Home Blood Pressure Telemonitoring and Case Management to Control Hypertension

描述(申请人提供)：高血压影响了近7000万美国人，有效控制了不到一半的人。由于无法控制的高血压是导致中风、充血性心力衰竭、肾脏疾病和心肌梗死的主要原因，开发具有成本效益和可扩展的高血压控制策略已被确定为国家的当务之急。NHLBI资助的随机超级链接试验(家庭血压远程监测和病例管理以控制高血压)开发和实施了一种非常有效但简单的两步非办公室血压控制策略：(A)患者在家中使用远程监护仪测量血压，远程监护仪将血压数据存储并通过电话调制解调器以电子方式传输给药剂师；(B)在定期电话访问中，药剂师建议患者坚持用药和生活方式，并根据与初级保健医生的合作实践协议调整降压药治疗。这一简单的策略现在已经在一项随机试验中得到了严格的评估，在随机试验中，它使在登记后6个月和12个月实现并保持血压控制的患者的比例翻了一番(常规护理组为31.4%，干预组为58.5%，P=.0002)。在12个月的随访中，干预组与常规护理组相比，收缩压降低了11 mm Hg(P&lt；0.0001)，舒张压降低了5 mm Hg(P=0.02)。这项建议的目的是延长对450名参加超级链接干预和常规护理小组的患者的随访，以实现三个具体目标：(A)提供关于长期耐用性的新数据；(B)评估超级链接干预的成本效益；以及(C)使用混合方法来确定成功实施干预和将干预转化为实践的关键因素。所有患者将被邀请参加两次研究诊所访问，在入选后36个月、48个月和60个月测量血压。扩展的数据将包括对体重指数、抗高血压治疗和依从性的系列评估、家庭血压监测的使用、对医疗护理的满意度以及对临床心血管事件的监测。长期的健康影响和成本效益将使用直接观察的措施和最先进的心血管事件和治疗成本的微观模拟预测模型来量化。焦点小组和对研究对象、药剂师和卫生系统利益相关者的半结构化访谈将提供关于1)优化干预的成功交付，以及2)转化为临床实践的战略和障碍的额外视角。这些结果将填补至关重要的知识空白，并为以下方面提供实用信息 实施这种可扩展和有效的新护理模式的成本和好处，这种模式为改善数百万患有无法控制的高血压的美国人的结局带来了巨大的希望。

DESCRIPTION (provided by applicant): Hypertension affects nearly 70 million Americans, and is effectively controlled in less than half. Because uncontrolled hypertension is a leading cause of stroke, congestive heart failure, renal disease, and myocardial infarction, development of cost-effective and scalable hypertension control strategies has been identified as an urgent national priority. The NHLBI-funded randomized HyperLink trial (Home Blood Pressure Telemonitoring and Case Management to Control Hypertension) has developed and implemented a very effective yet simple two-step non-office-based blood pressure (BP) control strategy: (a) patients measured BP at home using telemonitors that stored and electronically transmitted BP data to a pharmacist via a telephone modem, (b) In periodic telephone visits, pharmacists advised patients on medication adherence and lifestyle, and adjusted antihypertensive therapy under a collaborative practice agreement with primary care physicians. This simple strategy has now been rigorously evaluated in a randomized trial in which it doubled the proportion of patients who achieved and maintained BP control at both 6 and 12 months following enrollment (31.4% in usual care and 58.5% in the intervention group, P=.0002). It achieved systolic BP 11 mm Hg lower (P<0.0001) and diastolic BP 5 mm Hg lower (P=0.02) in the intervention group compared to the usual care group at 12-month follow-up. The purpose of this proposal is to extend follow-up of the 450 patients enrolled in the HyperLink intervention and usual care groups to achieve three specific aims: (a) provide new data on the long-term durability (b) assess the cost-effectiveness of the Hyperlink intervention, and (c) use mixed methods to identify critical factors for delivering the intervention successfully and translating i into practice. All patients will be invited to attend two research clinic visits to measure BP at tme points 36, 48, and 60 months following enrollment. Extended data will include serial assessments of BMI, antihypertensive treatment and adherence, use of home BP monitoring, satisfaction with medical care, and surveillance for clinical cardiovascular events. Long-term health impact and cost-effectiveness will be quantified using directly observed measures and state-of-the-art microsimulation prediction modeling of cardiovascular events and treatment costs. Focus groups and semi- structured interviews with study subjects, pharmacists, and health system stakeholders will provide additional perspectives on 1) optimizing successful delivery of the intervention, and 2) on strategies and barriers for translation into clinical practce. These results will fill critically important knowledge gaps and provide practical information about the costs and benefits of implementing a this scalable and effective new care model that holds great promise for improving outcomes for millions of Americans with uncontrolled hypertension.