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Improving Blood Pressure Control: Results of Home-based Post-acute Care Interventions

Journal of General Internal Medicine volume 26, pages 280–286 (2011)Cite this article

Abstract

Background

Blood pressure (BP) control remains elusive for many Americans. Although home health nurses are uniquely positioned to help vulnerable individuals achieve BP control, hypertension (HTN) management has not been a high priority in post-acute care.

Objective

To examine the effects of two home-based interventions designed to improve BP outcomes among high-risk African-American patients.

Design

Cluster randomized controlled trial.

Participants

A total of 845 newly admitted patients with uncontrolled HTN (JNC7 stages 1 or 2).

Interventions

The “basic” intervention delivered key HTN information to clinicians and patients, and a home BP monitor to patients, while the patients received usual post-acute care. The “augmented” intervention provided more intensive and extensive HTN information, monitoring and feedback for 3 months beyond the index home care admission.

Measures

Primary: BP control. Secondary: reductions in mmHG SBP and DBP, improvements in proportions improving JNC7 stage or achieving clinically meaningful reductions in SBP and DBP.

Methods

Multivariate regression models.

Key Results

The basic intervention produced no significant BP improvements; the augmented intervention significantly improved stage 2 patients’ outcomes. Among stage 2 patients, the augmented intervention increased BP control by 8.7 percentage points relative to usual care (8.9% vs. 17.6%; p = 0.01), yielded an 8.3 mmHG relative reduction in SBP (p = 0.01), and increased the proportion achieving at least a 20 mmHG reduction in SBP by 16.4 percentage points (p = 0.01).

Conclusion

Among stage 2 patients, a nurse-led intervention providing additional HTN medication review and patient self-management support during the 3-month post-acute care period yielded significant improvements in 3-month BP control, plus improvements in secondary BP outcomes.

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Figure 1

Notes

  1. A standard concern in experiments with longitudinal follow-up is the potentially biasing effects of sample attrition. Multivariate results comparing patients lost to follow-up with those for whom complete data were obtained using baseline characteristics revealed no evidence of attrition bias in this sample.

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Acknowledgements

This work was supported by grant R01 HL078585 from the National Heart, Lung and Blood Institute (NHLBI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, And Blood Institute or the National Institutes of Health. The authors wish to acknowledge the significant contributions of the intervention staff involved in this project: Paula Wilson, Nicole Fraser and Sharon Browne-Isles and the programming support provided by Sridevi Sridharan.

Conflict of Interest

None disclosed.

Disclosures

The authors do not have any financial interests in the manuscript.

Author information

Affiliations

  1. Department of Medicine and Center for Patient Care and Outcomes Research (PCOR), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Liliana E. Pezzin PhD, JD

  2. Center for Home Care Policy and Research, Visiting Nurse Service, New York, NY, USA

    Penny H. Feldman PhD, Jennifer M. Mongoven MPH, Margaret V. McDonald MSW & Timothy R. Peng PhD

  3. Department of Public Health, Weill Cornell Medical College, New York, NY, USA

    Linda M. Gerber PhD

Authors
  1. Liliana E. Pezzin PhD, JD
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  2. Penny H. Feldman PhD
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  3. Jennifer M. Mongoven MPH
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  4. Margaret V. McDonald MSW
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  5. Linda M. Gerber PhD
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  6. Timothy R. Peng PhD
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Corresponding author

Correspondence to Liliana E. Pezzin PhD, JD.

Additional information

NIH trial registry: NCT00139490

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Pezzin, L.E., Feldman, P.H., Mongoven, J.M. et al. Improving Blood Pressure Control: Results of Home-based Post-acute Care Interventions. J GEN INTERN MED 26, 280–286 (2011). https://doi.org/10.1007/s11606-010-1525-4

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  • DOI: https://doi.org/10.1007/s11606-010-1525-4

Key words

  • hypertension
  • blood pressure
  • home health care
  • African American