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

描述（申请人提供）：6500万美国人被诊断患有高血压（HTN）。尽管诸如JNC 7之类的临床指南广为传播，控制血压的药物的可用性，以及从业人员认识到血压（BP）控制可以降低发病率和死亡率，但绝大多数HTN患者（4000万）仍未得到控制。导致血压控制率低的因素与提供者、患者和医疗保健系统有关。提供者接受高于既定治疗目标的血压，不建议改变生活方式，不能滴定药物。患者可能不按医嘱服药，可能不去看医生，可能不记得医生的建议，也可能不遵守改变生活方式的建议。医疗保健系统促进了分散、不协调的护理，这导致了昂贵、低效、不方便的办公室就诊，因此经常被患者错过。为了改善血压控制，我们建议通过开发虚拟高血压诊所“v-HTN”来解决这三个方面的问题。本提案的主要目的是：1)开发“v-HTN”，一个全面的基于互联网的、符合HIPAA的虚拟高血压诊所，结合治疗算法、家庭血压监测和定制的、针对患者的咨询和支持干预；2)采用可用性和可接受性的方法，包括在学习和使用软件程序时进行深入访谈，以及两组焦点小组：3)根据反馈对方案进行细化，并重新测试方案的可行性。如果这个虚拟高血压诊所成功并广泛实施，血压控制率将会提高，心血管发病率和死亡率将会下降，高血压治疗的成本将会降低。

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.