Reducing Hypertension in a Poststroke Black and Hispanic Home Care Population: Results of a Pragmatic Randomized Controlled Trial.
blood pressure
hypertension
nurse practitioner
randomized controlled trial
stroke
Journal
American journal of hypertension
ISSN: 1941-7225
Titre abrégé: Am J Hypertens
Pays: United States
ID NLM: 8803676
Informations de publication
Date de publication:
01 04 2020
01 04 2020
Historique:
received:
15
05
2019
revised:
18
07
2019
accepted:
11
09
2019
pubmed:
22
9
2019
medline:
22
12
2020
entrez:
22
9
2019
Statut:
ppublish
Résumé
Uncontrolled hypertension (HTN) is a leading modifiable stroke risk factor contributing to global stroke disparities. This study is unique in testing a transitional care model aimed at controlling HTN in black and Hispanic poststroke, home health patients, an understudied group. A 3-arm randomized controlled trial design compared (i) usual home care (UHC), with (ii) UHC plus a 30-day nurse practitioner transitional care program, or (iii) UHC plus nurse practitioner plus a 60-day health coach program. The trial enrolled 495 black and Hispanic, English- and Spanish- speaking adults with uncontrolled systolic blood pressure (SBP ≥ 140 mm Hg) who had experienced a first-time or recurrent stroke or transient ischemic attack. The primary outcome was change in SBP from baseline to 3 and 12 months. Mean participant age was 67; 57.0% were female; 69.7% were black, non-Hispanic; and 30.3% were Hispanic. Three-month follow-up retention was 87%; 12-month retention was 81%. SBP declined 9-10 mm Hg from baseline to 12 months across all groups; the greatest decrease occurred between baseline and 3 months. The interventions demonstrated no relative advantage compared to UHC. The significant across-the-board SBP decreases suggest that UHC nurse/patient/physician interactions were the central component of SBP reduction and that additional efforts to lower recurrent stroke risk should test incremental improvements in usual care, not resource-intensive transitional care interventions. They also suggest the potential value of pragmatic home care programs as part of a broader strategy to overcome HTN treatment barriers and improve secondary stroke prevention globally. Trial Number NCT01918891.
Sections du résumé
BACKGROUND
Uncontrolled hypertension (HTN) is a leading modifiable stroke risk factor contributing to global stroke disparities. This study is unique in testing a transitional care model aimed at controlling HTN in black and Hispanic poststroke, home health patients, an understudied group.
METHODS
A 3-arm randomized controlled trial design compared (i) usual home care (UHC), with (ii) UHC plus a 30-day nurse practitioner transitional care program, or (iii) UHC plus nurse practitioner plus a 60-day health coach program. The trial enrolled 495 black and Hispanic, English- and Spanish- speaking adults with uncontrolled systolic blood pressure (SBP ≥ 140 mm Hg) who had experienced a first-time or recurrent stroke or transient ischemic attack. The primary outcome was change in SBP from baseline to 3 and 12 months.
RESULTS
Mean participant age was 67; 57.0% were female; 69.7% were black, non-Hispanic; and 30.3% were Hispanic. Three-month follow-up retention was 87%; 12-month retention was 81%. SBP declined 9-10 mm Hg from baseline to 12 months across all groups; the greatest decrease occurred between baseline and 3 months. The interventions demonstrated no relative advantage compared to UHC.
CONCLUSION
The significant across-the-board SBP decreases suggest that UHC nurse/patient/physician interactions were the central component of SBP reduction and that additional efforts to lower recurrent stroke risk should test incremental improvements in usual care, not resource-intensive transitional care interventions. They also suggest the potential value of pragmatic home care programs as part of a broader strategy to overcome HTN treatment barriers and improve secondary stroke prevention globally.
CLINICAL TRIALS REGISTRATION
Trial Number NCT01918891.
Identifiants
pubmed: 31541606
pii: 5572492
doi: 10.1093/ajh/hpz148
pmc: PMC7109355
doi:
Banques de données
ClinicalTrials.gov
['NCT01918891']
Types de publication
Journal Article
Pragmatic Clinical Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
362-370Subventions
Organisme : NIA NIH HHS
ID : P30 AG022845
Pays : United States
Organisme : NINDS NIH HHS
ID : U54 NS081765
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© American Journal of Hypertension, Ltd 2019. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Références
CMAJ. 2013 Jan 8;185(1):23-31
pubmed: 23128283
BMJ. 2010 Aug 23;341:c3995
pubmed: 20732968
Hypertension. 2017 Jan;69(1):5-10
pubmed: 27849567
JAMA. 2014 Feb 5;311(5):507-20
pubmed: 24352797
J Stroke. 2017 May;19(2):152-165
pubmed: 28592775
Am J Hypertens. 2015 Jun;28(6):699-716
pubmed: 25498998
Stroke. 2014 Jul;45(7):2160-236
pubmed: 24788967
Am J Kidney Dis. 2010 Mar;55(3):590-8
pubmed: 19962803
Implement Sci. 2013 Jun 04;8:60
pubmed: 23734703
Clin Trials. 2012 Jun;9(3):322-9
pubmed: 22371630
Dialogues Clin Neurosci. 2011;13(2):217-24
pubmed: 21842619
J Comp Eff Res. 2016 Mar;5(2):155-68
pubmed: 26946952
Hypertension. 2016 Nov;68(5):1066-1072
pubmed: 27620388
Circulation. 2016 Aug 9;134(6):441-50
pubmed: 27502908
N Engl J Med. 2016 Aug 4;375(5):454-63
pubmed: 27518663
Health Aff (Millwood). 2001 Nov-Dec;20(6):64-78
pubmed: 11816692
Milbank Q. 1996;74(4):511-44
pubmed: 8941260
CMAJ. 2017 Jul 24;189(29):E954-E961
pubmed: 28739847
Online J Issues Nurs. 2014 May 31;19(2):2
pubmed: 26824837
Perm J. 2016 Winter;20(1):53-9
pubmed: 26824963
JAMA Intern Med. 2013 Jan 14;173(1):46-51
pubmed: 23229778
Stroke. 2015 Dec;46(12):3560-3
pubmed: 26470778
Niger J Clin Pract. 2019 Jan;22(1):69-78
pubmed: 30666023
Curr Hypertens Rev. 2015;11(2):123-31
pubmed: 25808682
Hypertension. 2011 Jan;57(1):29-38
pubmed: 21115879
Can J Cardiol. 2018 May;34(5):506-525
pubmed: 29731013
J Am Geriatr Soc. 2004 May;52(5):675-84
pubmed: 15086645
Health Aff (Millwood). 2011 Apr;30(4):746-54
pubmed: 21471497
J Am Heart Assoc. 2017 Sep 22;6(9):
pubmed: 28939713
Hypertension. 2007 Nov;50(5):854-61
pubmed: 17846352
Hypertension. 1992 Nov;20(5):601-5
pubmed: 1428110
BMC Med Inform Decis Mak. 2014 Jun 12;14:52
pubmed: 24920046
Home Health Care Serv Q. 2003;22(3):1-17
pubmed: 14629081
JAMA. 2002 Oct 9;288(14):1775-9
pubmed: 12365965
Curr Cardiol Rev. 2015;11(3):238-45
pubmed: 25418513
JAMA. 2017 Jan 10;317(2):165-182
pubmed: 28097354
Trials. 2015 Jan 27;16:32
pubmed: 25622823