Development of an implementation-ready antihypertensive self-titration intervention to improve US blood pressure control

近二分之一的美国成年人患有高血压，这是心肌梗死的主要原因， 中风和死亡尽管高血压的重要性和广泛的可用性 在药物治疗方面，2018年只有44%的患者控制了血压。这是 部分原因是我们提供护理的方式，需要新的战略来实现更好的 血压控制。由非医生进行药物滴定的团队护理是一种 这是一个很有前途的办法，但所需的费用和基础设施使这一选择不太可行。一个 另一种策略是让患者通过检查血液自行管理高血压 压力，并遵循患者和初级保健医生之间预先计划的算法， 在家里加强药物治疗尽管有证据表明它的有效性和成本- 由于这种方法的有效性，它尚未被纳入常规护理。 在这个项目中，我们建议开发一种易于实施的抗高血压自我滴定 通过定性访谈和抗高血压药物的真实评估了解干预措施 坚持。建议的目标是：（1）探讨实施的障碍和促进因素 常规美国初级保健中抗高血压自我滴定;（2）评估对 抗高血压治疗;和（3）开发一个实施准备抗高血压自我- 滴定方案，执行可用性测试，并准备一个务实的，随机的 测试干预措施的有效性。该项目的首要目标是开发一个 创新的高血压护理替代模式，有可能改善血液 压力控制、患者自我效能和疾病理解 博士哈夫是一个执业初级保健医生致力于研究的职业生涯，以改善 心脏代谢疾病的预防和治疗，该提案包括培训计划 这将加速她在实施科学、定性和定量领域的职业发展， 方法，卫生服务研究方法和科学写作。导师团队由 Niteesh Choudhry是卫生服务研究和实施科学方面的专家， 心脏代谢疾病，包括预防心脏病学的知名专家（Paul Ridker，co- 导师），生物统计学（罗伯特格林，共同导师），和实施科学和定性 方法（凯伦埃蒙斯，共同导师），并将确保成功完成拟议的 项目和培训。在这个项目结束时，哈夫博士将能够独立地 设计、瞄准和评估心脏代谢疾病的干预措施。的结果 建议的K23将是计划中的R 01级应用的宝贵试验工作。

Nearly 1 in 2 US adults has hypertension, and it is a leading cause of myocardial infarction, stroke, and death. Despite the importance of hypertension and the widespread availability of medication treatment, only 44% of patients had controlled blood pressures in 2018. This is in part due to the way in which we deliver care, and new strategies are needed to achieve better blood pressure control. Team-based care with medication titration by a non-physician is a promising approach, but the cost and infrastructure required make this option less feasible. An alternative strategy is to have patients self-manage their own hypertension by checking blood pressures and following an algorithm, pre-planned between the patient and primary care doctor, to intensify their medications at home. Despite evidence for the effectiveness and cost- effectiveness of this approach, it has not yet been incorporated into routine care. In this project, we propose to develop an implementation-ready antihypertensive self-titration intervention informed by qualitative interviews and real-world assessments of antihypertensive adherence. The proposed aims are to: (1) explore barriers and facilitators to the implementation of antihypertensive self-titration in routine US primary care; (2) assess adherence to antihypertensive treatments; and (3) develop an implementation-ready antihypertensive self- titration protocol, perform usability testing, and prepare a proposal for a pragmatic, randomized trial to test the intervention’s effectiveness. The overarching goal of the project is to develop an innovative alternative model of hypertension care that has the potential to improve blood pressure control, patient self-efficacy, and disease understanding Dr. Haff is a practicing primary care physician committed to a career in research to improve the prevention and treatment of cardiometabolic disease, and this proposal includes a training plan that will accelerate her career development in the areas of implementation science, qualitative methods, health services research methods, and scientific writing. The mentorship team, led by Niteesh Choudhry, an expert in health services research and implementation science related to cardiometabolic disease, includes well-known experts in preventive cardiology (Paul Ridker, co- mentor), biostatistics (Robert Glynn, co-mentor), and implementation science and qualitative methods (Karen Emmons, co-mentor), and will ensure successful completion of the proposed project and training. By the conclusion of this program, Dr. Haff will be able to independently design, target, and evaluate interventions for cardiometabolic disease. The results of the proposed K23 will be invaluable pilot work for a planned R01-level application.