A community-based program called “Check It, Change It” used in combination with the American Heart Association’s Heart360 and on-the-ground providers effectively reduced blood pressure among a large group of diverse patients, according to a recently published study.
The success of this pilot program was noteworthy because it demonstrated that varied and customized approaches to managing blood pressure may have greater staying power, according to researchers. One in three Americans has high blood pressure.
Researchers led by Kevin L. Thomas, MD, of Duke Clinical Research Institute, reported that a single approach that used several components could work among a diverse group. The approach involved grouping patients by the severity of the blood pressure; teaching them how to use the Web-based portal Heart360 so they could routinely enter blood pressure information on their own; and having physician assistants and community health coaches work directly with patients to continue helping them bring their blood pressure down, such as advice on diet and exercise.
Community-based approaches have often been tested among homogenous groups but not as often among racially and socioeconomically diverse groups.
A total of 1,756 patients from Durham, North Carolina, participated in the study. At the start of the study, patients were asked to enter blood pressure measurements into Heart360 at least once every two weeks.
Patients were placed in one of three groups: those with a blood pressure reading of less than 140/90; those with a reading of 140/90 to 159/99; and those with a reading of more than 159/99.
Those with the lowest blood pressure levels received the lowest intervention, a bimonthly automated reminder to enter their blood pressure measurements into Heart360. Those in the middle group with elevated blood pressure also had to use Heart360 and received lifestyle counseling and medication evaluation from physician assistants. Those with the highest blood pressure levels received the most hands-on follow-up, including an assigned community health coach who conducted home visits.
The patients’ average age was 60. Sixty-six percent were female; 76 percent were black; 16 percent lacked health insurance and 22 percent had not completed high school. More than one-third of those enrolled had never used the Internet prior to the study and nearly 40 percent owned a blood pressure machine.
After six months in the program, the mean overall systolic blood pressure declined 4.7 mmHg. The goal for patients was to achieve a blood pressure of less than 140/90. Nearly half—44 percent of individuals with blood pressure levels of more than 140/90 at the start of the program reached their goals, and 58 percent reached a blood pressure less than 140/90mmHg or had a greater than or equal to 10mmHg decrease in systolic blood pressure when the program completed. The findings were reported in an issue of Circulation: Cardiovascular Quality and Outcomes.
Researchers say they found a connection between greater use of Heart360 and systolic blood pressure decrease.
“Every component of the program was centered on empowering the individual,” said Dr. Thomas. He added that while there was a bit of a digital divide. Some patients, particularly elderly individuals, did not feel comfortable entering information through a website. But many patients embraced the new approach.
“Self-motivation and self-empowerment were important factors in lowering blood pressure. Heart 360 certainly contributed among individuals who utilized it consistently. ”
Dr. Thomas said based on these findings, the combination of Heart360, community-based coaches and physician assistants and other components of “Check It, Change It” could be applied to the management of other chronic conditions.
“The core premise and structure of our program is transferrable to other chronic conditions such as diabetes, asthma, and high cholesterol,” he said. “We need to evaluate this model in those diseases and in different communities.”
Based on the positive results of the Check It, Change, the AHA is expanding the program to other cities under the name Check. Change. Control. Visit heart.org/checkchangecontrol to see if there’s a program near you.
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