Community-Based Program Bears Fruit in Supporting BP Control

A multicomponent-tiered hypertension program known as “Check It, Change It” (CICI) may be associated with improving blood pressure (BP) control in a diverse community-based population, according to a study published Oct. 28 in Circulation: Cardiovascular Quality Outcomes.

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To date, the most successful BP interventions have been pharmacist- or nurse-led home monitoring programs using web-based technology and automated provider alerts, and have generally been implemented in selected populations with full health care insurance and among technologically savvy individuals. Aiming to see whether a multifaceted BP control program that uses a web-based health portal, community health coaches, and physician assistant guidance could be broadened to improve hypertension control in a large community setting, Kevin Thomas, MD, FACC, Department of Medicine, Duke University, and his colleagues developed the CICI program, enrolling 1,756 patients with hypertension from eight clinics in North Carolina’s Durham County between Sept. 12, 2010 and Nov. 11, 2011.

Stratifying participants into three tiers according to their initial BP (tier 1 [BP <140/90 mm Hg] =51 percent of population, tier 2 [BP=140/90–159/99 mm Hg] =30 percent of total, and tier 3 [BP ≥159/99 mm Hg] =19 percent of total), after six months the mean overall systolic BP declined 4.7 mm Hg and rates of achieving target BP control (<140/90) increased overall from 51 percent at baseline to 63 percent. At six months, 69 percent had either reached their BP target or had reduced their baseline systolic BP by 10 mm Hg or more.

“CICI represents a unique partnership between a community, academic medical center and a patient-focused professional organization to collaborate successfully in creating and implementing a hypertension management program,” the authors note. “This community-based program successfully integrated health care providers, [a web-based health portal] and remote monitoring to engage, empower and assist a distinct group of community residents to achieve better hypertension control with the biggest impact on those with the most poorly controlled hypertension. We think multidisciplinary collaborations such as in CICI can serve as a potential model for community-based chronic disease management moving forward.”

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Hypertension

Keywords: Pharmacists, Cooperative Behavior, Fruit, Academic Medical Centers, Disease Management, Physician Assistants, Blood Pressure, Blood Pressure Determination, Hypertension, Systole, North Carolina

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