Home Based Program Lowered High Blood Pressure for 81% of Patients in 7 Weeks

National Heart Month to Raise Awareness of Heart Disease the Leading Cause of Death

February is National Heart Month to raise awareness of heart disease, which is the leading cause of death in the United States. Last week in our blog post of February 1, 2019 we wrote about the association of eating nuts like almonds and walnuts with heart health. This week we are writing about a home-based program to lower high blood pressure.

Hypertension – High Blood Pressure

Hypertension (high blood pressure), which can lead to heart disease, strokes, heart failure and kidney failure, is the main problem that needs to be tackled in order to lower the death toll from cardiovascular events like strokes and heart attacks. Research also shows a possible association between high blood pressure and the onset of dementia.

New Definition of High Blood Pressure

According to the latest statistics by the American Heart Association (AHA), 116.4 million or 46% of American adults are estimated to have high blood pressure. This reflects the new guidelines which now define high blood pressure as 130/80 or greater, whereas the previous definition was 140/90. Unfortunately, most people who have high blood pressure do not even know they have it. High blood pressure does not usually produce any symptoms and for this reason has been called the “silent killer.” Also, many of those people who are known to have high blood pressure fail to get it lowered to the current guidelines.

Remote Home Based Program Lowered Blood Pressure in Seven Weeks for 81% of Patients in the Pilot Study

Brigham and Women’s Hospital in Boston, Massachusetts have developed a unique home based remote care program for managing high blood pressure. The results of this pilot study were published December 23, 2018 in Clinical Cardiology. Traditionally, patients have been treated for high blood pressure by periodic visits to their doctor, but in many cases this has not been successful in getting people’s blood pressure under control. The new remote program developed by Brigham and Women’s Hospital was able to get blood pressure under control for 81% of the patients in the pilot study within seven weeks.

The Brigham Protocol-based Hypertension Optimization Program (BP-HOP)

The participants in the pilot Brigham Protocol-based Hypertension Optimization Program (BP-HOP) pilot study were 130 (57 men and 73 women) patients who had uncontrolled high blood pressure. The average age was 59 years. There were 25 who had type 2 diabetes. People who were pregnant or had advanced kidney disease were excluded from the program. Those who were accepted into the program signed an agreement form and were given a blue-tooth enabled BP (blood pressure) device and were taught by a patient navigator how to correctly use it to measure their blood pressure at home. The device was set up to convey data transmission directly to the server of the platform and from there to the patient’s electronic medical record (EMR). Thus, the patients did not have to use a computer or a smart phone. For safety reasons at the beginning of the project, medication titrations were performed by a nurse practitioner and pharmacists. Patient navigators were also trained in the process to help the patients who were living at home. Thus, the patient navigators were able to handle the blood pressure management with the patients on a daily basis. The navigators were part of a larger team under the supervision and management of non-MD practitioners that was overseen by a medical doctor who was an expert in disease.

The Therapeutic Algorithm

Patients measured their blood pressure at home for one week, two times a day (morning and evening) before taking their blood pressure lowering medicine. The therapeutic algorithm was based on the blood pressure measurements that were taken at home by the patients and automatically sent to the remote clinic team. The blood pressure measurements were calculated on the average for a week in order to see if the dosages were correct and when necessary medical dosage adjustments were made in consultation by phone between the patient and the navigator. The pharmacist reviewed and signed for new prescriptions. When necessary, lab tests to measure electrolytes and kidney function were carried out.

Not only was this program found to be more effective in getting high blood pressure under control, but it also is less expensive than many of the current practices.

Types of Medicines used in the Program

ACE inhibitors
Angiotensin-receptor blockers
Calcium channel blockers
Diuretics

Results

Blood pressure control was achieved in 81% of the 130 patients without needing a large increase in medication. The most common new drug added was Amlodipine. Eleven patients dropped out of the program and three had resistant high blood pressure and were sent to specialized care.

Follow up showed that seven months after the patients had graduated from the program their blood pressure was still under control, even though they were no longer in regular contact with the staff and were no longer getting reminders to measure their blood pressure or guidance about the medicines.

Recommendations by the Researchers

This new remote program got blood pressure under control quickly and at a much lower cost than traditional methods.
In order for successful management of high blood pressure there has to be ongoing measurements of blood pressure.
Patient navigators are important to motivate the patients to carry out the process. Also, the patient navigators educated the patients on making positive lifestyle changes such as

• Losing weight
• Cutting down on consumption of salt and alcohol
• Being more physically active
• Not smoking

The Need for Short or Long-term Rehabilitation and Skilled Nursing Care

If you or your loved one are in need of short-term rehabilitation or long-term skilled nursing care, the Van Duyn Center for Rehabilitation and Nursing in Syracuse, New York offers expert rehabilitation after illness or surgery.

Conclusion

This remote home-based pilot study that was successful in lowering high blood pressure in 130 people in only seven weeks, hopefully, will be an example for the establishment of more programs like this. Only by reaching the millions of people with uncontrolled high blood pressure will we see a reduction in deaths from strokes, heart attacks, kidney failure and heart failure.