title: Check it, change it: a community-based, multifaceted intervention to improve blood pressure control.
abstract: BACKGROUND
  Although home blood pressure (BP) monitoring interventions have shown potential in selected populations, it is unclear whether such strategies can be generalized. We sought to determine whether a multifaceted BP control program that uses a web-based health portal (Heart360), community health coaches, and physician assistant guidance could improve hypertension control in a diverse community setting.
  
  
  RESULTS
  Between September 12, 2010, and November 11, 2011 Check It, Change It, a community-based hypertension quality improvement program, enrolled 1756 patients with hypertension from 8 clinics in Durham County, NC. The Check It, Change It community intervention was evaluated using a prepost study design without a concurrent control. Participants were stratified into 3 tiers according to their initial BP: tier 0 (BP <140/90 mm Hg)=51% of population, tier 1 (BP=140/90-159/99 mm Hg)=30% of total, and tier 2 (BP ≥159/99 mm Hg)=19% of total. Overall, median age was 59 years (interquartile range, 49-69), 67% were female, and 76% black. After 6 months, the mean overall systolic BP declined 4.7 mm Hg. Rates of achieving target BP control (<140/90) increased overall from 51% at baseline to 63% by 6 months, and 69% had either reached their BP target or had reduced their baseline systolic BP by 10 mm Hg or more.
  
  
  CONCLUSIONS
  A multicomponent-tiered hypertension program was associated with improved BP control in a diverse community-based population.
authors.affiliation: From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.). kevin.thomas@duke.edu.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Thomas
authors.affiliation: From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.).
authors.forename: Bimal R
authors.initials: BR
authors.lastname: Shah
authors.affiliation: From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.).
authors.forename: Sharon
authors.initials: S
authors.lastname: Elliot-Bynum
authors.affiliation: From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.).
authors.forename: Kristin D
authors.initials: KD
authors.lastname: Thomas
authors.affiliation: From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.).
authors.forename: Katrina
authors.initials: K
authors.lastname: Damon
authors.affiliation: From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.).
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Allen LaPointe
authors.affiliation: From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.).
authors.forename: Sarah
authors.initials: S
authors.lastname: Calhoun
authors.affiliation: From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.).
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.affiliation: From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.).
authors.forename: Khadijah
authors.initials: K
authors.lastname: Breathett
authors.affiliation: From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.).
authors.forename: Robin
authors.initials: R
authors.lastname: Mathews
authors.affiliation: From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.).
authors.forename: Monique
authors.initials: M
authors.lastname: Anderson
authors.affiliation: From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.).
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.affiliation: From the Department of Medicine, Duke University, Durham, NC (K.L.T., B.R.S., R.M., M.A., R.M.C., E.D.P.); Duke Clinical Research Institute, Durham, NC (K.L.T., B.R.S., K.D.T., N.M.A.L., S.C., L.T., R.M., M.A., R.M.C., E.D.P.); Healing with CAARE, Inc, Durham, NC (S. E.-B., K.D.); Duke Translational Medicine Institute, Durham, NC (R.M.C.); Department of Medicine, Ohio State University, Columbus, OH (K.B.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000592:standards*; D019058:Community Networks; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009017:Morbidity / Q000639:trends; D058996:Quality Improvement; D012111:Residence Characteristics; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: blood pressure; hypertension; quality improvement; residence characteristics; self blood pressure monitoring