A pilot study conducted by Brigham investigators found that an innovative care-delivery program helped participants reduce their blood pressure in just seven weeks.
Hypertension, or high blood pressure, affects nearly half of U.S. adults, according to the American Heart Association. Despite the serious consequences that can result from hypertension—which puts patients at an increased risk for heart attacks, strokes and other cardiovascular events—elevated blood pressure often remains untreated or undertreated for years.
Seeing opportunities for improvement, a team of innovators and clinicians at the Brigham developed a new care-delivery program for home use that aims to improve hypertension control rates quickly and at a significantly lower cost than traditional, clinic-based blood pressure programs.
The new approach, piloted with 130 participants, helped 81 percent of patients achieve blood pressure control in, on average, less than two months. The results of the pilot study were published recently in Clinical Cardiology. Patients who enrolled had uncontrolled blood pressure (greater than 140/90) and were recruited from Brigham and Women’s Primary Care Associates, Longwood, and the Watkins Cardiovascular Clinic.
“This is a striking result, especially given the very short time frame in which control was reached,” said Naomi Fisher, MD, director of the Brigham’s Hypertension Service and Hypertension Specialty Clinic. “There are a few notable health care systems that have matched or exceeded this control rate, but most clinical practices do not approach this rate of success.”
To overcome some of the challenges that clinical practices face, Fisher and colleagues combined several innovative strategies to create their program. Participants each received a Bluetooth-enabled blood pressure device that automatically transmits blood pressure measurements—taken by patients at home—into electronic medical records.
In addition, patients had access to “patient navigators”—non-physicians trained to use a clinical algorithm developed by hypertension specialists. The program enabled rapid assessment and medication dosage adjustments for patients. Medication adjustments were made every two weeks until home blood pressure was under 135/85.
The next step will be to test the program’s effectiveness with a larger population. With this approach, the team anticipates significant cost effectiveness and cost savings, in addition to the prevention of cardiovascular events and death from treating hypertension more intensively in men and women.
“The time-honored model of treating hypertension via traditional visits to the doctor is neither effective nor sustainable,” said Fisher. “Organizations can and should develop and adopt innovative technologies to create sustainable solutions for hypertension control.”
This work was supported by an institutional Brigham Care Redesign Incubator and Startup Program (BCRISP) award.