Improving the Management of Hypertension for Adults: The Impact of Home Blood Pressure Monitoring and Lessons Learned from a System-Level Hypertension Control Initiative

Purpose: To examine the effects of a pragmatic HBPM program on improving HTN control. Methods: SWHP commercial and Medicare members 18-85 y/o with persistently uncontrolled HTN were given a free home BP monitor and related educational tools to effective engage in and document HBPM via 3 separate cohorts: • Provider distribution during an office visit • Based on medical record reviews, mailed to the patient with PCP’s permission • Patient’s request at various health fairs Using the office-based BP readings in the EHR, we calculated the change in BP control for each subsequent visit and end of year. Results: From Sept 2016 through May 2017, with no undue burden placed on providers or their staff, 2550 members received the tools necessary to engage in HBPM. By the 3 rd office visit, 66.79% [±3.7%; 95% CI] achieved office-based BP readings of less than 140/90 mmHg. It was also noted that by the 3 rd office visit many providers were able to reduce the patient’s medications and still maintain control. The retrospective review, like that of previous studies, found HTN control rates continued to climb with 79.03% (78.18%-88.57%) [± 3.7%; 95%CI] achieving HTN control per HEDIS 2018 standards. The average sustained change in BP control was an 18.3 mmHg (11.9-19.0 mmHg) reduction in SBP and a 7.0 mmHg (4.2-9.5 mmHg) reduction in DBP. It is also worth noting 72.6% (71.1-77.14%) [± 3.7%; 95%CI] achieved HTN control per the new AHA/ACC guidelines. Conclusions: Clinical guidelines recommend HBPM to evaluate and treat HTN. Our HTN Control Initiative supports a multi-modality approach as being cost-effective and sets the groundwork for further QI efforts to better discern each process regarding the use of HBPM.