The control of blood pressure (BP) for patients with hypertension on medications has been elusive, despite the availability of evidence-based nationally recognized guidelines for treatment and 30 years of research addressing this. At present less than 50% of patients with known hypertension are adequately controlled. If BP control could be improved, significant decreases in cardiovascular morbidity and mortality would occur. We propose to conduct a randomized controlled trial of the effectiveness of applying the Chronic Care Model (CCM) to improve hypertension control. We will identify a cohort of Group Health Cooperative patients with hypertension on anti-hypertensive medications, who have access to the Internet and E-mail, and who have poorly controlled blood pressure (BP > 140/90). Subjects willing to participate will be randomly assigned to one of three intervention arms: Group-1 (UC) will receive usual care for their hypertension. This includes access to secure Intranet services already available at GHC (including a health library, messaging, and prescription refill services); Group-2 (BPM), will additionally receive home blood pressure monitors, instruction on their use, and a proficiency training session on Web-based communication; or Group-3 (BPM+RX), who will receive all of the above plus planned and proactive, self and care management support provided by clinical pharmacists via the Web. Our study hypothesis is that BPM+Rx will prove to be more efficacious than UC or BPM in improving the following primary outcomes: (1) change in mean diastolic, systolic, and the combined average of diastolic and systolic blood pressure and (2) proportion of patients with adequately controlled blood pressure (defined as a BP of equal to or <140 mmHg systolic and equal to or <90 mmHg diastolic).

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
1R01HL075263-01A1
Application #
6825076
Study Section
Community-Level Health Promotion Study Section (CLHP)
Program Officer
Einhorn, Paula
Project Start
2004-08-01
Project End
2008-05-31
Budget Start
2004-08-01
Budget End
2005-05-31
Support Year
1
Fiscal Year
2004
Total Cost
$782,817
Indirect Cost
Name
Group Health Cooperative
Department
Type
DUNS #
078198520
City
Seattle
State
WA
Country
United States
Zip Code
98101
Fishman, Paul A; Cook, Andrea J; Anderson, Melissa L et al. (2013) Improving BP control through electronic communications: an economic evaluation. Am J Manag Care 19:709-16
Green, Beverly B; Anderson, Melissa L; Ralston, James D et al. (2013) Blood pressure 1 year after completion of web-based pharmacist care. JAMA Intern Med 173:1250-2
Carter, Barry L; Bosworth, Hayden B; Green, Beverly B (2012) The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy. J Clin Hypertens (Greenwich) 14:51-65
Fishman, Paul A; Anderson, Melissa L; Cook, Andrea J et al. (2011) Accuracy of blood pressure measurements reported in an electronic medical record during routine primary care visits. J Clin Hypertens (Greenwich) 13:821-8
Green, Beverly B; Anderson, Melissa L; Ralston, James D et al. (2011) Patient ability and willingness to participate in a web-based intervention to improve hypertension control. J Med Internet Res 13:e1
Green, Beverly B; Cook, Andrea J; Ralston, James D et al. (2008) Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA 299:2857-67
Green, Beverly B; Ralston, James D; Fishman, Paul A et al. (2008) Electronic communications and home blood pressure monitoring (e-BP) study: design, delivery, and evaluation framework. Contemp Clin Trials 29:376-95