Improving Hypertension Control in Safety-Net Settings: The Boston Hypertension Equity Alliance in Treatment

ConditionsHypertension Hypertension Complicated

Trial statusRecruiting

Trial phaseNot applicable

Trial typeInterventional

Biological sexAll

Age18+

SponsorBoston Medical Center

About this trial

High blood pressure (BP) or hypertension (HTN) affects over 100 million individuals in the US, increasing the risk of adverse outcomes, including stroke, myocardial infarction (MI), and chronic kidney disease (CKD). Effective therapies include non-pharmacologic approaches and multiple medication classes. Successful HTN management requires ongoing patient engagement for BP monitoring and treatment intensification. Reaching this goal is challenging, and many patients with HTN do not have controlled BP.

Using a collaborative partnership between patients, clinicians, health system and public health stakeholders, and the research team the investigators plan to overcome barriers to widespread implementation of evidence-based health system strategies to improve BP control in a large, urban, primary care-based safety-net setting for diverse populations experiencing disparities in HTN-related outcomes.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Adult (age>18) patients receiving primary care at one of the 9 participating sites, with primary care provider (PCP) visit in the preceding year

Presence of HTN defined by one or more of: 1) diagnosis included on active problem list, 2) active HTN medications in prior year, 3) 3 separate elevated BP measurements

Uncontrolled HTN defined as systolic blood pressure (SBP)>140

Disqualifiers

Not meeting the inclusion criteria

Trial design

Design model

Sequential

Treatments tested in this trial

RBPM
Behavioral
Standardized blood pressure measurement and treatment protocols in clinical practice.
MII
Other intervention
Team-based interventions including multiple evidence-proven interventions such as clinician decision support, monitoring medication non-adherence, use of combination pills, and formulary modifications.

Treatment groups

16,895 Participants

are divided into 2 treatment groups

Group A: Remote Blood Pressure Monitoring (RBPM)Experimental treatment 1 intervention

Group B: Multilevel Intensification interventions (MII)Experimental treatment 2 interventions

Trial outcomes

Primary outcomes

Systolic blood pressure (SBP) improvement

Change in BP abstracted from the electronic health record (EHR).

Time frame

Baseline, every 3 months up to 54 months

Interventions received

The number and proportion of individuals who receive each intervention.

Time frame

Baseline, 54 months

Patient activation

Patient activation will be assessed with the Consumer Health Activation index (CHAI), a 10 item validated instrument that generates a score of 0-100, with ≥80 indicating moderate/high activation.

Time frame