A Web-Based Intervention, "E-HTN", Improves Blood Pressure Control

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DESCRIPTION (provided by applicant): Sixty-five million Americans have been diagnosed with hypertension (HTN). Despite the widespread dissemination of clinical guidelines such as JNC 7, the availability of medications to control blood pressure, and the recognition by practitioners that blood pressure (BP) control reduces morbidity and mortality, the vast majority of patients with HTN, 40 million, are uncontrolled. Factors that contribute to the poor rate of BP control relate to provider, patient, and the healthcare system. Providers accept blood pressures above established treatment goals, do not recommend lifestyle changes and fail to titrate medications. Patients may not take their medications as prescribed, may miss office visits, may not recall recommendations and may not adhere to advice on issues of lifestyle change. The healthcare system promotes fragmented, uncoordinated care, which leads to an office visit that is expensive, inefficient, inconvenient, and thus often missed by the patient. To improve blood pressure control, we propose to address all three areas with the development of a virtual hypertension clinic, "v-HTN". The primary aims of this proposal are 1) to develop "v-HTN", a comprehensive internet-based, HIPAA- compliant virtual hypertension clinic, incorporating treatment algorithms, home BP monitoring, and customized, patient-specific counseling and support interventions, 2) to employ usability and acceptability methodologies, including in-depth interviews while learning and using the software program, as well as focus groups, in two groups: patients and providers, and 3) to refine the program based on the feedback and to then retest the feasibility. If this virtual hypertension clinic is successful and widely implemented, blood pressure control rates will increase, cardiovascular morbidity and mortality will decline, and the cost of hypertension care will be reduced.