Improving blood pressure control: results of home-based post-acute care interventions

J Gen Intern Med. 2011 Mar;26(3):280-6. doi: 10.1007/s11606-010-1525-4. Epub 2010 Oct 13.

Abstract

Background: Blood pressure (BP) control remains elusive for many Americans. Although home health nurses are uniquely positioned to help vulnerable individuals achieve BP control, hypertension (HTN) management has not been a high priority in post-acute care.

Objective: To examine the effects of two home-based interventions designed to improve BP outcomes among high-risk African-American patients.

Design: Cluster randomized controlled trial.

Participants: A total of 845 newly admitted patients with uncontrolled HTN (JNC7 stages 1 or 2).

Interventions: The "basic" intervention delivered key HTN information to clinicians and patients, and a home BP monitor to patients, while the patients received usual post-acute care. The "augmented" intervention provided more intensive and extensive HTN information, monitoring and feedback for 3 months beyond the index home care admission.

Measures: Primary: BP control. Secondary: reductions in mmHG SBP and DBP, improvements in proportions improving JNC7 stage or achieving clinically meaningful reductions in SBP and DBP.

Methods: Multivariate regression models.

Key results: The basic intervention produced no significant BP improvements; the augmented intervention significantly improved stage 2 patients' outcomes. Among stage 2 patients, the augmented intervention increased BP control by 8.7 percentage points relative to usual care (8.9% vs. 17.6%; p=0.01), yielded an 8.3 mmHG relative reduction in SBP (p=0.01), and increased the proportion achieving at least a 20 mmHG reduction in SBP by 16.4 percentage points (p=0.01).

Conclusion: Among stage 2 patients, a nurse-led intervention providing additional HTN medication review and patient self-management support during the 3-month post-acute care period yielded significant improvements in 3-month BP control, plus improvements in secondary BP outcomes.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Americans* / ethnology
  • Aged
  • Aged, 80 and over
  • Blood Pressure / physiology*
  • Blood Pressure Monitoring, Ambulatory / standards*
  • Blood Pressure Monitoring, Ambulatory / trends
  • Continuity of Patient Care / standards*
  • Continuity of Patient Care / trends
  • Female
  • Home Care Services / standards*
  • Home Care Services / trends
  • Humans
  • Hypertension / diagnosis*
  • Hypertension / ethnology
  • Hypertension / prevention & control*
  • Male
  • Middle Aged
  • Treatment Outcome