Self-management of blood pressure medication for hypertensive veterans

对退伍军人医疗的预期影响：高血压是最常见的医疗问题 在美国退伍军人中。治疗是可行和有效的，但控制率保持在75%以下。而当 传统上，血压控制是通过连续就诊和药物治疗来实现的 提供者在基于办公室的护理、自我监控和自我管理期间发起的变化 降压药物是一项重要的战略，将使退伍军人取得更好的成就 控制血压。更好的高血压治疗系统对健康的影响是 显著减少，包括心血管疾病和肾脏疾病的发病率下降。 项目背景：来自英国的最新文献(TASMINH2和Tasmin-SR试验)已经 提示患者主导的降压药自我管理在 实现高血压控制，但如何将这些发现应用于美国仍然存在问题 人口。VA Healthcare System是测试和定制此功能的理想系统 治疗血压的策略。 项目目标： 我们建议解决以下简单而有力的临床研究问题： 患者是否主动使用预先指定的、可推广的血压药物进行自我管理 剂量递增方案临床有效、安全、患者和临床医生可接受的比较 在高血压退伍军人中控制血压的常规护理？ 项目方法：我们提出了一项为期12个月的随机、对照、非盲单中心研究。 患者自主血压药物的自我管理与常规护理的比较 通过病历进行研究队列随访。干预手臂的参与者将被提供 家用血压监测工具及其换血自我管理算法 必要时服用加压药物。接受常规护理的参与者将接受家庭监护 初级保健提供者提供的工具和典型的高血压护理。原发性血压 这项研究的结果衡量标准将是临床血压的组间变化。 可接受性、安全性、以患者为中心的结果和依从性将是关键的次要结果。

Anticipated Impact on Veterans’ Healthcare: Hypertension is the most common medical problem among US Veterans. Treatment is available and effective, but control rates remain under 75%. While blood pressure control has traditionally been achieved through sequential visits and medication changes initiated by providers during office-based care, self-monitoring and self-management of blood pressure medication is an important strategy that would empower Veterans to achieve better control of blood pressure. The health impacts of better systems for treatment of hypertension are significant, including decreased rates of cardiovascular and kidney disease. Project background: Recent literature from the UK (TASMINH2 and TASMIN-SR trials) have suggested that patient-driven self-management of blood pressure medications can be effective in achieving hypertension control, but questions remain as to how to apply these findings to a US population. The VA Healthcare System is an ideal system in which to test and customize this strategy for blood pressure treatment. Project objectives: We propose to address the following simple and powerful clinical research question: Is patient-initiated self-management of blood pressure medication using a pre-specified, generalizable dose escalation scheme clinically effective, safe, and acceptable to patients and clinicians, compared to usual care in controlling blood pressure in hypertensive veterans? Project methods: We propose a 12-month randomized, controlled, non-blinded, single-center study of patient-initiated self-management of blood pressure medication vs. usual care with planned post- study cohort follow-up via medical records. Participants in the intervention arm will be provided with home blood pressure monitoring tools and a self-management algorithm for changing their blood pressure medications as needed. Participants in the usual care arm will receive home monitoring tools and typical hypertension care from the primary care provider. The primary blood pressure outcome measure for the study will be between-group change in in-clinic blood pressure. Acceptability, safety, patient-centered outcomes and adherence will be key secondary outcomes.