“Our local population in the Bronx is predominantly black and Hispanic, and high blood pressure, type 2 diabetes, and cardiovascular risk factors are common in our community. Addressing high blood pressure is particularly important to reducing the incidence of these health conditions.” Masood A. Shariff, MD, study co-author, study co-author at Lincoln Hospital, New York City Hospital and Medical Center in the Bronx, a borough of New York City.
“Two years ago we initiated a targeted treatment program for people with uncontrolled high blood pressure in the care of a specialist clinic in our outpatient center and we found This approach was successful in helping participants better manage blood pressure.”
The goal of the program is to help more people reach their goal blood pressure of 120/80 mm Hg, as recommended by the American Heart Association/American College of Cardiology Guidelines.
To measure the program’s success, the researchers identified more than 2,700 people in the outpatient clinic who had uncontrolled high blood pressure higher than 130/80 mm Hg or had started a new blood pressure medication. at the beginning of the study period.
Medical records of each participant for the two years prior (August 2017 to October 2018) for the targeted intervention and two years later (January 2019 to March 2020) at the start of the special program particular has been considered. The participants had an average age of 61 years; 57% are women; 70% identify themselves as Hispanic; and 25% of participants identified themselves as Black.
The support program involved nurses, who worked closely with study participants to track their blood pressure histories from diaries kept by each person and assess whether they are taking their medication as prescribed and whether it is working to control their blood pressure. Other health care professionals provided study participants with information and support to address lifestyle changes, such as saltiness and weight loss, for improved nutrition and fortification. physical activity.
Nurses can connect with participants on a more personalized and routine basis than doctors can provide in a typical outpatient setting such as a clinic or clinic. At the start of the program, participants returned to the clinic after three weeks with the blood pressure nurse, compared with the standard three months to see a doctor. The three-weekly visits were continued once the medication was adjusted, and although this was more frequent at the start of the program, the researchers found that over the course of two years, the number of relapses Fewer examinations are needed due to uncontrolled high blood counts. pressure drop.
Since people can already control their high blood pressure, they don’t need to go to the clinic as often. The average number of visits decreased by 31% among study participants – from more than five visits in the two-year pre-intervention period to about three in the targeted treatment phase.
The mean uncontrolled high blood pressure measurements of all participants decreased from 3 cases before the intervention to 2 cases after the target program. Mean systolic blood pressure (top number) decreased by 7.6 mm Hg (to 135.5 mm Hg) in the targeted treatment group.
“Before targeted therapy, it took longer to get a person’s blood pressure under control. Doctors usually only saw patients every three to six months, and sometimes a few visits. to get the right dose of medication. And if a person doesn’t,” Shariff said: “Not taking their medication or taking it the wrong way, it won’t work if we don’t see them until six months later. “In a targeted treatment program, if a person’s blood pressure is not under control, they are seen earlier by a blood pressure nurse who can consult a doctor and adjust medication quickly, resulting in fewer visits overall and better blood pressure control for program participants.”
The program also helps identify why some people can’t control their blood pressure or aren’t taking their medication as prescribed, the researchers say. Issues that may affect some people include language barriers, lack of awareness of the importance of taking medication on time every day, or the importance of follow-up visits. Connecting with a blood pressure nurse on a consistent basis has helped address some of these issues.
“We believe that doing this targeted program with a blood pressure nurse has made a big difference,” said Mohammad Faiz, MD, study co-author and an internal medicine specialist at Lincoln Medical Center in London. Bronx, New York City said. “Using a multi-stakeholder team approach, especially in primary care settings, means having nursing, nutrition, and social work staff working closely with physicians to address issues that arise.” With medical problems and other issues, are key to reaching blood pressure goals.With a team approach, we can provide care much sooner than three to six months after starting. taking medication, and promoting healthy eating, checking blood pressure every day, checking to make sure it’s being taken correctly really makes a difference.”
The researchers note that given the burden of high blood pressure, type 2 diabetes, and cardiovascular risk in blacks and Hispanics, blood pressure counseling, screening, monitoring, and support is critical. important.
“We know that pre-existing social conditions, such as access to quality health care, employment, education and housing, influence disparities in health status. individual and community health.
One limitation to the study, the researchers say, is that the same study participants had previously attended treatment for high blood pressure through an outpatient clinic. However, those encounters are not personalized.
They also note that individual working and interacting styles can vary between nurses and nurses, and that some approaches may be more effective than others.