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Home Blood Pressure Outcomes Evaluation Study (HOMESTEAD)

家庭血压结果评估研究 (HOMESTEAD)

基本信息

批准号：
10364199
负责人：
Paul Englund Drawz
金额：
$ 49.43万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-06-01 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10364199
关键词：
Acute Renal Failure with Renal Papillary Necrosis Address Adherence Adult Adverse event Advisory Committees Age American American Heart Association Antihypertensive Agents Blood Pressure Cardiology Cardiovascular system Caring Case Management Case Manager Cessation of life Characteristics Chronic Disease Clinic Clinical Clinical Trials Country Data Diagnosis Disease Management Effectiveness Electrolytes Enrollment Ethnic Origin Evaluation Studies Event Goals Guidelines Home Home Blood Pressure Monitoring Hypertension Individual Knowledge Link Measurement Measures Methods Morbidity - disease rate Nephrology Observational Study Outcome Patient Selection Patients Persons Pharmaceutical Preparations Population Heterogeneity Preventive service Provider Race Randomized Controlled Trials Recommendation Reporting Risk Risk Factors Site Socioeconomic Status Subgroup Time United States Variant Veterans adverse event risk adverse outcome base blood pressure medication blood pressure reduction clinical practice clinical risk cohort college comorbidity design effectiveness evaluation hypertension control implementation strategy improved medication compliance mortality programs routine practice sex telehealth

项目摘要

PROJECT ABSTRACT Over 100 million US adults have hypertension, the number one chronic disease risk factor in the world. The United States Preventive Services Task Force and the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guidelines recommends measuring BP outside of the clinic for the diagnosis and management of hypertension. Home blood pressure monitoring (HBPM) involves self-measurement of BP by the patient and is the most common method for assessing out-of-office BP in the US. The guideline recommendations are based on high-quality observational studies in which out-of-office BP was typically obtained at a single point and individuals with high out-of-office BP were observed to have higher rates of cardiovascular outcomes and increased rates of all-cause mortality, regardless of office BP levels. Additionally, clinical trials have demonstrated that HBPM reduces clinic BP over short 6-12 month time frames, especially when combined with disease management programs. There are no studies evaluating the effectiveness of HBPM in routine clinical practice in a diverse population from across the country. Additionally, there are a lack of data on: a) whether use of HBPM reduces risk for clinical outcomes; b) the impact of HBPM on both short- and long-term clinic BP, clinical inertia, and medication adherence in routine clinical practice; and c) how clinicians and patients utilize HBPM. Over the last ~10 years, approximately 400,000 Veterans have measured home BPs as part of the VA’s telehealth program. We propose to identify Veterans age 18-90 years with uncontrolled clinic BP enrolled in HBPM programs and a cohort of Veterans not enrolled in HBPM programs. We will link telehealth data to clinical and outcome data. The proposal will make use of the large number of patients enrolled in the VA’s HBPM program and the variation in how the HBPM program is implemented across VA sites. In Aim 1, we will evaluate the effect of HBPM on major adverse cardiovascular events, non- cancer mortality, and adverse events. In Aim 2, we will assess the impact of HBPM on clinic BP, BP medication intensification, and medication adherence. In Aim 3, we will determine facility-, provider-, and patient-level factors associated with use of HBPM in routine practice. Results will establish a) the long-term benefits of HBPM, b) the association between HBPM and clinical events, and c) the effects in important subgroups. These findings will inform selection of patients for and the design of a much-needed randomized controlled trial evaluating the effect of HBPM on clinical outcomes compared to office-based hypertension management. Additionally, identifying factors associated with greater reductions in BP and greater number of home BP values transmitted, such as case management programs, may identify barriers to adherence that can be addressed and inform implementation strategies and the use of HBPM in clinical practice. The proposed study will answer questions critically important to implementation of HBPM in routine clinical practice with the ultimate goal of reducing the morbidity and mortality associated with hypertension.

项目摘要