Abstract 16873: Check It Change It: A Community Based Hypertension Program

Abstract

Background: Hypertension (HTN) affects approximately one in three people in the US, yet less than half have their blood pressure (BP) controlled to guideline recommendations. While interventions that engage patients in their home environment have shown potential, it is unclear whether such strategies can be generalized to diverse community settings.

Objective: To determine if an integrated, remote BP monitoring program utilizing a web-based health portal (Heart360®), community health coaches, and physician assistant (PA)- guided management can improve HTN control in a community.

Methods and Intervention: Check It, Change It (CICI) enrolled HTN patients from 8 clinics in Durham County, NC between 12/09/2010 and 11/11/2011. Participants were stratified after a 6-week BP monitoring period into 3 tiers: Tier 0 (BP <140/90 mmHg), Tier 1 (BP 140/90-159/99 mmHg), and Tier 2 (BP >160/100 mmHg). Tier 0 individuals received automated reminders for web-based remote BP monitoring and education. Tier 1 received tier 0 resources plus PA-directed BP management. Tier 2 received tier 0 and 1 resources plus community health coaching, inclusive of a home visit for detailed risk assessment.

Main outcome measures: 1) Proportion of participants with either a final BP <140/90 mmHg or ≥10 mmHg drop in SBP after 6 months of intervention, 2) Changes in SBP and DBP at 6 months.

Results: We enrolled 1,784 patients in CICI. Median age was 60 yrs. (IQR 50, 70), 66% female, and 76% black. At baseline, 873 (49.3%) participants had a BP <140/90 mmHg and by 6 months, 74% of participants either reached a BP <140/90 mmHg or had a ≥10 mmHg reduction in SBP. Overall, mean SBP (4.8 mmHg) and DBP (2.5 mmHg) decreased. Tier 1 persons had a 9.1 and 4.9 mmHg mean decrease in SBP and DBP, respectively, while Tier 2 individuals had a mean decrease of 23.6 mmHg (SBP) and 10.2 mmHg (DBP). At program conclusion, 34.2% of initial Tier 2 and 50.6% of Tier 1 participants’ BP decreased to <140/90.

Conclusion: The CICI program utilizing a web-based portal, in conjunction with access to remote monitoring, community health workers, and PA’s decreased BP in a diverse community-based setting. Our findings support the IOM multidisciplinary model recommendations for care to improve community-level BP.