Abstract 107: Home Electronic Blood Pressure Cuff Improved Compliance with Disease-Specific as well as General Blood Pressure Goals in an Underserved High-Risk Ambulatory Population
Objective: To determine the effectiveness of home electronic blood pressure cuffs to improve compliance with both disease-specific and the general Practice Performance Measures (PCPI) blood pressure goals in the high risk underserved population in a safety-net urban medical center.
Background: Achieving recommended blood pressure goals in an underserved patient population with a high cardiac disease burden is challenging. Intensive, clinician-led health maintenance programs have shown promise but are difficult to implement on a wide scale. The decreasing cost of electronic blood pressure cuffs offers an opportunity to provide patient-focused treatment.
Methods: Twenty-two consecutive patients who were not at either their disease-specific or PCPI goal of <140/90mmHg received an electronic blood pressure cuff for home use as part of their optimal medical treatment. This was a prospective, before-after study. Patients were relatively young (mean 59 years), had a high prevalence of coronary disease (32%), heart failure (37%) , valvular disease(37%) and preserved left ventricular ejection fraction (49%). In-clinic blood pressure measurements were collected. The time to the cross-over from medical therapy to medical therapy with a blood pressure cuff was an average 184.4 days (3.2 encounters with clinicians for medication changes) and average of 75.8 days (1.1 encounters) after the cross-over to follow-up. A paired student T-test was used for statistical comparison between the two groups.
Results: There was a statistically significant difference in the systolic blood pressures after the medical treatment period compared to the cross-over arm 143.3mmHg (CI 135.3-151 p-value=0.1) vs.134.6mmHg and diastolic pressure 81.09mmHg (CI 75.4-86,75 p-value=0.05) vs. 72.24mmHg. Overall compliance with the PCPI recommendation was higher in the cross-over arm (45% vs. 55%) as well as with the disease specific recommendations (18% vs. 25%).
Conclusion: There was a statistically significant improvement in both systolic and diastolic blood pressures in the underserved ambulatory patient with a home blood pressure cuff. There was also an improvement in compliance both with the PCPI and disease-specific goals guidelines.
- © 2012 by American Heart Association, Inc.