Blood pressure intervention programs vary in effectiveness, but show promise

January 12, 2017 – A new study suggests that community-based programs can help lower hypertension rates among participants.

Community-based blood pressure intervention programs show promise for improving participants’ blood pressure, according to a new study conducted by DCRI researchers.

The study, published this month in the Journal of Clinical Hypertension, examined the American Heart Association’s (AHA) Check. Change. Control . (CCC) program. CCC was a multi-intervention community-based initiative to improve blood pressure control in 18 cities in the United States.

High blood pressure is the leading cause of cardiovascular disease in the nation, affecting more than 78 million adults. In 2010, the AHA announced a plan to reduce deaths from cardiovascular disease and stroke by 20 percent by 2020. The CCC program was launched in 2013 as a part of this effort. In each of 18 target cities, AHA staff worked with volunteers and community partners to implement a cost-effective, scalable plan to enroll participants in an evidence-based hypertension management program that utilized blood pressure self-monitoring. In total, more than 4,000 patients were enrolled across all of the target cities.

In this study, the DCRI’s Monique Anderson, MD, MHS, and her colleagues sought to evaluate the CCC’s effectiveness using site enrollment goals, participant engagement, and blood pressure change from first to last measurement. The researchers collected data on each site’s program planning, pre-implementation, and post-implementation status using questionnaires. Blood pressure and demographic data logged by participants were obtained from the AHA’s web-based personal health portal. These data were used to estimate enrollment, engagement, and blood pressure outcomes for each of the 18 campaigns, as well as for the overall program.

Between January 1 and March 31, 2013, 4,069 adults were enrolled into the CCC program at the 18 sites. The median age of participants at each site was 51 years, and almost 75 percent of all participants were female.

The researchers found considerable variation in patient outcomes among the sites. Expected enrollment ranged from 350 to 1,200 patients. Actual enrollment ranged from 74 to 422 participants; the percent of actual versus expected enrollment for each site ranged from 9.3 percent to 120.6 percent. Participant engagement, defined as more than eight recorded blood pressure measurements over a 4-month period, averaged 14.7 percent and ranged from 0 percent to 52.8 percent. The highest 25th sites had a mean continuous patient engagement of 37.4 percent, the middle 50th 10.0 percent, and the lowest 25th 1.1 percent.  The highest 25th sites experienced a −13.7 mm Hg average reduction in blood pressure, the middle 50th a −3.3 mm Hg average reduction, and the lowest 25th a +1.1 mm Hg average increase in systolic blood pressure.

The most high-enrolling sites recruited at senior residential institutions and service organizations, held hypertension management classes, and worked closely with community partners. These top-performing sites also distributed blood pressure cuffs, regularly checked blood pressure at engagement activities, and trained volunteers.

Despite the large variation in outcomes among the sites, the CCC program was successful in reducing overall blood pressure. By focusing on factors shared by the most successful sites, the researchers concluded, future programs may have even more success in improving participants’ blood pressure.

In addition to Anderson, the study’s authors included Rachel Peragallo Urrutia, MD, MSc; Emily C. O’Brien, PhD; Nancy M. Allen LaPointe, PharmD; Alexander J. Christian, BSPH; Lisa A. Kaltenbach, MS; Laura E. Webb; Angel M. Alexander, MSPH; Paramita Saha Chaudhuri, PhD; Juliana Crawford; Patrick Wayte MBA; and Eric D. Peterson, MD, MPH.