Project Summary
This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.
What is the research about?
About one in three American adults has high blood pressure, a chronic health problem where the force of blood against artery walls is too high. High blood pressure can lead to serious health problems such as heart disease and stroke. There are effective ways to lower high blood pressure to recommended levels. Doing so can reduce the risk of heart attack and stroke. However, half of all people with high blood pressure do not reduce their blood pressure to recommended levels.
In this study, the research team is comparing two ways for healthcare teams to help patients lower their high blood pressure: in the clinic and having patients monitor it at home. The team also wants to know how patients want to receive care. Finally, the team is looking to see how well clinic- and home-based methods work in large health systems.
Who can this research help?
Results of this study may help health system administrators decide whether to offer clinic- or home-based blood pressure monitoring.
What is the research team doing?
The study includes 21 primary care clinics in Minnesota and western Wisconsin that are part of a large healthcare system. The research team is assigning half of the clinics by chance to use a clinic-based model of care and the other half to use a home-based model. In total, 2,000 adult patients with high blood pressure are taking part in the study.
At clinics offering clinic-based care, 1,000 patients meet face-to-face with doctors and medical assistants to discuss and track blood pressure. Patients have follow-up meetings with their doctors every two to four weeks. At clinics offering home-based care, 1,000 patients work with a pharmacist or nurse practitioner to track blood pressure using a home blood pressure monitoring device. Patients in the home-based program check in as needed with a pharmacist or nurse by telephone or email. Both models of care track and save patient blood pressure information.
The team is comparing results from the two programs to see if patients’ blood pressure levels change over 12 months. Researchers are also asking patients about their care experiences, including treatment side effects, success with self-monitoring, and how confident patients feel about caring for themselves. Finally, the team is looking at care in the clinics and having interviews and focus groups with patients and staff to see how fully the clinics carry out the two care models in practice.
Patients, patient advisors, and health system administrators take part in the study at all stages. For example, patients help design and select the questions for the survey the team is using to collect patient-reported outcomes.
Research methods at a glance
| Design Elements | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | Adults ages 18 to 85 years with uncontrolled hypertension noted in their medical records twice in the last 24 months |
| Interventions/ Comparators |
|
| Outcomes |
Primary: systolic blood pressure Secondary: side effects of antihypertensive medications, patient experience/satisfaction with care, patient confidence in self-management of blood pressure, diastolic blood pressure, lipid levels, statin use, smoking status, 10-year cardiovascular event risk, 30-year cardiovascular event risk, lab abnormalities related to hypertension and antihypertensive drug treatment, hypotension or fainting |
| Timeframe | 1-year follow-up for primary outcome |
More to Explore...
Videos
Helping Patients Better Control High Blood Pressure
Principal Investigator Karen Margolis speaks about this study, which is comparing two methods of monitoring high blood pressure to determine whether telehealth offers an edge over more traditional clinic-based care.
More Telehealth Research Needed
Principal Investigator Karen Margolis says more research is needed to determine whether telehealth offers an advantage to patients as it becomes more widely available.