Community Hypertension Screening and Care Referral With Blood Pressure-Measuring Kiosks, Digital Education Modalities, and Text Messages.
Community Hypertension Screening and Care Referral With Blood Pressure-Measuring Kiosks, Digital Education Modalities, and Text Messages.
复制标题
通过血压测量亭、数字教育方式和短信进行社区高血压筛查和护理转介。
DOI：
10.1093/ajh/hpab157
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发表时间：
2022
影响因子：
3.2
通讯作者：
Plante,TimothyB
中科院分区：
文献类型：
--
作者：
Hines,AnikaL;Plante,TimothyB
高血压是心血管疾病（CVD）的主要可改变原因，影响46%的美国成年人。在美国，高血压每年的社会成本为1310亿美元，在所有疾病中，高血压占残疾调整生命年的最大比例。3，4降血压药物是廉价、安全、耐受性好、经过验证的治疗方法，可大大降低与高血压相关的心血管疾病风险。尽管高血压的个人和社会成本，在美国的血压控制是糟糕透顶。估计有4000万成年人的血压≥ 140/90 mm Hg，其中1300万人不知道他们患有高血压。在美国，高血压患病率、控制不足和并发症的负担在某些亚组中不成比例。例如，美国黑人成年人的高血压患病率是美国任何群体中最高的，发病较早，控制较差，因此比白色美国成年人遭受更多的CVD事件。8，9在高血压患者中降低心血管疾病风险的关键第一步是识别个体血压升高，并提供关于使用降压药物治疗高血压临床护理重要性的教育。血压测量亭通常在美国的药店，购物中心和杂货店中找到，可以在几分钟内提供测量。有一个明显的机会，使用这些设备，也教育用户和转介那些血压升高的护理。在最新一期的《美国高血压杂志》上，Steven Shea博士和他的同事报告了零售店健康亭高血压试验（ROKHYT）的试验结果。10本可行性试验入组了140名通过电子邮件注册的商业自动血压测量亭成人用户，在研究开始前一年内进行了≥ 2次测量，其中1次必须在入组后90天内进行，体重< 300 lbs。在使用信息亭时，该设备显示的血压测量值按美国心脏病学会/美国心脏协会（ACC/AHA）2017年指南中定义的血压水平组进行分类（例如，血压< 120/80 mm Hg为正常血压，血压≥ 180/90 mm Hg为高血压危象）。建议那些有高血压危象的人立即通过信息亭寻求治疗。在来自美国各地的2,000名注册信息亭用户中，177人提供了同意书，140人最终随机接受干预或常规治疗。干预组接受了多方面的干预。电子传递的教育内容涵盖了与血压升高、降压药物的使用、饮食和高血压管理中的运动相关的主题，以及有关获得护理和坚持治疗的详细信息。该组的参与者还与互动短信联系，其中包括他们最近的BP测量结果的副本。先前亭测量的BP高于ACC/AHA 2017第2阶段高血压阈值（140/90 mm Hg）的患者通过短信被建议寻求高血压治疗，并在2周内返回亭测量的BP，对于那些没有返回重复测量的人，提醒消息。在重复测量时，他们报告了他们是否看到临床医生来管理高血压。先前BP< 140/90 mm Hg的参与者收到了与BP优化和BP临床管理作用相关的教育短信。干预组的参与者还被要求在1个月时在一个亭进行重复血压测量，然后在3、6和12个月时再次进行。普通的护理组没有收到任何...
Hypertension is a major modifiable cause of cardiovascular disease (CVD) that affects 46% of US adults. 1, 2 Its annual societal costs in the United States are $131 billion and among all diseases, hypertension contributes to the greatest proportion of disability-adjusted life years. 3, 4 Blood pressure (BP) lowering medications are inexpensive, safe, well-tolerated, proven therapeutics that greatly reduce the CVD risk related to hypertension. 5 Despite the personal and societal costs of hypertension, BP control in the United States is abysmal. An estimated 40 million adults have BP≥ 140/90 mm Hg, of which 13 million are unaware that they have hypertension. 6, 7 The burden of hypertension prevalence, inadequate control, and complications are disproportionate among certain subgroups in the United States. For example, Black US adults have the highest hypertension prevalence of any group in the United States, with earlier onset, poorer control, and consequently suffer more CVD events than White US adults. 8, 9 A critical first step in reducing CVD risk among those with hypertension is identification of elevated BP in individuals and providing education about the importance of clinical care of hypertension with BP-lowering medications. BP measurement kiosks are commonly found in pharmacies, shopping centers, and grocery stores in the United States and can provide a measurement in a few moments. There is an obvious opportunity to use these devices to also educate users and refer those with elevated BP toward care. In the current issue of the American Journal of Hypertension, Dr Steven Shea and colleagues report the results of the pilot for the Retail Outlet Health Kiosk Hypertension Trial (ROKHYT). 10 This feasibility trial enrolled 140 email-registered adult users of a commercial, automated BP measurement kiosk with≥ 2 measurements in the year prior to study initiation, 1 of which had to be within 90 days of enrollment, with weight< 300 lbs. At the time of kiosk use, the device presents BP measurements classified in BP-level groups as defined in the American College of Cardiology/American Heart Association (ACC/AHA)-led2017 guidelines (eg, normal BP for BP< 120/80 mm Hg, hypertensive crisis for BP≥ 180/90 mm Hg). Those with hypertensive crisis are advised to seek immediate care by the kiosk.Of the 2,000 registered kiosk users from across the United States invited to participate, 177 provided consent and 140 were ultimately randomized to either intervention or usual care. The intervention group received a multifaceted intervention. Electronically delivered educational content covered topics related to elevated BP, the use of BP-lowering medications, diet, and exercise in hypertension management, and details about accessing care and adherence to therapies. Participants in this group were also contacted with interactive text messages that included a copy of their most recent BP measurement. Those with prior kiosk-measured BP above the ACC/AHA 2017 stage 2 hypertension threshold (140/90 mm Hg) were advised via text messages to seek care for treatment of high BP and return for a kiosk-measured BP in 2 weeks, with reminder messages for those who did not return for repeat measurement. At that repeat measurement, they reported if they saw a clinician for management of high BP. Participants with prior BP< 140/90 mm Hg received educational text messages related to BP optimization and the role of clinical management of BP. Participants in the intervention group were also asked to follow-up at a kiosk at 1 month for a repeat BP measurement, then again at 3, 6, and 12 months. The usual care group did not receive any …