Success in the Achieving CARdiovascular Excellence in Colorado (A CARE) Home Blood Pressure Monitoring Program: A Report from the Shared Networks of Colorado Ambulatory Practices and Partners (SNOCAP).
BACKGROUND
Blood pressure (BP) control among primary care patients with hypertension is suboptimal. Home BP monitoring (HBPM) has been shown to be effective but is underused.


METHODS
This study was a quasi-experimental evaluation of the impact of the A CARE HBPM program on hypertension control. Nonpregnant adults with hypertension or cardiovascular disease risk factors were given validated home BP monitors and reported monthly average home BP readings by Internet or phone. Patients and providers received feedback. Change in average home and office BP and the percentage of patients achieving target BP were assessed based on patient HBPM reports and a chart audit of office BPs.


RESULTS
A total of 3578 patients were enrolled at 26 urban and rural primary care practices. Of these, 36% of participants submitted ≥2 HBPM reports. These active participants submitted a mean of 13.5 average HBPM reports, with a mean of 19.3 BP readings per report. The mean difference in home BP between initial and final HBPM reports for active participants was -6.5/-4.4 mmHg (P < .001) and -6.7/-4.7 mmHg (P < .001) for those with diabetes. The percentage of active participants at or below target BP increased from 34.5% to 53.3% (P < .001) and increased 24.6% to 40.0% (P < .001) for those with diabetes. The mean difference in office BP over 1 year between participants and nonparticipants was -5.4/-2.7 mmHg (P < .001 for systolic BP, P = .01 for diastolic BP) for all participants and -8.5/-1.5 mmHg (P = .014 for systolic BP, P = .405 for diastolic BP) for those with diabetes.


CONCLUSIONS
An HBPM program with patient and provider feedback can be successfully implemented in a range of primary care practices and can play a significant role in BP control and decreased cardiovascular disease risk in patients with hypertension.
From the Department of Family Medicine, University of Colorado, Aurora, CO (LD, BP, LZ, CS, RC, WL, MD, JMW); Denver Health, Colorado (LD); College of Public Health and Social Justice, St. Louis University, St. Louis, MO (JB); and Colorado HealthOP (JMW).
Lauren
L
DeAlleaume
From the Department of Family Medicine, University of Colorado, Aurora, CO (LD, BP, LZ, CS, RC, WL, MD, JMW); Denver Health, Colorado (LD); College of Public Health and Social Justice, St. Louis University, St. Louis, MO (JB); and Colorado HealthOP (JMW).
Bennett
B
Parnes
From the Department of Family Medicine, University of Colorado, Aurora, CO (LD, BP, LZ, CS, RC, WL, MD, JMW); Denver Health, Colorado (LD); College of Public Health and Social Justice, St. Louis University, St. Louis, MO (JB); and Colorado HealthOP (JMW). Linda.Zittleman@ucdenver.edu.
Linda
L
Zittleman
From the Department of Family Medicine, University of Colorado, Aurora, CO (LD, BP, LZ, CS, RC, WL, MD, JMW); Denver Health, Colorado (LD); College of Public Health and Social Justice, St. Louis University, St. Louis, MO (JB); and Colorado HealthOP (JMW).
Christin
C
Sutter
From the Department of Family Medicine, University of Colorado, Aurora, CO (LD, BP, LZ, CS, RC, WL, MD, JMW); Denver Health, Colorado (LD); College of Public Health and Social Justice, St. Louis University, St. Louis, MO (JB); and Colorado HealthOP (JMW).
Robert
R
Chavez
From the Department of Family Medicine, University of Colorado, Aurora, CO (LD, BP, LZ, CS, RC, WL, MD, JMW); Denver Health, Colorado (LD); College of Public Health and Social Justice, St. Louis University, St. Louis, MO (JB); and Colorado HealthOP (JMW).
Jackie
J
Bernstein
From the Department of Family Medicine, University of Colorado, Aurora, CO (LD, BP, LZ, CS, RC, WL, MD, JMW); Denver Health, Colorado (LD); College of Public Health and Social Justice, St. Louis University, St. Louis, MO (JB); and Colorado HealthOP (JMW).
William
W
LeBlanc
From the Department of Family Medicine, University of Colorado, Aurora, CO (LD, BP, LZ, CS, RC, WL, MD, JMW); Denver Health, Colorado (LD); College of Public Health and Social Justice, St. Louis University, St. Louis, MO (JB); and Colorado HealthOP (JMW).
Miriam
M
Dickinson
From the Department of Family Medicine, University of Colorado, Aurora, CO (LD, BP, LZ, CS, RC, WL, MD, JMW); Denver Health, Colorado (LD); College of Public Health and Social Justice, St. Louis University, St. Louis, MO (JB); and Colorado HealthOP (JMW).
John M
JM
Westfall
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D003120:Colorado; D055812:Community-Based Participatory Research / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods; D058996:Quality Improvement; D012189:Retrospective Studies; D055815:Young Adult
Community-Based Participatory Research; Hypertension; Practice-based Research; Quality Improvement