Self-blood pressure monitoring in an urban, ethnically diverse population: a randomized clinical trial utilizing the electronic health record.
BACKGROUND
Hypertension is a leading risk factor for cardiovascular disease. Although control rates have improved over time, racial/ethnic disparities in hypertension control persist. Self-blood pressure monitoring, by itself, has been shown to be an effective tool in predominantly white populations, but less studied in minority, urban communities. These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with limited resources.


RESULTS
The New York City Health Department in partnership with community clinic networks implemented a randomized clinical trial (n=900, 450 per arm) to investigate the effectiveness of self-blood pressure monitoring in medically underserved and largely black and Hispanic participants. Intervention participants received a home blood pressure monitor and training on use, whereas control participants received usual care. After 9 months, systolic blood pressure decreased (intervention, 14.7 mm Hg; control, 14.1 mm Hg; P=0.70). Similar results were observed when incorporating longitudinal data and calculating a mean slope over time. Control was achieved in 38.9% of intervention and 39.1% of control participants at the end of follow-up; the time-to-event experience of achieving blood pressure control in the intervention versus control groups were not different from each other (logrank P value =0.91).


CONCLUSIONS
Self-blood pressure monitoring was not shown to improve control over usual care in this largely minority, urban population. The patient population in this study, which included a high proportion of Hispanics and uninsured persons, is understudied. Results indicate these groups may have additional meaningful barriers to achieving blood pressure control beyond access to the monitor itself.


BACKGROUND
http://clinicaltrials.gov. Unique Identifier: NCT01123577.
From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY. stella.yi@nyumc.org.
Stella S
SS
Yi
From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY.
Bahman P
BP
Tabaei
From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY.
Sonia Y
SY
Angell
From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY.
Anne
A
Rapin
From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY.
Michael D
MD
Buck
From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY.
William G
WG
Pagano
From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY.
Frank J
FJ
Maselli
From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY.
Alvaro
A
Simmons
From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY.
Shadi
S
Chamany
D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D057286:Electronic Health Records; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000208:ethnology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010353:Patient Education as Topic; D011237:Predictive Value of Tests; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013997:Time Factors; D016896:Treatment Outcome; D014504:Urban Health / Q000208:ethnology*; D035862:Vulnerable Populations / Q000208:ethnology*
D000959:Antihypertensive Agents
blood pressure monitoring; clinical trial; hypertension; lifestyle; population