effective patterns of SBPM use by patients. Best practices for integration of self monitoring into HTN into regular treatment have also yet to be established.

Objectives:

The goal of this study is to assess the impact of SBPM under conditions consistent with existing community health clinic resources and infrastructure in NYC's medically underserved neighborhoods using commonly available automated home BP monitors. By using a community clinic's electronic health record (EHR) and automated BP monitors with the capability to transmit readings to a research database, we can facilitate a more rigorous evaluation of a pilot SBPM intervention and assess patterns of home monitor use and clinical management and their association with outcomes.

The three specific aims of this intervention are to:

1. Assess whether use of SBPM reduces elevated BP and increases HTN control to similar levels in two historically understudied minority populations, Blacks and Latinos.
2. Confirm pilot findings by assessing the impact of SBPM on BP and HTN control compared to usual care using randomized controlled trial methodology.
3. Develop standards and refine guidance for the effective use of SBPM that can be easily communicated to key stakeholders.

Detailed Description

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Conditions

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Hypertension Cardiovascular Disease

Keywords

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Self Blood Pressure Monitoring SBPM Randomized Control Trial Hypertension (HTN) Cardiovascular Disease (CVD) HTN CVD

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Intervention

Group Type EXPERIMENTAL

Home Blood Pressure Monitor Group

Intervention Type OTHER

Participants receive home monitors, modems, educational materials and training. Participants will send home BP readings to research database monthly and receive usual care by providers for 9 months.

Control

Participants receive usual care by providers.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Home Blood Pressure Monitor Group

Participants receive home monitors, modems, educational materials and training. Participants will send home BP readings to research database monthly and receive usual care by providers for 9 months.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adult patients attending one of the participating primary care clinics
* Diagnosis of hypertension for at least 6 months
* Ethnicity or Race of Latino, Black or White
* Physically and mentally able to monitor BP at home
* \*Uncontrolled BP at last office visit
* \*Uncontrolled BP at current office visit

Note: \*Uncontrolled BP is defined as systolic BP ≥ 140 and/or diastolic BP ≥ 90, or systolic BP ≥ 130 and/or diastolic BP ≥ 80 mm Hg for participants with chronic kidney disease or diabetes.

Exclusion Criteria

* Arm circumference greater than 17.5 inches (maximum size of large BP cuff)
* Already monitoring BP at home at request of health care provider
* No access to a land line telephone line (to upload home readings)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Robert Wood Johnson Foundation

OTHER

Sponsor Role collaborator

NYU Langone Health

OTHER

Sponsor Role collaborator

Riverdale Family Practice, New York City

UNKNOWN

Sponsor Role collaborator

Heritage Health Center (HHHNYC), New York City

UNKNOWN

Sponsor Role collaborator

New York City Department of Health and Mental Hygiene

OTHER_GOV

Sponsor Role lead

Responsible Party

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Stella Yi

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Lutheran Family Health Centers

Brooklyn, New York, United States

Site Status

New York City Department of Health and Mental Hygiene

New York, New York, United States

Site Status

Heritage Health Care

New York, New York, United States

Site Status

Riverdale Family Practice

The Bronx, New York, United States

Site Status

Countries

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United States

References

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Cappuccio FP, Kerry SM, Forbes L, Donald A. Blood pressure control by home monitoring: meta-analysis of randomised trials. BMJ. 2004 Jul 17;329(7458):145. doi: 10.1136/bmj.38121.684410.AE. Epub 2004 Jun 11.

Reference Type BACKGROUND
PMID: 15194600 (View on PubMed)

Angell SY, Garg RK, Gwynn RC, Bash L, Thorpe LE, Frieden TR. Prevalence, awareness, treatment, and predictors of control of hypertension in New York City. Circ Cardiovasc Qual Outcomes. 2008 Sep;1(1):46-53. doi: 10.1161/CIRCOUTCOMES.108.791954.

Reference Type BACKGROUND
PMID: 20031787 (View on PubMed)

Taylor JR, Campbell KM. Home monitoring of glucose and blood pressure. Am Fam Physician. 2007 Jul 15;76(2):255-60.

Reference Type BACKGROUND
PMID: 17695570 (View on PubMed)

Agency for Healthcare Research and Quality. Utility of Blood Pressure Monitoring Outside the Clinic Setting: Agency for Healthcare Research and Quality; 2002.

Reference Type BACKGROUND

Yi SS, Tabaei BP, Angell SY, Rapin A, Buck MD, Pagano WG, Maselli FJ, Simmons A, Chamany S. Self-blood pressure monitoring in an urban, ethnically diverse population: a randomized clinical trial utilizing the electronic health record. Circ Cardiovasc Qual Outcomes. 2015 Mar;8(2):138-45. doi: 10.1161/CIRCOUTCOMES.114.000950. Epub 2015 Mar 3.

Reference Type DERIVED
PMID: 25737487 (View on PubMed)

Other Identifiers

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PCIP-CVD-ESBPM2010

Identifier Type: -

Identifier Source: org_study_id