Long-Term Outcomes and Costs of Web-Based Hypertension Care Hypertension (HTN) is the most common chronic condition in the U.S., affecting almost 1 in 3 adults;however, it remains inadequately treated in most. Clinic-based health services interventions have achieved success in reducing BP and improving HTN control. There is however, a gap in the scientific literature and policy experience regarding the durability of these effects. Understanding the long-term impact of a successful intervention is of particular importance for HTN treatment where the greatest health benefits-as measured by decreased mortality, cardiovascular events, and renal failure are achieved by persistent reductions in BP. We propose to study the long-term effectiveness of a Web-based communication intervention to improve BP control based on the results of a randomized trial, e-BP: Electronic Communications and Home Blood Pressure Monitoring Study (R01 CA075263-01A1, B. Green, PI). In the 3-arm study patients with uncontrolled HTN were randomized to usual care or to receive home BP monitors and training to use an existing integrated patient Web portal, or this plus pharmacy care delivered over the Web. After 12 months, patients receiving Web- based pharmacist assistance were almost 2 times as likely to have controlled BP compared to usual care. Over 92% of the patients'randomized are still enrolled within Group Health more than 12 months after the last follow-up assessment. Given historical patterns of disenrollment among Group Health enrollees we anticipate over 75% of trial participants will remain with the health plan for a total of 5 years after the study's end, allowing us to assess the long-term effects of the interventions on BP and costs. Thus we propose the following aims:
Aim #1 : To evaluate the durability of treatment outcomes, systolic BP, diastolic BP, and BP control over time after the intervention ended.
Aim #2 : To evaluate long-term changes in: (1) the number of and adherence to anti-hypertensive medications prescribed;(2) use of secure messaging;and (3) use of home BP monitors over time.
Aim #3 a: To analyze long-term changes in health services utilization and cost among patients participating in the e-BP trial for at least 5 years following randomization Aim #3b: To estimate the long-term incremental cost effectiveness of the pharmacy intervention using results from the analysis of long-term HTN control-Aim 1, and changes in long-term health care costs-Aim 3a.

Public Health Relevance

Long-Term Outcomes and Costs of Web-Based Hypertension Care Hypertension (HTN) is a common chronic condition in the United States, affecting almost 1 in 3 adults;however, it remains inadequately treated in most. A recent research study showed that HTN control could be improved by providing patients with home blood pressure monitors, Web-based resources to communicate with their health care team, and pharmacist assistance with medications. However it is unknown whether HTN control persisted and health care costs decreased after the study ended. We will study the long-term effects of a Web-based HTN intervention on blood pressure and health care costs.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Health Services Organization and Delivery Study Section (HSOD)
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Einhorn, Paula
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Group Health Cooperative
United States
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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
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
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; 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